Arthritis Nursing Care Plans Diagnosis and Interventions
Arthritis NCLEX Review and Nursing Care Plans
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
- 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
- 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.
- Osteoporosis and fractures. Aside from the affected joints, the nearby bones can eventually weaken, making the patient at a high risk for developing fractures.
- 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.
- 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.
- 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.
- 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
- Medications. The following medications are commonly used in the treatment of arthritis:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) – to reduce inflammation and relieve pain
- Steroids – to slow down the damage of the joints, reducing inflammation and pain
- Disease-modifying antirheumatic drugs (DMARDs) – to slow down RA progression, reducing the risk for permanent tissue and joint damage; not suitable for OA
- Biologic response modifiers – DMARDs that target specific parts of the immune system that stimulates the inflammation; not suitable for OA
- Colchicine – if NSAIDS do not work to reduce pain and swelling in gout patients, this medication is prescribed for gout flare ups.
- 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).
- 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.
- 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.
Arthritis Nursing Diagnosis
Nursing Care Plan 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.
|Arthritis Nursing Interventions||Rationales|
|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 Care Plan for Arthritis 2
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.
|Arthritis Nursing Interventions||Rationales|
|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 pain
Steroids – to slow down the damage of the joints, reducing inflammation and pain
Disease-modifying antirheumatic drugs (DMARDs) – to slow down RA progression, reducing the risk for permanent tissue and joint damage; not suitable for OA
Biologic response modifiers – DMARDs that target specific parts of the immune system that stimulates the inflammation; not suitable for OA
Colchicine – 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.|
Nursing Care Plan for Arthritis 3
Nursing Diagnosis: Impaired Physical Mobility related to intolerance to activity; reduced muscle strength secondary to arthritis as manifested by restricted range of movement, impaired coordination, and reduced muscle strength.
- The patient will verbalize good pain tolerance at a level of 3 to 4 on a rating score of 0 to 10.
- The patient’s affected body part will improve its strength, mobility, and function.
- The patient will sustain a position of function with limited muscular contractures.
|Arthritis Nursing Interventions||Rationale|
|Check the patient’s vital signs. Ask to rate the pain from 0 to 10, and report the patient he/she is having.||To produce a baseline set of assessments for the patient. Using 10 point pain scan is a pain rating tool accepted worldwide to be both accurate and effective.|
|Recognize the patient’s pain through employing active listening.||Nurses are responsible for assessing the patient’s pain, and also to report it to the attending physician. Accepting their pain reports in an unhealthy and nontherapeutic relationship may hinder pain management and disintegrate rapport.|
|Evaluate and constantly monitor the level of joint inflammation and pain.||The degree of activities and exercises relies on the progress and resolution of inflammatory actions.|
|Keep the patient on bed rest or chair rest when recommended. Set a schedule for activities to provide periods of rest and good nighttime sleep.||Systemic rest is required during acute exacerbations and throughout the phase of the disease to lessen fatigue and improve strength.|
|Assist with activities such as active and passive range of motion, resistance exercises, and isometric exercises when tolerated.||Insufficient exercise may result in stiffness of joints. ROM, resistive exercises, and isometrics are helpful activities to maintain and improve the function of joints, strengthen muscles and enhance general stamina. However, these activities must be under the supervision of the physician. Extreme activities may lead to damage to joints.|
|Advise the patient to maintain an upright head and straight posture when sitting, standing, and walking.||Maintaining good posture maximizes the function of joints and mobility. However, poor posture affects negatively the muscles and joints.|
|Encourage the patient to do activities of daily living (ADLs) as tolerated. It may include observance of good hygiene, proper dressing, and feeding themselves.||Activities that can be performed should be recommended to increase functions.|
|Explain and provide safety practices such as raising chairs and toilet seats; using handrails in the tub, shower, and toilet; Correct usage of mobility equipment, and wheelchair safety.||These procedures will prevent incidents of injury and falls.|
|Reposition the patient regularly in his/her comfortable position, using sufficient personnel. Exhibit and support with transfer techniques, and make use of mobility equipment such as a walker, cane, and trapeze.||Regular repositioning relieves pressure on tissues and promotes blood flow. Practice easier self-care and independence. By doing proper transfer techniques, shearing and abrasion of the skin will be prevented.|
|Support the joints with splints and braces. Use pillows, sandbags, and trochanter roll when positioning.||It helps in reducing the risk of injury by promoting joint stability. Also, it maintains the correct joint position and body alignment and lessens contractures.|
|Advise using a smaller or thinner pillow under the neck.||To avoid bending the neck.|
