Outcomes (NOC)	Interventions (NIC) and Rationales
Mobility • Joint movement _____ • Muscle movement _____ • Endurance _____ • Performance of usual routine _____ • Muscle endurance _____ • Activity _____ Self-Care: Activities of Daily Living (ADLs) • Eating _____ • Dressing _____ • Toileting _____ • Bathing _____ • Grooming _____ Measurement Scale 1 = Severely compromised 2 = Substantially compromised 3 = Moderately compromised 4 = Mildly compromised 5 = Not compromised	Exercise Therapy: Joint Mobility • Determine limitations of joint movement and effect on function to establish baseline for plan of care. • Collaborate with physical and occupational therapy in developing and executing an exercise program to maintain and improve joint function. • Explain to patient/caregiver the purpose and plan for joint exercises to provide information and support for the patient. • Initiate pain management measures before beginning joint exercise (e.g., hot packs, warm shower) to relieve stiffness and increase mobility • Assist patient to optimal body position for passive/active joint movement (e.g., with correct application of resting splints, selection of properly fitting footwear, and selection and use of assistive devices) to prevent or limit joint deformity. Self-Care Assistance • Monitor patient’s ability for independent self-care to plan appropriate interventions. • Monitor patient’s need for adaptive devices for personal hygiene, dressing, grooming, toileting, and eating to compensate for contractures and weakness so patient can perform as many self-care activities as possible. • Establish a routine for self-care activities to foster maximum independence. • Assist patient in accepting dependency needs to ensure all needs are met. • Teach family to encourage independence, and to intervene only when patient is unable to perform to promote independence. Pain Management • Determine impact of pain experience on quality of life (e.g., sleep, appetite, activity, cognition, mood, relationships, performance of job, and role responsibilities) because these are major deterrents to successful disease management and must be addressed. • Inform other health care professionals/family members of nonpharmacologic strategies being used by the patient to encourage preventive approaches to pain management.

Outcomes (NOC)

Interventions (NIC) and Rationales

Mobility

• Joint movement _____

• Muscle movement _____

• Endurance _____

• Performance of usual routine _____

• Muscle endurance _____

• Activity _____

Self-Care: Activities of Daily Living (ADLs)

1 = Severely compromised

2 = Substantially compromised

3 = Moderately compromised

4 = Mildly compromised

5 = Not compromised

Exercise Therapy: Joint Mobility

• Determine limitations of joint movement and effect on function to establish baseline for plan of care.

• Collaborate with physical and occupational therapy in developing and executing an exercise program to maintain and improve joint function.

• Explain to patient/caregiver the purpose and plan for joint exercises to provide information and support for the patient.

• Initiate pain management measures before beginning joint exercise (e.g., hot packs, warm shower) to relieve stiffness and increase mobility

• Assist patient to optimal body position for passive/active joint movement (e.g., with correct application of resting splints, selection of properly fitting footwear, and selection and use of assistive devices) to prevent or limit joint deformity.

Self-Care Assistance

• Monitor patient’s ability for independent self-care to plan appropriate interventions.

• Monitor patient’s need for adaptive devices for personal hygiene, dressing, grooming, toileting, and eating to compensate for contractures and weakness so patient can perform as many self-care activities as possible.

• Establish a routine for self-care activities to foster maximum independence.

• Assist patient in accepting dependency needs to ensure all needs are met.

• Teach family to encourage independence, and to intervene only when patient is unable to perform to promote independence.

Pain Management

• Determine impact of pain experience on quality of life (e.g., sleep, appetite, activity, cognition, mood, relationships, performance of job, and role responsibilities) because these are major deterrents to successful disease management and must be addressed.

• Inform other health care professionals/family members of nonpharmacologic strategies being used by the patient to encourage preventive approaches to pain management.

