Collaborative Problems/Potential Complications
Based on assessment data, potential complications may include the following:
Adverse effects of medicationsPlanning and Goals
The major goals for the patient may include relief of pain and discomfort, relief of
fatigue, promotion of restorative sleep, increased mobility, maintenance of self-care,
improved body image, effective coping, and absence of complications.
Nursing Interventions
An understanding of the underlying disease process (ie, degeneration or inflammation,
including degeneration resulting from inflammation or vice versa) guides the nurse's
critical thinking processes. In addition, knowledge about whether the condition is
localized or more widely systemic influences the scope of the nursing activity.
Some rheumatic diseases (eg, OA) are more localized alterations in which control of
symptoms such as pain or stiffness is possible. Others (eg, gout) have a known cause
and specific treatment to control the symptoms. The diseases that usually present the
greatest challenge are those with systemic manifestations, such as the diffuse
connective tissue diseases. The plan of nursing care in Chart 54-2 details the nursing
interventions to be considered for each nursing diagnosis.
Relieving Pain and Discomfort
Medications are used on a short-term basis to relieve acute pain. Because the pain may
be persistent, nonopioid analgesics such as acetaminophen are often used. After
administering medications, the nurse needs to reassess pain levels at intervals. With
persistent pain, assessment findings should be compared with baseline measurements
and evaluations. Additional measures include exploring coping skills and strategies that
have worked in the past.
The patient needs to understand the importance of taking medications, such as NSAIDs
and DMARDs, exactly as prescribed to achieve maximum benefits. These benefits
include relief of pain and anti-inflammatory action as the disease is brought under
control. Because disease control and pain relief are delayed, the patient may mistakenly
believe the medication is ineffective or may think of the medication as merely ―pain
pills,‖ taking them only sporadically and failing to achieve control over the disease
activity. Alternatively, the patient may not understand the need to continue the
medication for its anti-inflammatory actions once pain control has been achieved.
A weight reduction program may be recommended to relieve stress on painful joints.
Heat applications are also helpful in relieving pain, stiffness, and muscle spasm.
Superficial heat may be applied in the form of warm tub baths or showers and warm
moist compresses. Paraffin baths (dips), which offer concentrated heat, are helpful to
patients with wrist and small-joint involvement. Maximum benefit is achieved within
20 minutes after application. More frequent use for shorter lengths of time is most
beneficial. Therapeutic exercises can be carried out more comfortably and effectively
after heat has been applied.
However, in some patients, heat may actually increase pain, muscle spasm, and
synovial fluid volume. If the inflammatory process is acute, cold applications in the
form of moist packs or an ice bag may be tried. Both heat and cold are analgesic to
nerve pain receptors and can relax muscle spasms. Safe use of heat and cold must be
evaluated and taught, particularly to patients with impaired sensation. Further study of
the effectiveness of these modalities is needed.