Arthritis nursing diagnosis and measures

Pain related to inflammatory stimulation and joint wear, body movement disorders related to limited joint mobility and decreased muscle strength, and potential complications related to long-term disease course and improper intervention (joint deformity, muscle atrophy, deep vein thrombosis, etc.)； The corresponding core nursing principles are "layered intervention, individualized adaptation, and two-way cooperation between doctors and patients." There is no standardized plan suitable for all patients, and it needs to be dynamically adjusted based on the type of arthritis, disease course, and personal tolerance.

Many people think that nursing diagnosis is a fixed item that nurses follow in a manual. In fact, there are two different diagnostic logics in the industry, and there is no absolute right or wrong: one is to follow the international NANDA standardized classification and sort all possible nursing problems according to priority, which facilitates medical record archiving and cross-agency collaboration.； The other is the flexible diagnosis of “patient chief complaint as the core” advocated in domestic primary care in recent years, which completely follows the patient’s true feelings. For example, if a young man has an acute gout attack and is so painful that he breaks into a cold sweat and can't even put on his slippers, then all interventions must focus on pain relief first. ； If an aunt in the stable stage of degenerative knee arthritis is most troubled by pain when walking 200 meters when going out to buy groceries, then the focus will naturally turn to improving mobility. Last month, a 62-year-old patient with rheumatoid arthritis was admitted to the ward. Her knuckles were deformed. When she first arrived, she repeatedly said that the most uncomfortable thing was that she could not even hold chopsticks and had to be fed by her family members. At that time, we did not put the pain first as usual, but instead put "improving the fine mobility of the upper limbs" as the first priority. After two weeks of intervention, she was able to drink porridge with a spoon by herself, and she said she felt much better when meeting people.

When it comes to specific intervention measures, the differences between different schools are actually quite obvious. It is not as absolute as the "unified cold compress and unified rest" mentioned on the Internet. Take pain care as an example. In Western medicine, the routine is to use non-steroidal anti-inflammatory drugs in the acute phase, combined with local cold compresses to reduce inflammatory effusion. This relieves pain quickly, but some elderly people with poor stomachs are prone to acid reflux after eating. ； Teachers of traditional Chinese medicine rehabilitation believe that as long as there are no local skin ulcers or infections, the analgesic effect of warm acupuncture and traditional Chinese medicine in the acute phase will be more lasting and there will be no gastrointestinal irritation. Our department now usually presents two options for patients to choose from. Young people who are anxious for pain relief can take oral medicine first, and elderly people with poor tolerance can give priority to external treatments. It is not wrong.

Many patients have major misunderstandings about activity intervention. They either think that "you have to take care of your arthritis and you can't do anything", or they think that "the more it hurts, the more you need to practice, and it will be fine if you wear it out." I met a 70-year-old man before. After suffering from knee arthritis, he heard others say that mountain climbing can provide exercise. He climbed the hill behind his house every day. After climbing for half a month, he was in so much pain that he couldn't stand up. An MRI showed that a large piece of cartilage had been worn away. ； There is also a 30-year-old patient with ankylosing spondylitis who is too painful to move and lies flat every day. After half a year, he lost 10 kilograms of muscle mass and the pain became even worse. In fact, there is no unified standard for the amount of activity. You can just try it yourself: walk for 10 minutes, and if the pain is relieved within 10 minutes after stopping, then this amount is appropriate. If the pain persists for more than half an hour, you have to reduce it. What we usually recommend to patients are non-weight-bearing activities such as swimming and squatting against the wall. Don't run, jump, or climb stairs. This is purely to make yourself suffer.

As for the prevention of potential complications, different types of arthritis have completely different priorities. Osteoarthritis patients who have been bedridden for a long time should press their legs more and hook their feet more to avoid blood clots in their lower limbs. ； Patients with rheumatoid arthritis should always pay attention to maintaining the functional position of their joints. Do not sleep on pillows that are too high, and do not always clench and bend your fingers. Otherwise, over time, they will become fixed and unable to straighten. ； Gout patients should not just focus on joint pain, but also check uric acid and kidney function regularly. Otherwise, uric acid crystals will settle in the kidneys, which will be a big problem. During my follow-up visits, I have seen too many patients messing around, either buying Internet-famous health care products that "cure arthritis" randomly, or scalding their feet with boiling water every day, which only makes the feet more swollen the more they are applied. In fact, the most practical care is small things: wear knee pads when the weather is cold to prevent the joints from getting cold.

To put it bluntly, arthritis is a chronic disease. Care is not a one-time task, and there is no perfect standard answer. Your own physical feelings always come first. If you are not sure what to do, ask a nurse or rehabilitation practitioner in a regular hospital, which is much more reliable than watching folk remedies through short videos.