Nursing Diagnosis

Chronic pain related to joint inflammation, misuse of joints, and ineffective pain and/or comfort measures as evidenced by communication of pain descriptors, guarding behavior, and limited joint function; hot, swollen, painful joints

Patient Goals

1. Effectively uses drug and nondrug pain management strategies to control pain

2. Verbalizes satisfactory pain management

Outcomes (NOC)	Interventions (NIC) and Rationales
Pain Control • Uses preventive measures _____ • Uses nonanalgesic relief measures _____ • Uses analgesics as recommended _____ • Reports uncontrolled symptoms to health care professional _____ • Reports pain controlled _____ Measurement Scale 1 = Never demonstrated 2 = Rarely demonstrated 3 = Sometimes demonstrated 4 = Often demonstrated 5 = Consistently demonstrated	Pain Management • Perform a comprehensive assessment of pain to include location, characteristics, onset/duration, frequency, quality, intensity or severity of pain, and precipitating factors to establish a pattern and baseline assessment and to plan appropriate interventions. • Evaluate, with patient and health care team, effectiveness of past pain management measures to determine what has helped and not helped in the past. • Reduce or eliminate factors that precipitate or increase the pain experience (e.g., fear, fatigue, and lack of knowledge) to minimize negative stimuli that may increase pain. • Teach use of nondrug techniques (e.g., relaxation, distraction, hot/cold applications, and massage) before pain occurs or increases, and along with other pain management measures to promote muscle relaxation and decrease tension. • Provide the person with optimal pain relief with prescribed analgesics to help decrease pain and inflammation. • Notify physician if measures are unsuccessful or if current complaint is a significant change from patient’s past experience of pain to provide alternative interventions as needed.

Outcomes (NOC)

Interventions (NIC) and Rationales

Pain Control

• Uses preventive measures _____

• Uses nonanalgesic relief measures _____

• Uses analgesics as recommended _____

• Reports uncontrolled symptoms to health care professional _____

• Reports pain controlled _____

Measurement Scale

1 = Never demonstrated

2 = Rarely demonstrated

3 = Sometimes demonstrated

4 = Often demonstrated

5 = Consistently demonstrated

Pain Management

• Perform a comprehensive assessment of pain to include location, characteristics, onset/duration, frequency, quality, intensity or severity of pain, and precipitating factors to establish a pattern and baseline assessment and to plan appropriate interventions.

• Evaluate, with patient and health care team, effectiveness of past pain management measures to determine what has helped and not helped in the past.

• Reduce or eliminate factors that precipitate or increase the pain experience (e.g., fear, fatigue, and lack of knowledge) to minimize negative stimuli that may increase pain.

• Teach use of nondrug techniques (e.g., relaxation, distraction, hot/cold applications, and massage) before pain occurs or increases, and along with other pain management measures to promote muscle relaxation and decrease tension.

• Provide the person with optimal pain relief with prescribed analgesics to help decrease pain and inflammation.

• Notify physician if measures are unsuccessful or if current complaint is a significant change from patient’s past experience of pain to provide alternative interventions as needed.

Nursing Diagnosis

Disturbed body image related to chronic disease activity, long-term treatment, deformities, stiffness, and inability to perform usual activities as evidenced by social withdrawal, flat affect, altered self-concept

