Arthritis nursing diagnosis and measures

The core clinical nursing diagnosis for arthritis focuses on three categories - chronic joint pain directly related to inflammatory reaction and joint wear and tear, physical mobility impairment related to joint pain, stiffness, and structural damage, and lack of knowledge related to chronic disease management and insufficient awareness of trigger prevention.； The corresponding core nursing principles are graded analgesia, joint function protection, and full-cycle self-management. There is no so-called "universal care plan". All measures must be adjusted based on the patient's arthritis type, disease stage, and individual tolerance. Copying online experience may only aggravate symptoms.

Don’t believe it, last week I met a 52-year-old Aunt Zhang, a patient with knee osteoarthritis, during a follow-up visit in the Rheumatology and Immunology Department. I watched a short video and saw someone saying, “The arthritis will not hurt if you exercise more and it won’t hurt.”

Let’s first talk about pain care, which accounts for the highest proportion. This is also the core complaint of 90% of arthritis patients who seek medical treatment for the first time. The controversy about analgesia has actually never stopped: Conservative nursing ideas give priority to physical interventions, such as warm compresses, acupuncture, and low-frequency pulse therapy. They believe that non-drug interventions have no burden on the liver, kidneys, and gastrointestinal tract and are suitable for long-term chronic disease care. ； A more radical view is that the pain should be controlled to less than 3 points as soon as possible (on a 10-point scale, a score of less than 3 will not affect daily activities and sleep) to avoid being afraid to move due to fear of pain, which will lead to muscle atrophy and uneven stress on joints, which will accelerate wear and tear. In clinical practice, I usually choose a compromise solution. For example, if the patient only has a dull pain after catching a cold, and the score is within 2 points, giving him a sea salt pack that can be heated repeatedly, applying it for 20 minutes a day, and wearing a fleece kneepad when going out can basically relieve the pain. ； If the pain is so painful that it is difficult to squat down, and the score is 4-6, give priority to prescribing topical non-steroidal anti-inflammatory drug gel. After applying it, rub it until the skin is warm and absorbed. It has much fewer side effects than oral drugs. ； Only when the pain is so severe that you can't sleep at night and the score reaches 7 or above, short-term oral analgesics will be recommended, and you must be told to take them after meals to avoid stomach damage.

By the way, here is the choice between hot and cold compresses that many people are confused about: If the joints are red, swollen and hot in the acute phase, such as an acute attack of gout or active rheumatoid arthritis, do not apply hot compresses. The more you apply, the more the blood vessels will dilate and the swelling will increase. Just wrap an ice pack in a towel at room temperature and apply it for 10 minutes.； Hot compresses are suitable only for soreness and stiffness after catching cold in the chronic stage. Don't do it the other way around and aggravate the pain.

Let’s talk about the care of physical mobility disorders. The core is actually “sparing use + training muscles”. There is no unified exercise standard. I met a 28-year-old patient with ankylosing spondylitis before. His hip arthritis was so painful that he dared not move. He had been lying down for three months and his hip joint was directly adhered. In the end, he had to undergo surgery to loosen it. I also met an aunt who wore out her meniscus from square dancing, but she didn't control the situation properly. Try to reduce the load on your joints during daily life activities: use a trolley suitcase when shopping, don’t carry it on one shoulder, use a toilet to go to the toilet, don’t squat down, put commonly used things in the cabinet at waist height, don’t squat down enough, these small details can reduce more than half of joint wear. For exercise, choose low-weight-bearing exercises, such as swimming, walking on flat roads, and sitting and kicking. It is appropriate for joint pain to last no more than an hour after each exercise. If the pain persists until the next day, it is too much. Patients with knee arthritis can do straight leg raises every day while lying down, straighten their legs and lift them to a position 15 cm away from the bed and stop for 10 seconds. Do this 20 times a day to strengthen their thigh muscles. Once the muscles are stabilized, the burden on the joints will be less. It is more effective than taking any health supplements.

Regarding patients’ lack of knowledge, there are actually too many pitfalls. Many people think that arthritis is caused by the cold. In fact, catching cold is just an inducement, not the cause: osteoarthritis is caused by long-term wear and tear, rheumatoid arthritis is an autoimmune disorder, and gouty arthritis is caused by high uric acid deposition in the joints. The precautions for different types are quite different. Gout patients should avoid drinking beer, seafood, and thick broth. Rheumatoid patients should stay up less late and avoid active periods caused by colds. Osteoarthritis patients should lose weight first. For every 10 pounds gained, the knees will bear an additional 30 pounds of pressure. Just remember these core things. There is no need to memorize a long list of taboos. If you remember too much, you will easily miss out. Glucosamine and chondroitin, which are the most frequently asked questions, are currently recommended differently by different guidelines. The latest European and American guidelines believe that they have no clear effect on moderate to severe osteoarthritis. Many domestic clinical observations have found that taking them can indeed relieve pain in mild patients. My suggestion is not to buy high-dose health products from overseas. See a doctor for evaluation before taking them. If you take them for 3 months, stop if there is no effect. There is no need to waste money.

Finally, I would like to share my personal experience: Don’t wear knee pads all year round. Wear them only when you feel pain, go out in cold weather, or when exercising. Wearing them every day will cause the thigh muscles to atrophy due to disuse, which will make the joints less stable. Arthritis is a chronic disease that will follow you throughout your life. There is no absolute right or wrong way to care. You don’t need to pursue a “perfect care plan.” Just make it comfortable for you. If you are unsure, ask your nurse in charge or your doctor. Don’t blindly try “ancestral plasters” or “radical cures” on social media.