Primary Nursing Diagnosis

Pain (chronic) related to joint irritation and destruction

OUTCOMES. Comfort level; Pain control behavior; Pain level; Symptom control behavior; Symptom severity; Well-being

INTERVENTIONS. Pain management; Analgesic administration; Cutaneous stimulation; Heat or cold application; Touch; Exercise therapy; Progressive muscle relaxation

H PLANNING AND IMPLEMENTATION Collaborative

MEDICAL. Initial medical treatment consists of prescribing pharmacologic therapy. An appropriate ongoing exercise program, which includes teaching proper body mechanics, is prescribed by the physical therapist. Therapy may include the use of moist heat in the form of soaks and whirlpools. Hot soaks and paraffin dips may be used to relieve hand pain, and a cervical collar and hand splints may be used for painful joints. A transcutaneous electric nerve stimulator (TENS) may be particularly helpful for vertebral pain relief. The physical therapist teaches the patient to use a walker and cane if indicated. Occasionally, the patient needs to learn to manage activities of daily living in the home with the help of assistive technical aids. If considerable help is required in learning these skills, the occupational therapist becomes part of the team effort.

SURGICAL. Surgical treatment may be undertaken to restore joint function when conservative treatment is ineffective. Patients who are in relatively good physical and mental condition may be candidates for joint reconstructive surgery (arthroplasty). Other surgical procedures include debridement, to remove loose debris within a joint, and osteotomy, which involves cutting the bone to realign the joint and shift the pressure points to a less denuded area of the joint. An osteotomy requires internal fixation with wires, screws, or plates, as well as limited joint movement with restricted weight-bearing for a prescribed period of time. Fusion of certain joints (arthrodesis) may be done for the vertebrae and certain smaller joints when other types of procedures have not been successful in eliminating pain. Fusion eliminates movement in the joint and therefore is undertaken as a last resort. Patients who undergo knee replacement surgery are placed on a continuous passive motion machine, which is set to put the patient's leg through an increasing range of motion and thus prevent scar tissue.

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