Patient Goals

1. Discusses feelings about and the meaning of changes in physical appearance

2. Verbalizes acceptance of body appearance and function

Outcomes (NOC)	Interventions (NIC) and Rationales
Body Image • Internal picture of self _____ • Adjustment to changes in physical appearance _____ Adaptation to Physical Disability • Adapts to functional limitations _____ • Modifies lifestyle to accommodate disability _____ • Accepts need for physical assistance _____ • Reports decrease in negative body image _____ • Reports increase in psychological comfort _____ Measurement Scale 1 = Never demonstrated 2 = Rarely demonstrated 3 = Sometimes demonstrated 4 = Often demonstrated 5 = Consistently demonstrated	Body Image Enhancement • Identify effects of patient’s culture, religion, race, sex, and age in terms of body image to determine extent of problems and plan appropriate interventions. • Assist patient to discuss body changes caused by illness or surgery to identify problems and plan appropriate interventions. • Assist patient to separate physical appearance from feelings of personal worth so a positive body image is fostered in spite of physical manifestations. • Facilitate contact with individuals with similar changes in body image to promote sharing and socialization for patient. • Determine patient’s confidence in own judgment to identify problems and plan appropriate interventions. • Provide experiences that increase patient’s autonomy to strengthen self-image. • Assist patient to accept dependence on others, as appropriate, to help accept realistic choices. • Assist in setting realistic goals to achieve higher self-esteem.

Outcomes (NOC)

Interventions (NIC) and Rationales

Body Image

• Internal picture of self _____

• Adjustment to changes in physical appearance _____

Adaptation to Physical Disability

• Adapts to functional limitations _____

• Modifies lifestyle to accommodate disability _____

• Accepts need for physical assistance _____

• Reports decrease in negative body image _____

• Reports increase in psychological comfort _____

Measurement Scale

1 = Never demonstrated

2 = Rarely demonstrated

3 = Sometimes demonstrated

4 = Often demonstrated

5 = Consistently demonstrated

Body Image Enhancement

• Identify effects of patient’s culture, religion, race, sex, and age in terms of body image to determine extent of problems and plan appropriate interventions.

• Assist patient to discuss body changes caused by illness or surgery to identify problems and plan appropriate interventions.

• Assist patient to separate physical appearance from feelings of personal worth so a positive body image is fostered in spite of physical manifestations.

• Facilitate contact with individuals with similar changes in body image to promote sharing and socialization for patient.

• Determine patient’s confidence in own judgment to identify problems and plan appropriate interventions.

• Provide experiences that increase patient’s autonomy to strengthen self-image.

• Assist patient to accept dependence on others, as appropriate, to help accept realistic choices.

• Assist in setting realistic goals to achieve higher self-esteem.

Nursing Diagnosis

Ineffective self-health management related to complexity of chronic health problem, sense of powerlessness, pain, and decisional conflicts as evidenced by questioning management plan, self-doubt about ability to manage disease, ability to perform activities for only short periods

Patient Goals

1. Participates in planning and carrying out therapeutic regimen

2. Expresses confidence in ability to make treatment decisions

Outcomes (NOC)	Interventions (NIC) and Rationales
Knowledge: Arthritis Management • Cause and contributing factors _____ • Usual course of disease process _____ • Potential body changes due to disease _____ • Strategies to balance activity and rest _____ • Energy conservation techniques _____ • Strategies to protect joints _____ • Strategies to manage pain _____ • Effective exercise routine _____ • Correct use of assistive devices _____ • When to obtain assistance from a health professional _____ Measurement Scale 1 = No knowledge 2 = Limited knowledge 3 = Moderate knowledge 4 = Substantial knowledge 5 = Extensive knowledge	Anticipatory Guidance • Determine patient’s usual method of problem solving to identify where interventions need to focus. • Provide information on realistic expectations related to patient’s behavior to ensure correct understanding of disease management. • Assist the patient to identify and adapt to anticipated role changes so that effects of the disease are expected. • Refer patient to community agencies (e.g., Meals on Wheels, Arthritis Foundation) to provide the patient with resources to meet desired outcomes. • Include family/caregiver to increase their sense of control and to increase patient’s sense of support. Teaching: Disease Process • Appraise the patient’s current level of knowledge related to specific disease process to plan teaching interventions. • Explain the pathophysiology of the disease and how it relates to the anatomy and physiology to increase patient’s understanding of the process. • Describe rationale behind management/therapy/treatment recommendations so that patient can make informed decisions about disease management. • Instruct the patient on measures to control/minimize symptoms, as appropriate, to encourage participation in care.

