Arthritis care rounds

There is no universal template for arthritis care. It needs to be stratified according to "acute phase/remission phase" and classified into "osseous/rheumatoid/gouty". Priority should be paid to the three core actions of pain management, joint function maintenance, and complication prevention. At the same time, the patient's individual feelings must be taken into account in adjusting the plan to avoid mechanical application of standards.

As soon as I turned into the corridor of the ward, I heard Aunt Wang in bed 3 complaining to her family about her knee pain. She was admitted to the hospital last week due to an acute attack of osteoarthritis caused by cold. Xiao Zhou, the nurse in charge of the bed, had just adjusted the frequency of her cold compress from every 4 hours to every 6 the day before. Once an hour, I walked over and touched the skin temperature of her knee. It dropped 1°C faster than yesterday, and the swelling around the patella also disappeared by nearly one-third. I raised my hand to help her pull up the quilt that had slipped under her knee: "How much pain would you rate today?" ”“If you don’t move, 3 points, much better than yesterday! ”

When the department held a regular nursing meeting before, some nurses mentioned that many elderly patients felt that cold compresses were too cold and could not bear it. Can they be replaced by hot compresses? At that time, we also published two editions of the guideline - the 2023 version of the Western Medicine "Osteoarthritis Diagnosis and Treatment Guidelines" clearly requires that cold compresses be given priority when the skin temperature rises in the acute phase to avoid the spread of inflammation. However, the TCM nursing standards also mention that if it is osteoarthritis induced by cold evil, the local skin temperature will not be Obviously increased, warm compress can relieve muscle spasm. We later tried several similar patients. As long as the temperature is controlled within 40°C and no more than 15 minutes each time, the analgesic effect is indeed better than that of simple cold compress, and there is no aggravation of inflammation. There are no deadlocks in nursing care.

The young man in bed 7 next to him had his head buried in scrolling through his mobile phone. He was 28 years old and had an acute attack of gouty arthritis. His right ankle was swollen like a steamed bun. When he was admitted to the hospital yesterday, he was sweating from the pain. The nurse raised his affected limb by 30 degrees as usual, but he turned over instead. He tossed and turned and couldn't fall asleep. He said it hurt more when his feet were dangling. Later, we adjusted him to a height of 15 degrees and placed a soft pillow next to his feet to prevent the quilt from rubbing against the affected area. He slept soundly for 6 hours last night and didn't even take spare painkillers. To be honest, sometimes norms are dead, people are alive, and the patient's feelings always come first.

Walking inside is Uncle Zhang, who lives in bed 12. He has been suffering from rheumatoid arthritis for 8 years. This time he came in because of the aggravation of metacarpophalangeal joint deformity. When he saw me coming over, he held up the grip ball in his hand and complained: "I heard others say that practicing more grip strength can prevent deformation. Why is it that after practicing for a week, it hurts more?" ”I pinched the swelling of his metacarpophalangeal joints. It was still in the active stage of inflammation, so he shouldn’t have done resistance exercises in the first place. We had argued with colleagues in the rehabilitation department before: the rehabilitation department believed that early mild resistance could prevent muscle atrophy, but the nursing consensus of the rheumatology department was to give priority to passive stretching during the active period to avoid adding burden to the damaged synovium. In the end, we compromised and helped the patient do passive joint activities three times a day for 10 minutes each time during the active period. After the C-reactive protein dropped, we slowly added low-intensity resistance training. After trying it for more than half a year, the feedback from the patients was good, and there was no case of the condition being aggravated by exercise.

After checking beds 12, I went around to bed 21 to check on Grandma Li. She was 76 years old and was on the 5th day after her knee surgery for osteoarthritis. Our department had previously admitted a similar elderly patient. She lay in bed for half a month fearing pain after the surgery, and her thigh muscles shrank by 2 centimeters. It took more than a month of practice to return to the pre-operative level. For example, on the second day after the operation, we helped her get off the ground and stand with a walker for 5 minutes. Now she can walk slowly for two steps, and there is no venous thrombosis in the lower limbs. Many family members and even new nurses think that arthritis requires more care and less movement. In fact, the boundary between movement and immobility is the most important test of nursing care.

Finally, when I went back to the nurse's station to share the precautions with everyone, I didn't list 1, 2, 3, or 4, but just said two words: First, don't just follow the rules, and ask the patient if it hurts or if he feels comfortable.； Second, don’t confuse different types of arthritis. Don’t forget to remind patients with gout repeatedly not to drink broth, don’t let patients with rheumatoid touch cold water, and don’t let patients with osteoarthritis climb stairs. Oh yes, I almost forgot. I will sort out the nursing records of those special cases next week for everyone to take a look at. After all, what we care about is the patients’ joints and their quality of life.