arthritis management and nursing care

[John]

Arthritis - Management and Nursing Care

Aims

z    Relief of symptoms

z    Prevention of joint damage

z    Maintenance of joint function

z    Preservation of quality of life

Chemotherapy

z    Analgesics

z    Non-steriodal anti-inflammatories (NSAIDS)

z    Corticosteroids

z    Intraarticular medications

z    Disease-modifying drugs (DMARDS)

Analgesics

z    Non-opioid

y   Acetylsalicylic acid

y   Paracetamol

y   Compound

x  aspirin/paracetamol + opioid (e.g. Digesic)

z    Opioid

y   Short-term

y   Acute

x  E.g. Tramadol, morphine

NSAIDs

z    Non-steroidal anti-inflammatory drugs

y   Naproxen, Ibuprofen, Diclofenac

z    Relieve pain and inflammation

z    Detrimental effect on gastric mucosa

z    COXIBs

y   Celebrex, Vioxx

Others

z    Corticosteroids

z    Inta-articular corticosteroids

z    Viscosupplementation

y   Synvisc

DMARDs

z    Induce disease remission/suppression in RA

z    Influence short and long-term outcomes

z    Used in conjunction with other therapies

z    Toxic - require monitoring

z     Methotrexate, penicillamine, Auranofin, hydroxychloroquine, cyclophosphamide

y   Leflunomide

y   Entanercept

Surgical Intervention

z    Good treatment option

y   reduces pain

y   maintains/improves joint function

y   correction/prevention of deformity

y   maintenance of independence

y   cosmetic

z    Synovectomy, Tenosynovectomy, arthroplasty - partial & total, arthrodesis

Other treatments

z    Relaxation, meditation, visualisation

z    Complimentary therapies

y   e.g. Osteopathy, Acupuncture

z    Heat - wax, mud, spa, hydrotherapy

z    Cold - ice packs

z    Ultrasound

z    TENs

Maintenance of joint function

z    Regular exercise - ROM, Aerobic

z    Adequate rest

y   ­ Pain: ¯ exercise ­ rest

z    Splinting - resting and working

z    Work simplification & Time management

y   Pace, plan, prioritise, posture, help

z    Joint protection

Preservation of quality of life

z    Education

y   Person and family

y   Shown to

x  increase knowledge

x  change behaviour

x  increase physical function

x  increase psychosocial health

z    Understanding and Communication

The little things

“It is often these ‘little things’, which are imbued with nursing knowledge and skill, that are covered over and lost in the busy world of clinical practice. It is the ‘little things’, which are often taken-for-granted, that tip the balance between independence and dependence for the person with arthritis. Benner  suggests that attending to the ‘little things’ of client care is fundamental to expert nursing care. In caring for those who live with arthritis attending to the ‘little things’ is essential“ (Roy, 2001, p.189).

 

Oh, who will unsnarl my body

into gestures of love?

Who will give my heart room

to fly free in its rickety cage? …

Who will nudge the dreams back into my head,

back into my bones, where rhyming with one

another like wind chimes,

They will make music wherever I move?

(Millar, 1988, p.45)

References

z     Hill, J. (Ed.). (1998). Rheumatology nursing: A creative approach. Edinburgh: Churchill Livingstone.

 

z     Lorig, K. (1994). Living a healthy life with chronic conditions: Self management of heart disease, arthritis, stroke, diabetes, asthma, bronchitis, emphysema and others. Palo Alto, CA: Bull.

 

z     Millar, V. (1988). Insomniac's prayer. In M. Saxton & F. Howe (Eds.), With wings: An anthology of literature by women with disabilities (p. 45). London: Virago.

References

z     Phipps, W. J., Sands, J. K., & Mark, J. F. (1999). Medical - surgical nursing: Concepts and clinical practice. (6th ed.). St. Louis: Mosby.

 

z     Roy, D. E. (1995). Exploring the realities: the lived experience of chronic rheumatoid arthritis. Unpublished honours dissertation, Massey University, Palmerston North, New Zealand.

 

z     Roy, D. E. (2001). The everyday always-thereness of living with rheumatoid arthritis. Unpublished doctoral dissertation, Massey University, Albany, New Zealand.