Outcomes (NOC)

Interventions (NIC) and Rationales

Knowledge: Arthritis Management

• Cause and contributing factors _____

• Usual course of disease process _____

• Potential body changes due to disease _____

• Strategies to balance activity and rest _____

• Energy conservation techniques _____

• Strategies to protect joints _____

• Strategies to manage pain _____

• Effective exercise routine _____

• Correct use of assistive devices _____

• When to obtain assistance from a health professional _____

Measurement Scale

1 = No knowledge

2 = Limited knowledge

3 = Moderate knowledge

4 = Substantial knowledge

5 = Extensive knowledge

Anticipatory Guidance

• Determine patient’s usual method of problem solving to identify where interventions need to focus.

• Provide information on realistic expectations related to patient’s behavior to ensure correct understanding of disease management.

• Assist the patient to identify and adapt to anticipated role changes so that effects of the disease are expected.

• Refer patient to community agencies (e.g., Meals on Wheels, Arthritis Foundation) to provide the patient with resources to meet desired outcomes.

• Include family/caregiver to increase their sense of control and to increase patient’s sense of support.

Teaching: Disease Process

• Appraise the patient’s current level of knowledge related to specific disease process to plan teaching interventions.

• Explain the pathophysiology of the disease and how it relates to the anatomy and physiology to increase patient’s understanding of the process.

• Describe rationale behind management/therapy/treatment recommendations so that patient can make informed decisions about disease management.

• Instruct the patient on measures to control/minimize symptoms, as appropriate, to encourage participation in care.

^*Nursing diagnoses listed in order of priority.

eNursing Care Plan 65-2 Patient With Systemic Lupus Erythematosus

Nursing Diagnosis*

Patient Goals

1. Uses energy conservation techniques

2. Sets and completes priority activities

3. Adapts lifestyle to energy level

Outcomes (NOC)	Interventions (NIC) and Rationales
Energy Conservation • Uses energy conservation techniques _____ • Balances activity and rest _____ • Organizes activities to conserve energy _____ • Adapts lifestyle to energy level _____ Measurement Scale 1 = Never demonstrated 2 = Rarely demonstrated 3 = Sometimes demonstrated 4 = Often demonstrated 5 = Consistently demonstrated	Energy Management • Assist patient in assigning priority to activities to accommodate energy levels. • Assist patient to schedule rest periods to temporarily reverse the effect of fatigue. • Teach activity organization and time-management techniques to prevent fatigue. • Encourage alternate rest and activity periods to promote rehabilitation and to foster maximum participation in activities. • Instruct patient/significant other to recognize signs and symptoms of fatigue to allow appropriate reduction in activity. • Instruct patient/caregiver to notify health care provider if signs and symptoms of fatigue persist to increase patient’s support and family’s understanding of disease and related problems.

Outcomes (NOC)

Interventions (NIC) and Rationales

Energy Conservation

• Uses energy conservation techniques _____

• Balances activity and rest _____

• Organizes activities to conserve energy _____

• Adapts lifestyle to energy level _____

Measurement Scale

1 = Never demonstrated

2 = Rarely demonstrated

3 = Sometimes demonstrated

4 = Often demonstrated

5 = Consistently demonstrated

Energy Management

• Assist patient in assigning priority to activities to accommodate energy levels.

• Assist patient to schedule rest periods to temporarily reverse the effect of fatigue.

• Teach activity organization and time-management techniques to prevent fatigue.

• Encourage alternate rest and activity periods to promote rehabilitation and to foster maximum participation in activities.

• Instruct patient/significant other to recognize signs and symptoms of fatigue to allow appropriate reduction in activity.

• Instruct patient/caregiver to notify health care provider if signs and symptoms of fatigue persist to increase patient’s support and family’s understanding of disease and related problems.

