NOC Comfort Level

INTERVENTIONS

Assess severity of joint pain, location, duration, remissions and exacerbations, stiffness and what precipitates pain such as weight gain, activity, fatigue; effect on mobility and participation in ADL; presence of joint deformity.

Administer medications (specify) as ordered and assess effect of medications in relieving pain.

Apply warm compresses, packs, or soaks to painful areas; paraffin baths and whirlpool as ordered.

Provide 1 to 2 rest periods during day and quiet environment for sleep.

Encourage child to assume position of comfort; elevate and support painful joints when changing position.

Apply splints if ordered for night use.

Explain cause of pain to child and measures that should be taken to relieve pain.

Teach child and parents about factors (stress, climate movement) that exacerbate pain episodes, and to express or report presence of

RATIONALES

Provides information symptomatic of the effect of the disease on the musculoskeletal system: allows for analgesic/ anti-inflammatories selection and better management of activity involvement; inflammatory process cause pain with the edema resulting from joint effusion and synovial thickening and limited motion resulting from muscle spasms; joint deformity results from joint destruction.

(Action of drugs: relieves pain and the inflammatory process associated with the pain; drugs may be administered alone or in combination including the nonsteroidal anti-inflammatory drugs that act as analgesic, antipyretic and anti-inflammatory; slower acting antirheumatic drugs which may be added for optimal effect if NSAIDs are ineffective; corticosteroid drugs in lowest effective dose for short period of time especially in the presence of a life-threatening situation.)

Promotes circulation to the area by vasodilation to relieve pain; moist heat relieves painful, stiff areas.

Decreases stimulation that increases pain, and it promotes rest, especially during acute episodes.

Promotes diversionary activity to detract from pain.

Provides immobilization of joints to ease pain during movement.

Provides reasons for treatments and medications.

Promotes opportunity to avoid those situations or activities that contribute to exacerbations of pain and to provide for immediate pain at the onset.

Instruct parents and child in accurate administration of medications including side effects and importance of compliance with regimen whether taken qid, h.s., or bid and side effects to report (specify).

Teach parents to give warm bath daily for 10 minutes or warm wet packs with a towel bath to painful areas.

Instruct parents and child to avoid overactivity or movement of affected joints.

Teach child relaxation techniques, music therapy and diversionary activities such as TV, reading, games.

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