3. Maintain a healthy, well-balanced diet.

Pathophysiology
4. Maintain a healthy weight.
5. Practice safety measures to help prevent synovitis Genetic hormonal Mechanical
(for example, keep stairways, walkways, yards, and factors injury Previous joint
driveways free of clutter, and salt or sand icy patches damage
in the winter).
6. Wear protective equipment when playing. Others
CHONDROCYTE
7. Avoid exercising or playing sports when tired or in RESPONSE
pain.
8. Follow body mechanics. Release of cytokines

Evaluation: Expected Outcomes Stimulation, production and release of proteolytic

1. Comfort level is promoted. enzyme, metalloproteinase collagenase
2. Nutritional level is maintained.
3. Minimized movement of affected part.
Resulting damage predispose to further damage
4. Sleeping time is increased.
5. Anxiety is reduced.
FLOWCHART 10.10 Pathophysiology of arthritis
ARTHRITIS
Ctinical Manifestations
Arthritis is an inflammation and tenderness of the joints.
It can affect one joint or multiple joints. 1. Warm, painful and swollen joint.
2. Decreased range of motion.
3. Fever,chills and leukocytosis.
Types of Arthritis 4. Redness of the skin around the joint.
1. Osteoarthritis: A condition
in which the cartilage 5. Some patients with arthritis notice their
that protects and cushions joints breaks down symptoms
are worse in the morning.
resulting in damage to the tissue and underlying
bone and causing painful joint Diagnostic Evaluation
2. Rheumatoid Arthritis (RA): Ansymptoms.
inflammation of the 1. Blood tests are done to confirm a diagnosis of
membranes or tissues lining the joints, which may arthritis and monitor disease activity and response to
destroy the joint tissues, including cartilage, treatment. It confirms the presences of elevated ESR,
ligaments, tendons and bone.
3. Gouty arthritis (gout): An inflammatory joint C-Reactive Protein (CRP), rheumatoid factor,
disease; usually the result of a defect in body antinuclear antibody and Anti-Cyclic Citrullinated
chemistry with a painful buildup of uric acid Peptide antibody (anti-CCP).
2. Synovial fluid is collected to check for infection.
crystals in the knees and big toes.
3. X-ray is also used to confirm joint deformity.
Etiology 4. Computed tomography is typically used tor
1. Hematogenous spread. examining joints that are deep in the body and
difficult to assess with conventional X-ray,
2. Directly through trauma or surgical instrumenta
tion.
especially in the spine or pelvis.
3. Previous trauma to joints. 5. MRI is frequently used to discover abnormalities in
4. Joint replacement. the soft tissue components of joints (which are
5. Co-existing arthritis. invisible on X-ray) to determine whether treatment is
6. Weak immune system.
effective and to look for disease complications.
7. Most commonly,it iscaused by S. aureus. Management
Risk Factors 1. To control infection: I/V Broad-spectrum I/Vantb
1. Advanced age, diabetes mellitus and rheumatoid otics according to the culture results such as ampicil
lin, gentamycin are used.
arthritis.
2. Monitoring of synovial fluid: The physician may
2. Pre-existing joint disease or joint replacement. aspirate the joint with aneedle to remove excesslVe
 UNIT-10 Nursing Management of Patients with
joint fluid,, exudates. Musculoskeletal Problems 941
sterility and decrease Synovial
in WBCsfluid monitored for
i
3. Immobilization: and knces) as well as joints of the distal interphalangeal
immobilized Inflamed
by a splint that joint supported and (scc figure 10.33 and 10.34).
is and proximal interphalangeal joints of the fingers
patient. provides comfort to the
A Toprevent
periodically isreoccurrence: Assessment of the patient
5. Arthrotomy or necessary to check its reoccurrence.
and remove dead arthroscopy
tissue.
is used to drain the joint
6. The inflamed joint is
supported and
afunctional
position by a splint thatimmobilized in
patient's comfort. increases the
7. After the
infection has
therapy, NSAIDs such asresponded to antibiotic
ibuprofen,
motrin, or advil may be prescribed to naproxen,
damage. In order to control pain, limit joint
also used. acetaminophen
is
8. DMARDs are drugs that reduce the signs and FIGURE 10.33 Typical interphalangeal joint changes
associated with osteoarthritis
symptoms of rheumatoid arthritis and can influence
the progression of tissue
destruction. These
such as methotrexate, leflunomide mnay also drugs
mobility and quality of life. improve
Nursing Management
1. Assess the patient's nutrition and fluid status. Cervical vertebrae
2. Once the infection subsides,
encourage for
sive range of motion exercises.
progres
3. Explain patient about disease and its treatment.
4. Teach patient the measures to relieve pain using
pharmacologic and non-pharmacologic interven Lower lumbar vertebrae
tions.
5. Assess the physical signs and symptoms; assess the Hip.
patient for psychosocial,functional and vocational
needs.
6. Provide hot shower which helps to decrease joint First carpometacarpal
stiffness and make exercise easier for the patient.
7. Provide rest and exercise later in the day is most
beneficial for the patient.
Distal interphalangeal
8. Provide physical therapy, occupational and social
worker.
9. Complementary therapies that may help to decrease Knee
inflammation or pain include Capsaicin cream, fish
such as
oil, magnetic therapy and antioxidants
vitamin Cand vitamin E.
10. Teach the ways of controlling pain.
pain as well as to
11. Medications are adjusted to control
decrease the inflammation process.
First metatarsophalangeal
Osteoarthritis
non-inflammatory, slowly
Osteoarthritis is a chronic,
causes deterioration of FIGURE 10.34 Joints most frequently involved
Progressing disorder that (hips
joints
cartilage. It affects weight-bearing
in osteoarthritis
articular
 proximal
nodes)
the bones.bones thatwithpelvis.
bones
evaluate analgesics,
and
Bouchard's joints. the joints
and movement.examination.
the the assess affected.
destruction. inhibitors
or infection.
joints affected in in examining spine
to of conditions
changes to non-narcotic
stiffness.
joints. ends
useful the are
difficult
anddistal arthritis. joints
(Heberden'inmovement
s affected
on in
revealsjoint COX-2
physical and
are theunderlying for especially
of and joint
enlargements which
of
at arthritis,
joints fromusedand fluid extent acetaminophen,(affects
aAsymmetry
Localized
respectively.
joints the Evaluation
Diagnostic
cartilage
using but are
(hips, or
down
swelling andaffected damnage
of of body
typically determines
synovial side hands Reduced
flexibility
deformity ofrange X-ray, the Management
Medical not
the
other) jointmost
common)
grating history andto management one
and Bonespurs bend
climb
stairs)
Backache: lead theconventional
deformities
determines on Stiffness a
inknees, to ignore
bony Reduced of
PossibleMedical
Possible be
maymayis
of amount
in of
scan Management
joint Pain (hard
Bony X-rays scandeep Analysis as never
i.e. thatthatCT are BoneMRI Pain
such to
6. 7. 8. 9. 10. 1. 2. 3. 4. 5. 6. symptoms
1.