Nursing Diagnosis

Impaired skin integrity related to photosensitivity, skin rash, and alopecia as evidenced by rash anywhere on body, butterfly rash on face, hair loss, areas of ulceration on fingertips, complaints of urticaria and photosensitivity

Patient Goals

1. Maintains skin integrity with the use of topical treatments

2. Prevents exacerbations with the use of sunscreens and limited sun exposure

Outcomes (NOC)

Interventions (NIC) and Rationales

Tissue Integrity: Skin and Mucous Membranes

• Abnormal pigmentation _____

• Skin lesions _____

• Mucous membrane lesions _____

Skin Care: Topical Treatments

• Inspect skin of patients at risk of breakdown daily to try to prevent skin breakdown.

• Document degree of skin breakdown to plan appropriate interventions.

• Apply topical antiinflammatory agent to affected area to control skin manifestations.

Teaching: Disease Process

• Discuss lifestyle changes that may be required to prevent future complications and/or control disease process (e.g., use of sunscreens and sun protective clothing when outdoors) as sun exacerbates manifestations.

• Instruct the patient on measures to control symptoms that are affecting the skin to minimize skin effects.

Nursing Diagnosis

Impaired comfort related to illness-related symptoms, treatment-related side effects, and the potential for variable and unpredictable progression of the disease as evidenced by reports of distressing symptoms, being unable to sleep, being afraid of disease outcome, and/or experiencing diffused joint pain and dermatologic manifestations

Patient Goals

1. Achieves maximum symptom management

2. Maintains optimal role function and a positive self image

Outcomes (NOC)	Interventions (NIC) and Rationales
Symptom Severity • Associated discomfort _____ • Associated fear _____ • Impaired physical mobility _____ • Impaired role performance _____ • Impaired life enjoyment _____ • Sleep deficit _____ Measurement Scale 1 = Severe 2 = Substantial 3 = Moderate 4 = Mild 5 = None Symptom Control • Monitors symptom onset _____ • Monitors symptom persistence _____ • Monitors symptom severity _____ • Monitors symptom frequency _____ • Monitors symptom variation _____ • Uses preventive measures _____ • Uses symptom relief measures _____ • Obtains health care when warning signs occur _____ • Reports symptoms controlled _____ Measurement Scale 1 = Never demonstrated 2 = Rarely demonstrated 3 = Sometimes demonstrated 4 = Often demonstrated 5 = Consistently demonstrated	Pain Management • Perform a comprehensive assessment of pain to include location, characteristics, onset/duration, frequency, quality, intensity or severity of pain, and precipitating factors to plan appropriate interventions. • Ensure that patient receives attentive analgesic care to manage pain. • Teach use of nondrug techniques (e.g., relaxation, guided imagery, distraction, and hot/cold application) before pain occurs or increases, and along with other pain management measures to replace or supplement analgesics. Environmental Management: Comfort • Determine sources of discomfort, (e.g., damp dressings, positioning of tubing, constrictive dressings, wrinkled bed linens, and environmental irritants) to plan appropriate interventions. • Prevent unnecessary interruptions and allow for rest period to enhance sleep patterns. • Facilitate hygiene measures to keep the individual comfortable (e.g., wiping brow, applying skin creams, or cleaning body, hair, and oral cavity). • Position patient to facilitate comfort (e.g., using principle of body alignment, support with pillows, support joints during movement, splint over incisions, and immobilize painful body part). • Provide relevant and useful educational resources concerning the management of illness to patients and their families to encourage self-management of symptoms. Teaching: Disease Process • Appraise the patient’s current level of knowledge related to specific disease process to plan appropriate teaching. • Describe common signs and symptoms of the disease so that patient may learn what to expect. • Explore with the patient what she/he has already done to manage the symptoms to identify interventions that work for the patient. • Discuss lifestyle changes that may be required to prevent future complications and/or control the disease process. • Provide reassurance about patient’s condition, as appropriate, to decrease anxiety and promote a positive self-image.