|Teach pursed-lip breathing and deep breathing exercises.||Pursed-lip breathing and deep breathing exercises are nonpharmacological techniques to promote pain relief and promote comfort.|
|Provide mattress or pressure foams.||It reduces the risk of developing decubitus resulting from pressure on fragile tissues secondary to immobility.|
|Administer pain medications as ordered.||Pain medications are given to provide relief to the patient. However, it must be prescribed by the attending physician. There are several types of pain medicine and each of them has its mechanism of action. This is to avoid overdosage and the risk of severe side effects.|
|Evaluate the efficacy of pain medications as ordered and monitor any signs and symptoms of side effects.||Pain medication must be evaluated per individual patient since each person’s absorption and metabolism is different from one another.|
|Recommend physiotherapy or occupational therapy to the patient as required.||To facilitate more specialized management in terms of helping to build confidence and increase everyday physical activity.|
Nursing Care Plan for Arthritis 4
Nursing Diagnosis: Risk for Injury related to altered mobility secondary to arthritis.
- The patient will be free from incidents that may result in injury.
- The patient will identify the safety measures in preventing injury.
- The patient will show how to perform prevention and safety measures.
- The patient and family members will perform strategies to promote safety and avoid falls at home.
|Arthritis Nursing Interventions||Rationale|
|Assess the patient’s history of injury.||There’s an increased risk of fall-related readmission among the elderly population. Patients are more likely to face injury again if they have a history of one or more falls in the past six months.|
|Evaluate age-related physical changes.||Patients in old age have weaker muscle, lesser flexibility, and endurance and are most at risk of injury.|
|Create an individual plan of care for preventing injury. Design a plan of care that is particularized to the patient’s unique needs.||Each patient has their own different needs, and planning an individualized injury prevention program is important in providing safety for the healthcare team. Standard precautions such as universal fall precautions are strategies in general, helping to grow a safe environment that prevents accidents and presents preventive measures for all patients.|
|Assist with the patient’s active and passive range of motion exercises and isometrics as tolerated.||Maintains and improves muscular strength, the function of the joints, and endurance.|
|Advise the patient to lose weight to decrease stress on weight-bearing joints||Excessive weight adds stress to the joints, which can increase the deterioration of the joint cartilage.|
|Use a bed buffer and place the bed as low when sleeping.||To reduce the incidence of injury from falling during sleep.|
|Instruct the patient to use the softest part available during exercise.||A soft and flat surface reduces the shaking of the client’s joints and the risk of hurtful steps that may worsen the condition.|
|Discuss the proper use of adaptive mobility equipment like walkers, canes, and crutches as indicated.||To enhance mobility of the joints, promote safety, and maintain a high quality of life.|
|Prepare an assistive device that the patient can use during transfer and ambulation.||Using gait belts by all healthcare team members can promote safe assistance during the transfer from bed to chair. Assistive equipment such as canes, walkers, and wheelchairs can enhance the patient’s stability and balance when walking.|
|Discuss to the patient the following safety measures: Raised chairs and toilet seatHandrails Proper use of mobility apparatusWheelchair safety guide||To avoid accidental incidents and falls.|
|Place the patient in an accessible room, preferably closer to the nurse||To provide more continuous monitoring and immediate response to call needs.|
|Arrange the patient’s personal items within easy reach, such as call light, urinal, water, and telephone.||It may require the patient to reach out or walk if the items are placed too far, and it can be a possible hazard or may attribute to injury from a fall.|
|Respond to the patient’s call light/bell immediately.||To prevent the patient from going out of bed alone and without any assistance.|
|Give high-risk patients with a hip pad.||Hip pads when worn properly may prevent hip fracture when a fall happens.|
|Put an anti-slip floor mat at the bedside.||Floor mats provide cushion and reduce the impact during falls.|
|Make the patient familiar with the layout of the room.||Injury is more likely to happen if the environment is not familiar, for example, furniture and equipment placement in a particular area. The patient must be familiar with the room layouts to avoid tripping over furniture or any large objects.|
|Place appropriate room lighting, especially at night.||Based on studies, appropriate lighting at home reduces the risk of injuries like falls among older patients.|
|Instruct the patient how to walk safely at home, including safety measures such as handrails in the bathroom.||Relieve anxiety at home and reduce the risk of injury during walking inside their home. Raised toilet seats can make safe transfer easier on and off the toilet.|
|Refer to physical and occupational therapy as indicated.||These processes can allow patients to integrate exercise into their day-to-day routine. Among senior patients, group exercises can be helpful.|
|Discuss safety and prevention of accidents to family members.||Safety measures are important to the patient especially those in confined areas in preventing accidents and injuries.|
Nursing Care Plan for Arthritis 5
Nursing Diagnosis: Disturbed Body Image related to increased energy expenditure secondary to arthritis as manifested by changes in the function of affected areas, negative self-talk, lifestyle changes, changes in social involvement, and feeling of helplessness.
