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)
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
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
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
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
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.
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
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
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
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.