Outcomes (NOC)

Interventions (NIC) and Rationales

Symptom Severity

• Associated discomfort _____

• Associated fear _____

• Impaired physical mobility _____

• Impaired role performance _____

• Impaired life enjoyment _____

• Sleep deficit _____

• Monitors symptom onset _____

• Monitors symptom persistence _____

• Monitors symptom severity _____

• Monitors symptom frequency _____

• Monitors symptom variation _____

• Uses preventive measures _____

• Uses symptom relief measures _____

• Obtains health care when warning signs occur _____

• Reports symptoms controlled _____

Measurement Scale

1 = Never demonstrated

2 = Rarely demonstrated

3 = Sometimes demonstrated

4 = Often demonstrated

5 = Consistently demonstrated

Pain Management

• Ensure that patient receives attentive analgesic care to manage pain.

• Teach use of nondrug techniques (e.g., relaxation, guided imagery, distraction, and hot/cold application) before pain occurs or increases, and along with other pain management measures to replace or supplement analgesics.

Environmental Management: Comfort

• Determine sources of discomfort, (e.g., damp dressings, positioning of tubing, constrictive dressings, wrinkled bed linens, and environmental irritants) to plan appropriate interventions.

• Prevent unnecessary interruptions and allow for rest period to enhance sleep patterns.

• Facilitate hygiene measures to keep the individual comfortable (e.g., wiping brow, applying skin creams, or cleaning body, hair, and oral cavity).

• Position patient to facilitate comfort (e.g., using principle of body alignment, support with pillows, support joints during movement, splint over incisions, and immobilize painful body part).

• Provide relevant and useful educational resources concerning the management of illness to patients and their families to encourage self-management of symptoms.

Teaching: Disease Process

• Appraise the patient’s current level of knowledge related to specific disease process to plan appropriate teaching.

• Describe common signs and symptoms of the disease so that patient may learn what to expect.

• Explore with the patient what she/he has already done to manage the symptoms to identify interventions that work for the patient.

• Discuss lifestyle changes that may be required to prevent future complications and/or control the disease process.

• Provide reassurance about patient’s condition, as appropriate, to decrease anxiety and promote a positive self-image.

Nursing Diagnosis

Deficient knowledge related to lack of exposure to and unfamiliarity with information resources as evidenced by questions about SLE, misinterpretation of information, and lack of adherence to treatment instructions

Patient Goals

1. Describes the disease process and the rationale for prescribed treatment

2. Expresses confidence in ability to recognize complications and use precautions to prevent their occurrence

Outcomes (NOC)	Interventions (NIC) and Rationales
Knowledge: Disease Process • Specific disease process _____ • Effects of disease _____ • Measures to minimize disease progression _____ • Signs and symptoms of complications _____ Measurement Scale 1 = No knowledge 2 = Limited knowledge 3 = Moderate knowledge 4 = Substantial knowledge 5 = Extensive knowledge	Teaching: Disease Process • Describe disease process to increase the patient’s awareness of likely changes related to its progression. • Discuss therapy/treatment options to increase probability of successful long-term management. • Provide family/caregiver with information about patient’s progress to provide support during exacerbation and increase their sense of involvement. • Instruct patient on which signs and symptoms to report to health care provider (e.g., fever, edema, decreased urine output, chest pain, and dyspnea) to ensure early intervention. • Refer patient to local community agencies/support groups (e.g., Lupus Foundation, Arthritis Foundation) to provide additional sources of information and support.

Outcomes (NOC)

Interventions (NIC) and Rationales

Knowledge: Disease Process

• Specific disease process _____

• Effects of disease _____

• Measures to minimize disease progression _____

• Signs and symptoms of complications _____

Measurement Scale

1 = No knowledge

2 = Limited knowledge

3 = Moderate knowledge

4 = Substantial knowledge

5 = Extensive knowledge

Teaching: Disease Process

• Describe disease process to increase the patient’s awareness of likely changes related to its progression.

