Arthritis nursing diagnosis and measures

The core clinical nursing diagnoses for arthritis can be summarized into three categories: "chronic joint pain/physical mobility impairment/lack of disease-related knowledge". The core principles of corresponding care are analgesia priority, functional maintenance, and cognitive upgrading. There is no universal solution for all types of arthritis, and individual adjustments need to be made according to different types of arthritis, such as osteoarthritis, rheumatoid arthritis, and gouty arthritis.

Don’t tell me, I have been nursing in the joint department for almost 8 years, and nine out of ten patients I met have encountered misunderstandings. I just want to talk about a few recent cases. Last week, I met 52-year-old Aunt Zhang in the clinic. Her knees had been hurting for three years while climbing stairs. She always thought she was suffering from calcium deficiency. She took calcium tablets and drank bone soup. When she arrived, her right knee was swollen like a steamed bun, making it difficult to bend her knees. She was diagnosed with degenerative osteoarthritis. Her first nursing diagnosis was chronic pain, which is directly related to cartilage wear and synovial inflammation. What’s interesting is that there is currently no unified clinical standard for the assessment of pain levels: Community screening prefers to use the Numeric Rating Scale (NRS), which allows patients to score 0-10, and the results can be obtained in 1 minute; care for geriatric or cognitive impairment patients prefers to use the Wong-Baker Facial Expression Scale, which requires just pointing the expression without speaking. Both schools have their own applicable scenarios, and there is no absolute good or bad.

Besides pain, the biggest impact on patients’ lives is limited movement. There was quite a debate in the nursing community about this a few years ago. When Xiao Yang, a 38-year-old rheumatoid patient, came for follow-up consultation, she said that she had morning stiffness for more than an hour and even combed her hair without help from her partner. Ten years ago, many nursing staff would advise her to move as little as possible to support her joints. Now evidence-based medicine has made it clear that as long as it is not an acute redness and swelling period, moderate low-load exercise can delay joint adhesions and protect joint function. The difference between the two views is essentially an iteration of the understanding of the disease process. Now it is necessary to adjust the activity plan in stages and cannot be generalized.

There is also a core problem hidden behind the scenes, which is that the vast majority of patients have wrong perceptions of this disease. Last month, a 24-year-old man with gout was admitted. His feet were so painful that he could not get off the ground when the attack occurred. He said that he never drank seafood and beer, so how could he get gout. When he asked, he learned that he had stayed up late for a week to catch up on projects, and had at least two cups of iced milk tea every day. His excessive fructose intake directly caused a spike in uric acid. The nursing diagnosis of such patients is a clear lack of knowledge. They think that as long as they avoid high-purine foods, everything will be fine. They are completely unaware that fructose, cold, strenuous exercise, and even excessive stress may induce arthritis attacks.

Specifically when it comes to nursing operations, many people actually have the wrong priorities and ask what supplements to take. In fact, the first step is to stop the pain. The different types of analgesia during acute attacks are quite different: for common osteoarthritis, topical non-steroidal anti-inflammatory drug gel is preferred, which has much fewer gastrointestinal side effects than oral administration. As a practical tip, many people just apply it and it’s done. In fact, you need to massage it for 2-3 minutes until it is completely absorbed. The drug can penetrate into the synovial membrane and double the analgesic effect; rheumatoid pain often requires immune modulators to alleviate the root cause; low-dose colchicine is the first choice for acute gout attacks. Don’t wait until the pain is unbearable before taking it. Taking it within 12 hours of the attack has the best effect. Too many patients are afraid of becoming addicted to painkillers. In fact, the standard use of non-opioid analgesics is not addictive at all. On the contrary, the pain makes them unable to sleep well and their immunity is reduced. It will only aggravate inflammation, which is completely unnecessary.

After the pain subsides, the second thing to do is to stop moving or not moving. During an acute attack, you must try to immobilize as much as possible and lift the affected joint about 10 centimeters higher than the heart. For example, if you have knee pain, put a small pillow on it to reduce swelling much faster. After the redness and swelling subside, patients with osteoarthritis should give priority to exercises that do not wear down their knees, such as swimming and squatting against the wall. Don’t believe in the folk remedies of “climbing mountains to exercise your knees.” There used to be a 60-year-old man who climbed Xiangshan Mountain every day to train his legs. After half a year, the cartilage was worn down to only a thin layer of skin. In the end, he had to have a joint replacement, which was not worth the gain. Rheumatoid patients should not clench their fingers when they have morning stiffness. When getting up in the morning, soak in warm water for 5 minutes and slowly move the knuckles. Patients with gout should not move around during an attack. When the gout is relieved, they can walk briskly or do Tai Chi. Do not do strenuous anaerobic exercise. Accumulation of lactic acid will compete with uric acid for metabolic channels, which can easily induce recurrence.

Finally, when it comes to long-term care, the most effective ones are not expensive health products, but rather trivial things. Osteoarthritis patients just need to remember to control their weight. If you think about it, for every 1 pound of weight gained, the knees have to bear an additional 3 pounds of weight when walking, and even more 5-6 pounds when running and jumping. Losing 5 pounds is equivalent to losing more than 20 pounds of burden on the knees, which is more effective than eating any amount of amino sugar. Gout patients should drink 2000ml of warm water every day. Do not use milk tea or carbonated drinks instead. The fructose in them will increase uric acid. Rheumatoid patients should not expose their knees or ankles just to look good when the season changes. I have seen too many little girls relapse when they get cold, crying in pain.

To be honest, arthritis is a typical "three-part cure and seven-part nourishment" disease. With good care, many people will never develop to the point of needing surgery in their lifetimes. Don't panic about "immortal cancer" on the Internet. Everyone's disease tolerance and causes are different. Seeking professional medical care to adjust individualized plans is more reliable than any folk prescription.