Ankylosing Spondylitis

Ankylosing Spondylitis Nursing Care Plans Diagnosis and Interventions

Ankylosing Spondylitis NCLEX Review Care Plans

Nursing Study Guide on Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a medical condition that involves the inflammation (spondylitis) and fusion (ankylosis) of the vertebrae or small bones in the spine.

Due to the fusion of the vertebrae, the patient usually has a hunched-forward posture may also affect the ribs and cause difficulty of breathing.

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The flexibility of the spine is also reduced in ankylosing spondylitis. The inflammation may also be seen in other areas of the body such as the eyes.

Also known as Bechterew disease, ankylosing spondylitis is described as a rare type of arthritis. The disease is found to be more common in men than in women, and is usually found in adult patients more than younger people.

Ankylosing spondylitis has no cure yet and is considered a rare, lifelong disease. The treatment is focused on alleviating symptoms and reducing the rate of progression.

Signs and Symptoms of Ankylosing Spondylitis

  • Lower back and/or hip pain – early sign of ankylosing spondylitis; usually worse in the morning and when the person is inactive (e.g. after watching TV, sitting, or taking a nap); may be accompanied with stiffness
  • Inflammation in other body parts – over time, the disease may aso affect other areas of the body such as shoulder joints, ribs, breastbone, back of the heel, and the eyes
  • Hunched-forward posture
  • Difficulty of breathing
  • Swelling of joints
  • Tiredness or fatigue

Causes and Risk Factors of Ankylosing Spondylitis

Ankylosing spondylitis has no known etiology, but some experts believe that the gene HLA-B27 increases the risk for developing this disease.

AS usually begins in the sacroiliac joints where the spine and pelvis meet. The condition can progress to the ligaments and tendons connected to the affected bones. AS can result to the fusion of vertebrae, which can change the posture of the person into a hunched one.

The pain can radiate from the lower back to the hips, buttocks, thighs, feet, heels, shoulders, rib cage, and hands.

The risk factors for AS include:

  • Age – AS usually starts in teens or young adulthood; most cases start before age 30
  • Gender – males are more affected than females
  • Hereditary

Complications of Ankylosing Spondylitis

  1. Spine-related issues. AS can cause fracture of the spine due to weak vertebrae. It may also result to a condition called cauda equina syndrome (CES) which is the irritation of the cauda equina or bundle of nerve roots situated at the bottom of the spinal cord as the damaged vertebrae press on it. CES may cause problems in bladder and/or bowel control, loss of reflexes, and sexual issues.
  2. Uveitis. Almost half of the patients with AS suffer from uveitis, a type of eye inflammation accompanied with light sensitivity and blurry vision.
  3. Cardiac issues. AS may cause the enlargment of the aorta and the subsequent distortion in the shape and function of the aortic valve. This may cause further fatigue and shortness of breath in an AS patient.

Diagnosis of Ankylosing Spondylitis

  • Physical exam – involves checking for the spine’s range of motion by asking the patient to bend in various directions as well as palpation of the spinal and pelvic areas
  • Imaging tests – X-rays will be done to check for abnormalities in the bones and joints; MRI may show more detailed pictures of the soft tissues and bones; AS might not be detected easily during its early stages despite performing imaging tests
  • Laboratory tests – blood test for inflammation markers can be done; there is no specific lab test for AS; genetic test for HLA-B27 gene may be done as well although it is not a definitive proof of AS

Treatment for Ankylosing Spondylitis

There is no cure for AS yet and the goals of treatment for this disease is the relief of stiffness and pain, delaying of its progression, and prevention of complications. Early treatment for AS is crucial as the joints may suffer from irreversible damage if the management is delayed.

  1. Physical Therapy. Staying active is the number one management for ankylosing spondylitis. Sitting, lying, and staying in one position for long periods of time increase the pain and stiffness of joints. An AS patient will benefit from an urgent referral to a physical therapist (PT) who will create an exercise and activity plan for him or her. Stretching and range-of-motion (ROM) exercises, as well as proper posture, walking, and sleeping positions will be discussed by the PT to the patient.
  2. Medications. The various drugs used for the symptomatic relief of AS include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) – commonly utilized to relieve pain, inflammation, and stiffness of joints in AS patients; however, they should be used as prescribed due to the risk for gastrointestinal bleeding
  • Steroids – to slow down the damage of the joints, reducing inflammation and pain; they can be in oral form or injectables directly to the inflamed joint
  • Tumor necrosis factor (TNF) blockers – alternative to NSAIDs if the latter are not effective; usually administered via subcutaneous injection or intravenous infusion; involves the use of monoclonal antibodies (MABs)
  • Interleukin-17 inhibitors – MABs that contribute to the immune defense of the body against inflammation and infection

