Arthritis

Arthritis Nursing Diagnosis Interventions and Care Plans

Arthritis NCLEX Review Care Plans

Nursing Study Guide for Arthritis

Arthritis is a medical condition that involves the inflammation of joints, which includes joint tenderness, swelling, and pain. Arthritis usually becomes worse as a person age.

There are different types of arthritis; the most common ones include osteoarthritis, rheumatoid arthritis, and gout. Other types of arthritis include ankylosing spondylitis, juvenile idiopathic arthritis, psoriatic arthritis, septic arthritis, and thumb arthritis.

The usual treatment plan for patients with arthritis involve reducing joint pain and improve their quality of life.

Signs and symptoms of Arthritis

Here are the common signs and symptoms of arthritis:

  • Swelling of the joints
  • Joint stiffness and/or pain
  • Warm sensation on the affected joints
  • Loss of appetite
  • Fatigue
  • Deformed joints, especially in the fingers and toes
  • Bony enlargement – found in the middle and end joints of the fingers

Causes and Risk Factors for Arthritis

Rheumatoid arthritis (RA) develops when the immune system attacks the lining of the joints called the synovium.

Osteoarthritis (OA), on the other hand, involves the degeneration of the joint, particularly the cartilage that covers the bones’ ends.

Gouty arthritis (GA), or simply known as gout, is caused by the formation of uric acid crystals in the joint, usually starting at the big toe.

Complications of Arthritis

  1. Rheumatoid nodules. RA puts a person at risk of developing rheumatoid nodules, which are firm clumps of tissue that form around the elbows, or other pressure points, or even inside the lungs.
  2. Osteoporosis and fractures. Aside from the affected joints, the nearby bones can eventually weaken, making the patient at a high risk for developing fractures.
  3. Joint deformity. Many types of arthritis can develop bony nodules on the fingers. In the long run, the patient may experience radial or ulnar deviations of the affected joint.
  4. Carpal tunnel syndrome. The wrists may also be affected by arthritis, causing them to be inflamed and compress the median nerve that innervates the hand and fingers.
  5. Functional impairment and disability. Arthritis can affect both gross and motor abilities of the limbs. These can make it difficult to do physical work and activities of daily living for the patient.
  6. Chronic pain syndrome. The neural pain pathways are persistently activated in severe arthritis, which can eventually develop chronic pain syndrome.

Diagnosis of Arthritis

  • Physical exam – to check for the signs and symptoms such as bony enlargement of the joints, as well as muscular strength and reflex exams
  • Blood tests for complete blood count, biochemistry, rheumatoid factor and anti-CCP antibodies – to diagnose RA; not indicated to diagnose OA but can be used to determine the type of arthritis; uric acid and creatinine levels are helpful for identifying gout
  • Imaging – X-ray of the affected joints; MRI and ultrasound to determine the severity
  • Joint aspiration – if there is fluid accumulation around the joint, the fluid can be aspirated for testing to determine the type of arthritis

Treatment for Arthritis

  1. Medications. The following medications are commonly used in the treatment of arthritis:
  2. Nonsteroidal anti-inflammatory drugs (NSAIDs) – to reduce inflammation and relieve pain
  3. Steroids – to slow down the damage of the joints, reducing inflammation and pain
  4. Disease-modifying antirheumatic drugs (DMARDs) – to slow down RA progression, reducing the risk for permanent tissue and joint damage; not suitable for OA
  5. Biologic response modifiers – DMARDs that target specific parts of the immune system that stimulates the inflammation; not suitable for OA
  6. Colchicine – if NSAIDS do not work to reduce pain and swelling in gout patients, this medication is prescribed for gout flare ups.
  7. Surgery. The doctor may recommend surgery to resolve unbearable joint pain due to arthritis. This includes joint replacement (replacing a damaged joint with an artificial joint), arthroscopy (to remove the damaged joint tissues or repair them if possible), osteotomy (for realignment of the bone of the arm or leg), and joint fusion (for realignment and stabilization of the affected joint).
  8. Physical therapy. This is an important part of the treatment regimen for arthritis and includes a physical therapist who can guide the patient with effective exercises to reduce the joint pain. Low impact exercises such as walking on flat surfaces and swimming are recommended to reduce the risk of putting stress on the damaged joint.
  9. Weight loss. Obesity is one of the most common risk factors for arthritis, thus, a crucial part of the treatment is to lose weight through diet and exercise.

Nursing Care Plans for Arthritis

  1. Nursing Diagnosis: Activity intolerance related to joint inflammation and pain  secondary to arthritis, as evidenced by pain score of 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 chronic 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 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.
If the patient is overweight or obese, create a weight loss plan with the patient, caregiver, physiotherapy/occupational therapy, doctors, and dietitian.Obesity is one of the most common risk factors for most forms of arthritis, thus, a crucial part of the treatment is to lose weight through diet and exercise.
  • Nursing Diagnosis: Pain related to joint inflammation secondary to arthritis, as evidenced by pain score of 10 out of 10, guarding sign on the affected fingers, restlessness, and irritability

Desired Outcome: The patient will report a pain score of 0 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 rheumatoid arthritis.To provide pain relief to the patient. The medications for RA include: Nonsteroidal anti-inflammatory drugs (NSAIDs) – to reduce inflammation and relieve painSteroids – to slow down the damage of the joints, reducing inflammation and painDisease-modifying antirheumatic drugs (DMARDs) – to slow down RA progression, reducing the risk for permanent tissue and joint damage; not suitable for OABiologic response modifiers – DMARDs that target specific parts of the immune system that stimulates the inflammation; not suitable for OAColchicine – if NSAIDS do not work to reduce pain and swelling in gout patients, this medication is prescribed for gout flare ups
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. Elevate the affected limb and place ice pack on it. Encourage pursed lip breathing and deep breathing exercises.To promote optimal patient comfort, pain relief, thereby reducing 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.

Other possible nursing diagnoses:

  • Fatigue
  • Deficient Knowledge
  • Situational Low Self-Esteem

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

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