• Discuss therapy/treatment options to increase probability of successful long-term management.

• Provide family/caregiver with information about patient’s progress to provide support during exacerbation and increase their sense of involvement.

• Instruct patient on which signs and symptoms to report to health care provider (e.g., fever, edema, decreased urine output, chest pain, and dyspnea) to ensure early intervention.

• Refer patient to local community agencies/support groups (e.g., Lupus Foundation, Arthritis Foundation) to provide additional sources of information and support.

^*Nursing diagnoses listed in order of priority.

This chapter discusses rheumatic diseases, which primarily affect body joints, tendons, ligaments, muscles, and bones. These diseases are often characterized by inflammation. Rheumatic diseases result from the loss of function in one or more of the connective or bone structures of the body. There are more than 100 kinds of rheumatic diseases. An estimated 46 million people in the United States have rheumatic conditions.¹

Arthritis

Arthritis, a type of rheumatic disease, involves inflammation of a joint or joints. Most forms of arthritis affect women more frequently than men.² The most common types of arthritis are osteoarthritis, rheumatoid arthritis, and gout.

Osteoarthritis

Osteoarthritis (OA), the most common form of joint (articular) disease in North America, is a slowly progressive noninflammatory disorder of the diarthrodial (synovial) joints. Currently 27 million Americans are affected by OA, with the numbers expected to greatly increase as the population ages.¹

OA involves the formation of new joint tissue in response to cartilage destruction.³ OA is not considered a normal part of the aging process, but aging is one risk factor for disease development.⁴ Cartilage destruction may actually begin between ages 20 and 30, and the majority of adults are affected by age 40. Few patients experience symptoms until after age 50 or 60, but more than half of those over 65 years of age have x-ray evidence of OA in at least one joint. After 55 years of age, women are affected by OA more often than men.⁵

OA is usually caused by a known event or condition that directly damages cartilage or causes joint instability (Table 65-1). The increased incidence of OA in aging women is believed to be due to estrogen reduction at menopause. Modifiable risk factors for OA have been identified, including obesity, which contributes to hip and knee OA. Regular moderate exercise, which also helps with weight control, has been shown to decrease the likelihood of disease development and progression. Anterior cruciate ligament injury, which is associated with quick stops and pivoting as in football and soccer, has been linked to an increased risk of knee OA.⁶ Occupations that require frequent kneeling and stooping are also linked to a higher risk of knee OA.

TABLE 65-1

CAUSES OF OSTEOARTHRITIS

Cause	Effects on Joint Cartilage
Trauma	Dislocations or fractures may lead to avascular necrosis or uneven stress on cartilage.
Mechanical stress	Repetitive physical activities (e.g., sports) cause cartilage deterioration.
Inflammation	Release of enzymes in response to local inflammation can affect cartilage integrity.
Joint instability	Damage to supporting structures causes instability, placing uneven stress on articular cartilage.
Neurologic disorders	Pain and loss of reflexes from neurologic disorders, such as diabetic neuropathy and Charcot’s joint, cause abnormal movements that contribute to cartilage deterioration.
Skeletal deformities	Congenital or acquired conditions such as Legg-Calvé-Perthes disease or dislocated hip contribute to cartilage deterioration.
Hematologic or endocrine disorders	Chronic hemarthrosis (e.g., hemophilia) contributes to cartilage deterioration.
Drugs	Drugs such as indomethacin (Indocin), colchicine, and corticosteroids can stimulate collagen-digesting enzymes in joint synovium.

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Nov 17, 2016 | Posted by admin in NURSING | Comments Off

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Nursing Management: Arthritis and Connective Tissue Diseases

Nursing Management

Arthritis and Connective Tissue Diseases

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Osteoarthritis

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Nursing Management: Arthritis and Connective Tissue Diseases

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Arthritis and Connective Tissue Diseases

Arthritis

Osteoarthritis

Etiology and Pathophysiology

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