hemo
hyperparathyroidism,
hypothyroidism,
chromatosis, activity, Osteoarthritis
gene.
Chondrocalcinosis,osteoarthritis.
collagen age.
with
rest.
10.35) thumb.
with of
improves
period
minutes). 10.35
II develop
increases figure of
type base
FIGURE
a
Abnormalabnormalities: (seeThisafter(<15use.therest). sounds
cracking
Slow
onset
of
osteoarthritis
to symptoms Mild
swelling
Clicking
or
likely Manifestations
hypomagnesemia,the;
etc. again
pain. withat
stiffness after
(stiffness
tenderness
on deformities.
Bone
5. Pathophysiology
factors: more stress 10.10
tloechart
worse
Reter and crepitus
weight
Excess morning
stiffness
Metabolic Factors
Riskof are Repeated often
GeneticTrauma
3. riskWomnen
Obesity.
3. andSwelling,
5.Gelling
42
Thye
Etiology
1.
U/ 4m 4.
The
1. 2. 4.
Clinical
Jointis MildPain
but
1. 2. 3. 4.
 activity12.as 1. 10. 6. 5. 4. 3.
Management 2.Nursing mobility iseredSurgical
Management joint
Surgical NIT-10
. 8. 7. correctTeach 1. Conservative: 5. 4 3, 2
Provide the
Advice Apply Advice
pain. tion.
gravates medicine.
Provide Advice Glucosamine
alternative
d. c. b. rebuilding
effects.) improveProper
Weight opioid[
these NSAIDs
Advil),)
pain. Support
causing
unremitting
Encourage bearing
joints. Supports
Encouragetreatment Advice knee.
and
hip
Teach
reduce b. a. fusion, a. analgesics)?
neck lumbosacral
position. Have Use when Use exercises.
Balance Range
aerobic
Heat and
intervention may Nursing
use heat patient compromised.severely the
weight-bearing
wearing crutches, sleeping
for with a splints, rest patient arthroscopy of and nutrition, loss,
well-being. such
nmostly(such
patient offor of t he cane, of be
weight
arthritis cane relief as prescribed to
pain between
motion remedies and if used Management
as
pain foot posture
prescribed. symptoms ice.
necessary,oxycodone,
undergoing to corsets
braces,
involved
to becomes crutches for as
and loss corrective inbraces of
avoid
include chondroitin sleep lbuprofen,
in
disorders.of hand cervical take exercise exercises, combination analgesic
and that
disabling tothe stress orrolled cloth and
terry rest as
much decrease knee. on activities cervical andjoints
prescribed arthroplasty. osteotomy, or and to of
body necessary. intolerable a have relieve codeine
cane
osteoarthritis.
side periods
orthopedic
as
shoes
It on accelerates
as
walker. and muscle sulfate stress
Naproxen,
affects Patients
arthritis mechanisms.
hips when
indicated to
potential
stress also opposite collars, excessive rest.
stress
with
or
possible and that with
helps and in pain debridement, to strengthening reduction hydrocodone and
are non-narcotic
surgery
of on under
towel precipitate
recumbent degenera patient It Musculoskeletal
Motrin,
metatarsalinvolvedknees. is common
cartilage on possibly,
joints. traction, usereliever joints.
without weight in consid
for the ag and to or

