Arthritis nursing diagnosis and measures

The clinical core nursing diagnosis of arthritis usually revolves around the four categories of "chronic pain, joint dysfunction, limited body movement, and lack of disease awareness." There is no universal plan for the corresponding intervention measures. It needs to be personalized based on the arthritis classification, disease course, and patient's individual tolerance. The core goals are to relieve uncomfortable symptoms, delay the progression of joint degeneration, and maintain the patient's normal quality of life.

To be honest, after spending almost 6 years in an orthopedic clinic, I have seen too many patients who are confused about arthritis care: 62-year-old Aunt Zhang has been diagnosed with knee osteoarthritis for 3 years. She always hears people say that she needs to walk more to remove bone spurs. She is limping in pain but still insists on walking for 1 hour every day. Wan Bu, when he came for a follow-up examination, his cartilage had worn out to the point where he needed to consider joint replacement; and Xiao Zhou, a 28-year-old gout patient, came to the emergency department after his knees swelled like steamed buns during an acute attack. He applied blood-activating plaster at home, but the pain kept him awake all night.

Let’s talk about the most obvious pain-related diagnosis first. The current Western medicine system usually combines the NRS pain score (0 points are no pain to 10 points are the most painful), signs of joint redness, swelling, heat and pain, and the degree of wear and tear shown on imaging to make judgments. Traditional Chinese medicine care will additionally refer to the causes of pain - for example, those that are aggravated by cold are mostly classified as cold-damp obstruction, and those that are aggravated by exercise are mostly due to liver and kidney deficiency. These two diagnostic logics are currently parallel in clinical practice, and no one is right or wrong. Of course, there is also a point of debate in the industry: some rehabilitation doctors advocate including "lowering of pain thresholds caused by anxiety" as an auxiliary diagnosis. After all, many patients do not have serious organic injuries, but because they are always worried about disability, the pain will be magnified several times. However, many doctors in the orthopedics department feel that it is enough to deal with organic problems, and there is no need to include psychological intervention in routine nursing diagnosis. There is no unified conclusion on this. In actual operations, it depends on the specific situation of the patient.

How should I deal with the pain? It’s true that not everyone is suitable for hot compresses. In the case of an acute gout attack like Xiao Zhou's, where the joints are red, swollen and hot, the first thing to do is to immobilize and stop moving the affected joints. Applying a warm towel across a cloth for about 15 minutes can relieve a lot of pain. If you apply a blood-activating plaster and soak your feet in hot water at this time, the blood vessels will expand, the inflammation will leak out more, and the pain will only become more severe. If you have chronic cold legs like Aunt Zhang's, which hurt when you are cold, you can usually apply a warm water bag or do moxibustion without any problem, and the comfort level will be even higher. If the pain is so severe that it affects your sleep, just follow your doctor's advice and take some non-steroidal anti-inflammatory drugs. You don't have to take it hard, and you don't have to worry about being dependent on painkillers. Taking regular doses in the short term has very little side effects.

When it comes to the diagnosis of joint dysfunction, many patients can actually detect this themselves: in the past, it was easy to squat down to pick things up, but now the pain is unbearable halfway through squatting, or the wrist cannot turn to the previous angle, and it is difficult to button up clothes, which means that the joint mobility has been damaged. There is also a misunderstanding that needs to be broken here: it really does not mean that the more it hurts, the more you need to practice. Articular cartilage is like the gasket in a bicycle bearing. It is already worn thin. If you continue to rub it hard every day, it will only break faster. Patients in the early and middle stages can usually do some non-weight-bearing strength training. For example, if you have knee arthritis, you can lie down and do straight leg raises and quadriceps isometric contractions to practice muscle strength to reduce the load on the joints. If you are overweight, losing 5 kilograms first will be more effective than taking health supplements for half a year. If you like to move, you can go swimming or walk in the water. The buoyancy of water can relieve most of the pressure on the joints, and it is friendly to almost all types of arthritis. This is also a highly recognized form of exercise in the industry. Oh, by the way, if you are a patient with rheumatoid arthritis, you should be extra careful not to touch ice water and avoid catching a cold during the change of seasons. Autoimmune arthritis is prone to acute attacks due to infection. This is also the experience we have summarized from many cases.

Many people think that arthritis is a disease only suffered by the elderly. Nowadays, there are a lot of young people in their twenties and thirties suffering from shoulder arthritis and wrist arthritis. Not long ago, there was a 26-year-old girl who was doing UI design. She held the mouse for 10 hours every day. She also held her mobile phone to watch videos after get off work. When she came, her wrist hurt so much that she couldn't even pick up the cup. She was diagnosed with stenosing tenosynovitis of the radial styloid process combined with wrist arthritis. She also asked me, "Aren't only old people getting arthritis?" This is a typical lack of disease awareness. The focus of this kind of care is actually to change your habits. For example, stop and shake your hands every 40 minutes. Don't always hold the phone on your wrist. You can also wear a wrist brace to support the joints. Oh, by the way, there is also the most frequently asked question about whether you should take glucosamine. There is currently no unified conclusion in the industry: the latest European and American guidelines say that for moderate or above osteoarthritis, glucosamine has the same effect as a placebo, and there is no need to take it. However, many domestic clinical studies show that early and mid-stage patients take it as prescribed by the doctor, and it can indeed relieve some discomfort. So my suggestion is not to buy health care products blindly, and first ask a doctor to evaluate your joint condition before making a decision.

In the final analysis, there has never been a standard answer to the care of arthritis. Whether you have old cold legs that are afraid of the cold or gouty arthritis that loves seafood, whether you have just been diagnosed in the early stage or in the late stage where wear and tear has been severe, the focus of care is very different. Don’t believe in any “universal care formula for arthritis”. Finding a reliable medical team and adjusting the plan regularly is better than anything else.