Nursing Care Plans for Ankylosing Spondylitis

Nursing Care Plan 1

Nursing Diagnosis: Pain related to vertebral and joint inflammation secondary to ankylosing spondylitis, as evidenced by pain score of 10 out of 10, guarding sign on the affected area (commonly lower back, hip, shoulders), joint swelling, hunched-forward posture, restlessness, and irritability

Desired Outcome: The patient will report a reduced pain score of 0 to 3 out of 10.

InterventionsRationales
Assess the patient’s vital signs. Ask the patient to rate the pain from 0 to 10 and describe the pain he/she is experiencing.To create a baseline set of observations for the patient. The 10-point pain scale is a globally recognized pain rating tool that is both accurate and effective.
Administer analgesics/ pain medications as prescribed. Administer other prescribed medications for ankylosing spondylitis.To provide pain relief to the patient. The medications for AS include: Nonsteroidal anti-inflammatory drugs (NSAIDs) – to reduce inflammation and relieve painSteroids – to slow down the damage of the joints, reducing inflammation and pain; they can be in oral form or injectables directly to the inflamed jointTumor necrosis factor (TNF) blockers – alternative to NSAIDs if the latter are not effective; usually administered via subcutaneous injection or intravenous infusion; involves the use of monoclonal antibodies (MABs)Interleukin-17 inhibitors – MABs that contribute to the immune defense of the body against inflammation and infection
Ask the patient to re-rate his/her pain 30 minutes to an hour after administering the analgesic.To assess the effectiveness of treatment.
Provide more analgesics at recommended/prescribed intervals.To promote pain relief and patient comfort without the risk of overdose.
Reposition the patient in his/her comfortable/preferred position. Encourage pursed lip breathing and deep breathing exercises.To promote optimal patient comfort and reduce anxiety/ restlessness.
Refer the patient to a pain specialist as required.To enable to patient to receive more information and specialized care in pain management if needed.

Nursing Care Plan 2

Nursing Diagnosis: Activity intolerance related to vertebral and joint inflammation and pain secondary to ankylosing spondylitis, as evidenced by pain score of 8 to 10 out of 10, fatigue, disinterest in ADLs due to pain, verbalization of tiredness and generalized weakness

Desired Outcome: The patient will demonstration active participation in necessary and desired activities and demonstrate increase in activity levels.

InterventionsRationales
Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.To create a baseline of activity levels and mental status related to acute pain, fatigue and activity intolerance.
Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with 60-90 minutes of undisturbed rest.To gradually increase the patient’s tolerance to physical activity. To prevent triggering of acute pain by allowing the patient to pace activity versus rest.
Administer analgesics as prescribed  prior to exercise/ physical activity. Teach deep breathing exercises and relaxation techniques. Provide adequate ventilation in the room.To provide pain relief before an exercise session. To allow the patient to relax while at rest and to facilitate effective stress management. To allow enough oxygenation in the room.
Refer the patient to physiotherapy / occupational therapy team as required.To provide a more specialized care for the patient in terms of helping him/ her build confidence in increasing daily physical activity.

Nursing Care Plan 3

Nursing Diagnosis: Impaired Physical Mobility related to vertebral and joint inflammation secondary to ankylosing spondylitis as evidenced by severe pain rated10/10, failure to perform ADLs, and verbalization of fatigue

Desired Outcome: Patient will maintain or regain functional mobility.

InterventionsRationales
Assess the patient’s function ability to perform activities of daily living (ADLs) such as eating, bathing, oral and perineal care.To identify patient’s current strengths and problems related to performing ADLs while dealing with AS.
Identify the patient’s need for assistance from significant others. Educate the significant others on how to assist the patient in performing ADLs and improving physical mobility through exercise.To identify patient’s support in terms of his/her physical, social, mental, and emotional health. To support the significant others on how they can assist the patient achieve optimal physical mobility.
Encourage physical mobility and demonstrate range of motion exercises.To prevent muscle atrophy and joint contractures.
Refer the patient to the physiotherapist.To provide specialized care and individualized exercise program.
Consider hip replacement surgery for severely damaged hip joint.Severe joint damage or pain due to AS can make a patient eligible for surgery. Hip replacement can also be done if the hip joint is severely damaged.

Other possible nursing diagnoses:

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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