Pediatric Nursing Demystified

Signs and Symptoms

Irritability

Poor appetite

Mild growth delay

Tires easily

Changes in gait

Poor weight gain

High fever

Rash

Flex position at rest

Test Results

Increased erythrocyte sedimentation rate (ESR)

Positive rheumatoid factor (RF) in serum

Positive immunoglobulin (Ig)G and IgM present in serum

Positive antinuclear antibodies (ANA) in serum

Low hemoglobin

Treatments

Administer nonsteroidal antiinflammatory drugs (NSAIDs) such as

ibuprofen and naproxen for pain relief. It can take 3 weeks for antiin-

flammatory response to occur.

Administer slow-acting antirheumatic drugs (SAARDS) such as

methotrexate, sulfasalazine, and hydroxychloroquine to suppress the

autoimmune response.

Administer steroids if other treatments fail. Steroids reduce inflamma-

tion but have adverse side effects with long-term use.

Administer etanercept (Enbrel) if NSAIDs and SAARDS fail. Etanercept

blocks the binding of tumor necrosis factor with cell surface receptors,

thus reducing inflammation.

Physical therapy to ensure safety ambulation.

Nursing alert Monitor the patient for signs of infection because antiinflamma-

tory medication suppresses the immune system.

Nursing Interventions

Perform range-of-motion exercise on the affected joint to maintain joint

mobilization.

Encourage nonweight bearing activities to strengthen muscles.

Use splints and braces to reduce flexion and minimize pain.

Monitor renal and hepatic labs to detect adverse reaction to long use of

NSAIDs.

Apply warm compresses on joints when sleeping to prevent viscous that

results in stiffness.

CHAPTER 13/ Musculoskeletal Conditions^293