Arthritis Nursing Process Flashcards

1
Q

Assessment

A
  • Pain assessment - PQRST including location, frequency, and duration of client’s joint pain and stiffness
  • Joints affected - asymmetric (OA) vs symmetric (RA)
  • Morning stiffness usually resolved in 30 minutes (OA) vs stiffness greater than 30 minutes (RA)
  • The extent to which symptoms affect client’s ability to perform ADLs
  • Pain-relieving practices - medications and non-pharmacological strategies
  • Support system
  • Physical examination of affected joint or joints includes assessment of tenderness, swelling, limitation of movement (ROM), and crepitation
  • Any deformities - Herberden’s nodes, Bouchard’s nodes (OA) vs ulnar drift, boutonniere, swan neck (RA)
  • An involved joint should be compared with the contralateral joint
  • Extra-articular manifestations (RA)
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2
Q

Diagnosis

A
  • Joint pain and stiffness related to joint inflammation
  • Chronic pain related to ineffective pain control and/or comfort measures
  • Impaired physical mobility related to joint pain, stiffness, and/or deformity
  • Self-care deficits related to joint deformity and pain with activity
  • Potential for altered nutritional intake related to pain
  • Disturbed body image related to deformity
  • Chronic low self-esteem related to inability to perform usual
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3
Q

Goal

A
  • Control symptoms and manage pain with hopes of satisfactory relief
  • Maintain/improve joint function with minimal loss of functional ability of the affected joints
  • Maintain a positive self-image
  • Perform self-care to the maximum amount possible
  • Participate in planning and carrying out the therapeutic regimen
  • Participate in family, social and leisure activities
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4
Q

Rest

A
  • Alternate scheduled rest periods with activity.
  • The affected joint should be rested during periods of acute inflammation.
  • Total bed rest is rarely necessary and should be avoided to prevent stiffness and immobility. Lying prone for half an hour twice daily can be recommended.
  • Good body alignment while resting can be maintained through use of a firm mattress.
  • To decrease the risk of joint contractures, pillows should never be placed under the knees. A small, flat pillow may be used under the head and shoulders.
  • Positions of extension should be encouraged, and positions of flexion should be avoided
  • Modify usual activities to decrease stress on affected joints. For example, the client with knee OA should avoid prolonged periods of standing, kneeling, or squatting.
  • Splints and braces to rest the inflamed joints, maintain proper alignment and prevent deformity from muscle spasms and contractures.
  • Tasks should also be spread throughout
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5
Q

Joint Protection

A

Client’s independence may be increased by:

  • Using assistive devices that help simplify tasks, such as built-up utensils, lightweight plastic dishes, electric can opener, raised toilet seats.
  • Wearing shoes with Velcro fasteners and clothing with buttons or a zipper down the front instead of the back makes dressing easier.
  • A cane or a walker offers support and relief of pain when walking.
  • A platform-wheeled walker further minimizes strain on the small joints of the hands and wrists.
  • See slide - patient teaching on joint protection
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6
Q

Cold and Heat Applications

A

Cold applications

  • Cold reduces inflammation and pain.
  • Application of ice is especially beneficial during periods of disease exacerbation.
  • Plastic bag of frozen vegetables (peas or corn), which can easily mould around the shoulder, wrists, or knees, are an easy home treatment.

Heat applications

  • Heat reduces stiffness and pain.
  • Heat therapy - moist hot packs, paraffin baths, whirlpool baths, warm baths or showers.
  • Heat and cold can be used as often as desired; however, the heat application should not exceed twenty minutes at one time, and the cold application should not exceed ten to fifteen minutes at one time.
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7
Q

Nutrition

A
  • Balanced nutrition is important.
  • Fatigue, pain, depression, limited endurance, and mobility deficits may cause a loss of appetite or interfere with the client’s ability to shop for and prepare food. Weight loss may result.
  • Corticosteroid therapy or immobility secondary to pain may result in unwanted weight gain.
  • If the client is overweight, a weight-reduction program is a critical part of the total treatment plan to reduce stress on joints.

Help the client evaluate the current diet to make appropriate

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8
Q

Excercise

A
  • A therapeutic exercise program is usually developed by a physiotherapist and includes exercises to improve flexibility, strength, and endurance.
  • Client should practice the exercises with supervision and ensure that the exercises are being done correctly.
  • Inadequate joint movement can result in progressive joint immobility and muscle weakness, and overaggressive exercise can result in increased pain, inflammation, and joint damage.

Examples: gentle ROM

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9
Q

Complimentary

A
  • Acupuncture, for example, has been found to be a safe and effective method for arthritis pain management.
  • Relaxation i.e. meditation
  • Other therapies include the use of yoga, Tai Chi, massage, guided imagery, and therapeutic touch.
  • Studies on the use of nutritional supplements such as glucosamine for relieving arthritis pain and improving joint mobility are inconclusive
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10
Q

Patient Teaching

A

Patient Teaching - (OA & RA)

  • Explain the chronic nature of their disease
  • Provide teaching on non-pharmacological pain management i.e. relaxation techniques, heat/cold applications
  • Provide teaching on drug therapy i.e. correct administration, reporting of side effects, and frequent medical and laboratory follow-up visits
  • Promote a healthy body weight to reduce strain on joints through appropriate diet and exercise

Patient teaching - Joint Protection

Maintain joint in neutral position to minimize deformity.

  • Press water from sponge instead of wringing.

Use strongest joint available for any task.

  • When rising from chair, push with palms rather than fingers.
  • Carry laundry basket in both arms rather than with fingers.

Distribute weight over many joints instead of stressing a few.

  • Slide objects instead of lifting them.
  • Hold packages close to body for support.

Change positions frequently.

  • Do not hold book or grip steering wheel for long periods without resting.
  • Avoid grasping pencil or cutting vegetables with knife for extended periods.

Avoid repetitious movements.

  • Do not knit for long periods.
  • Rest between rooms when vacuuming.

Modify home environment to include faucets and door-knobs that are pushed rather than turned.

Modify chores to avoid stress on joints.

  • Avoid heavy tasks.
  • Sit on stool instead of standing during meal preparation.
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