- The patient will express increased self-confidence in the capability to work with the illness, changes in lifestyle, and any possible limitations.
- The patient will plan realistic goals for the future.
|Arthritis Nursing Interventions||Rationale|
|Encourage the patient to verbalize concerns about the disease process and future expectations.||Allow recognizing fears and misconceptions and handle them directly.|
|Evaluate the patient’s recognized effect of changes in ADLs, participation in social activities, personal connections, and work-related activities.||Changes in body image can affect the patient’s capacity to perform daily roles and responsibilities.|
|Evaluate the outcome of body image disturbance in connection to the patient’s developmental period.||Adolescents and young adults patient may be one by one affected by changes in the structure or functions of their bodies, during the time of developmental changes are normally faster and at a period when social development and intimate relationships are exceptionally important.|
|Assess the patient’s behavior towards the real or perceived changed body part or function.||There is a wide range of behaviors related to body image disturbance, varying from completely ignoring the changed structure or function to preoccupation with it.|
|Advise them to eat a balanced diet, but remind them that special diets won’t cure some types of arthritis. Emphasize the importance of weight control.||Excess weight and obesity give additional stress to the joints.|
|Reinforce verbalization of feelings, whether positive or negative thoughts, regarding the actual or perceived loss.||Verbalization of feelings can improve the patient’s coping strategies. It encourages the patient to separate feelings towards the changes in body structure from feelings regarding self-worth.|
|Find out how the patient views self in typical lifestyle functioning.||Recognizing how a disease affects the perception of self and relations with others will identify the required additional intervention and counseling.|
|Display positive caring in routine tasks.||Positive regard by the healthcare team may inspire the patient to develop a more positive perception of the changes in their body.|
|Include hope within the parameters of an individual situation. Do not give false reassurance.||Encourage a positive attitude and opportunity to set goals and plan for the future based on reality.|
|Recognize and accept feelings of grief, hostility, and dependency.||Persistent pain is exhausting and may result in a feeling of anger and hostility. Acceptance gives the reaction that these feelings are normal.|
|Observe for any withdrawn behavior, use of denial, or too much concern with body changes.||May indicate emotional weariness or nonadaptive coping mechanism, and need deeper intervention or psychological support.|
|Put limitations on maladaptive attitudes. Assist the patient to acknowledge positive behaviors that will help in coping||Increase the feeling of accomplishment and self-esteem, which improves self-confidence|
|Include the patient in the planning of care and arranging of activities.||It gives a feeling of competency and self-worth to the patient and also motivates independence and involvement in therapy.|
|Assist in grooming necessities as needed.||Aiming for a well-groomed appearance enhances self-image.|
|Provide positive response for accomplishments.||Gives the patients time to feel good about themselves. Strengthening positive behavior promotes self-confidence.|
|Recommend psychiatric counseling by a nurse specialist in a psychiatric clinic, psychiatrist, or psychologist.||Patients and family members may need continuous support to work with the long-term and weakening process.|
|Give anti-depressant medications as prescribed.||Medications may be needed in case of severe depression until the patient comes about more effective coping techniques.|
|Advise interaction with family members and with the rehabilitation team.||Good communication gives constant support to patients and families.|
Other possible nursing diagnoses:
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. (2022). 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. (2020). 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
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