Arthritis nursing diagnosis and measures

Pain related to inflammatory stimulation and joint wear and tear, physical mobility impairment related to pain and joint structure destruction, and lack of knowledge related to insufficient awareness of the disease.； The corresponding core nursing measures follow the principles of laddering and individualization, giving priority to controlling pain, maintaining joint function, and correcting cognitive misunderstandings. There is no unified plan that applies to all patients, and it needs to be adjusted based on the type of arthritis, the severity of the disease, and the patient's basic condition.

I have been working as a clinical nurse in orthopedics for 7 years, and I have seen too many patients who go to extremes. Either they are sweating in pain and insisting on not taking medicine, or they are told that "you have to grind away the pain" and walk 20,000 steps a day, and finally turn a small problem into a surgery. Let’s first clarify the details of nursing diagnosis. We don’t just say “the patient has joint pain” to make a diagnosis. We must first understand the origin of the pain: If the joints are stiff and painful for more than half an hour in the morning, and it is difficult to even clench a fist, it is most likely the inflammatory pain of rheumatoid arthritis. ； If it hurts badly when walking up stairs or squatting, but it's fine when walking on level ground, it's basically the wear and tear pain of osteoarthritis. Nowadays, Western medicine nursing is accustomed to use the NRS pain score to quantify pain. A score of 10 is the pain of giving birth, and a score of 3 or less does not affect sleep at all. Traditional Chinese medicine nursing requires distinguishing between cold and heat. Cold paralysis is aggravated by cold and the joints are cold to the touch, while heat paralysis is red, swollen and hot. The two nursing ideas are completely different. No one is right or wrong. Only when the disease is right can it be effective.

In addition to pain, the most difficult problem is physical mobility impairment. Last year I took care of a 62-year-old aunt with grade 3 knee osteoarthritis, which could have been controlled by conservative treatment. She was afraid of pain and did not dare to move. She lay at home watching TV every day. In three months, her thigh muscles atrophied and became thinner than her grandson who was in junior high school. Finally, the stability of her knee became worse and worse, and the pain was so painful that she had to struggle to get out of bed. She almost had a joint replacement. Many people think that mobility impairment means that the joints are damaged and cannot move. In fact, 80% of the cases are caused by pain that causes too much pain to move, and muscle atrophy that cannot move the joints. It is rare that the joint structure is completely destroyed. The diagnosis of lack of knowledge is really too common. If you ask 10 arthritis patients at random, at least 7 will either think that "you have to completely rest for arthritis" or that "you can get rid of bone spurs by exercising more." Either extreme of the two extremes will cause trouble.

After clarifying the core problem to be solved, the specific nursing measures are actually not as complicated as everyone thinks, but there are really many people who fall into the trap. As far as analgesia is concerned, there is quite a controversy: many elderly people firmly believe that "painkillers hurt the stomach and kidneys", and they endure the pain to the point where they can't sleep all night long. There are also young people who take ibuprofen whenever they feel pain, and even take it for half a month until their stomach bleeds. The current mainstream view is that if the NRS score exceeds 3, you can take the lowest effective dose of non-steroidal anti-inflammatory drugs as needed. The side effects of taking it once in a while are far less harmful to the body than long-term poor sleep, pain and stress. ； If you have stomach problems or cold legs due to cold paralysis, you can really try moxibustion and fumigation with traditional Chinese medicine. I have a 70-year-old patient whose knees hurt so much that he can't go downstairs in winter. He insists on moxibustion on the Dubi point for 15 minutes every day. This winter, the frequency of pain has been reduced by half, and he rarely takes painkillers. Oh, by the way, sodium hyaluronate injected into joints is something that everyone is asking a lot about now. There is currently no unified conclusion in the academic community. Some studies believe that it can lubricate joints and relieve pain, and some think it is almost as effective as a placebo. My suggestion is that if the analgesic effect of conventional care is not good, you can try it about 3 times. If it doesn’t work, stop it. There is no need to spend more money.

When it comes to functional exercise, don’t believe in the unified “squat against the wall for 10 minutes a day” and “walk 10,000 steps a day” policies online. For people weighing more than 150 pounds, squatting against the wall will put 3 times more pressure on the knees than walking on the road. Synovitis can be caused by nothing serious. Instead, it is better to do straight leg raises in bed to train the quadriceps. You can do it while lying down and put no pressure on the joints. If a patient in the acute stage of rheumatoid arthritis is "burning with inflammation" in his joints, and you ask him to move more, wouldn't that just add fuel to the fire? At this time, you have to immobilize first, and then move slowly after the inflammation subsides. The most suitable patient I have seen is a 58-year-old uncle. His knees hurt when he squatted quietly, and when he walked for a long time, he went to the park to do Tai Chi for 20 minutes every day. After practicing for half a year, his knee pain improved a lot, and his quadriceps strength also improved. You really don’t need to stick to a certain internet celebrity exercise method, the one that suits you is the best.

Don’t ignore the small details of daily life. Wearing shorts when the air conditioner in the office is turned on at 16 degrees in the summer is more harmful to the joints than freezing in the winter. The 28-year-old girl who came to the clinic last week had frozen knees as if she had just been taken out of the refrigerator. She grimaced in pain when she squatted down. The MRI showed synovial edema, which was caused by the cold air blowing every day. Do not wear canvas shoes with hard soles when wearing shoes. The soles have a soft and thick sole of about 2cm, which can cushion a lot of the impact on the joints when walking. Many people also ask whether calcium supplements are needed for arthritis. In fact, only patients with osteoporosis need additional supplements. Calcium supplements for osteoarthritis alone are useless. Don’t waste money by buying a bunch of health products.

In fact, to put it bluntly, arthritis is a chronic disease that cannot be cured. The core of care is never to "cure it", but to learn to coexist peacefully with it, find a rhythm that suits you, don't torment the joints, and don't waste the joints. It is more effective than any folk remedies.