Moderate
Stage 2: Stage
Stages anddisorder
1: swelling,
Rheumatoid
Rheumatoid
Arthritis BOX Complications 17. Problems
T3.
3.No
joint 2. destructive
changes.
1. No " Debilitating
5. 4. 3. 2. 1.
pain. 18. 16. 15. 14.
destruction.
Osteoporosis
Presence severity bending,When Lose first. Set Strengthening 10.6 Loss Decreased
Loss
Contractures general
health.
Encourage kitchen Advice
clothing
shower pain periods
Suggest Advice
after deformities.
Teach
improve preventprevent
mobilityTeach
Active
subside. stretch
Passive
priorities
of weight, become
characterized
pain, knees Teaching of of stiffness
Early
Reumatoid stooping stretching
tightenedrange ability joint isometric
putting range
deformity. to for on inactivity.
performing of
muscledeformities.
of vary arthritis or if each range prepare without capsular and
nodules. stiffness necessary. ofand function. adequatemodifications,
bathing, a of
with scc hips
or day musclesmotionguidelines
is range
to
the
of problem. has jointsexercises musclemotion
is squatting. independently of been strength
or fiure are and used affected
motion. meals.buttons, and
Arthritis and by
systemic, is of
sitting importantthrough
without affected, used
do when andexercise. diet abated Avoid tone
l0.3o). lossjoint the
motion for
around tendonexercises
during patient
prevent placing and
most pain joint. and such
inflammation,
of
autoimmune, at and flexion for
slight function. avoid
and acute care table activities range graded
important flexion for sleep asbefore the tightening joint to
climbing inflammation osteoarthritis bench of and maintain
bone/cartilage inflammation for wearing
or involved
contractures. mnotion
exercises
adductionsupport,
The self. to
counter fatigue
and in
activities enhance in morning,
causing
coursechronic stairs, tubloose and
to afterjoint. joint
in or to to to 943
 A B Fibrin
Thick synovium

Fibrin
Vascular
granulation
Lymphocyte tissue
infiltrate
Inflammation
Bone
Inflamed synovium
Pannus destroys
cartilage at joint
periphery
-Soft tissue swelling

C D

Loss of bone
-Destruction
density of cartilage

Erosion
Joint of edges
deformity of bone

-Increased soft tissue

swelling due to
inflammation and
thickening of
synovium and capsule

FIGURE 10.36 Rheumatoid arthritis:

A. Early pathologic change in rheumatoid arthritis is rheumatoid synovitis. This
synovium is inflamed. There is a great increase
in lymphocytes and plasma cells. B. With time, there is articular cartilage
destruction; vascular
the surface of the cartilage (pannus) from the edges of the joint, and the articular granulation tissue grows across
surface
extending pannus, most marked at the joint margins. C. Inflammatory pannus causes focalshows loss ofofcartilage beneath the
of the joint there is osteolytic destruction of bone, responsible for destruction bone. At the edges
erosions seen on X-rays. This phase is associated with joint
deformity. D. Characteristic deformity and soft tissue swelling associated with long-standing
rheumatoid disease of the hands.
Stage 3: Severe Risk Factors
1. Cartilage/bone destruction.
2. Joint deformity. Following risk factors increases the risk to develop
3. Muscle atrophy. rheumatoid arthritis.
4. Presence of nodules. 1. Stress
2. Infectious agents.
Stage 4: Terminal 3. Environmental factors.
1. Same as stage 3. 4. Hormonal affect.
2. Fibrous/bony ankylosis.
Etiology Pathophysiology
1. Infectious agents, such as bacteria and virus. Phagocytosis produce enzymes within the joint. The en
2. Abnormal response of the immune system due to zyme breakdown collagen causing edema proliferation
of synovial membrane and ultimately pannus formation.
change in hormones.
3. Triggered by stressful events, such as physical or Pannus destroys cartilage and erodes the bone. The con
emotional trauma.
sequences are loss of articular surfaces and joint motion.
4. Smoking Muscle fibres undergo degenerative changes. Tendon
and ligament elasticity and contractility power are lost.
5. Obesity Then, rheumatiod arthritis will occur.
NUT-10 Nursing Management of Patients with Musculoskeletal Problems 945
initiation of rheumatoid arthritis
B Sjogren Keratoconjunctivitis

Activation of T cells, neutrophils and synovial fluid cells

Lyrnphadenopathy
Interstitial
Increased production of rheumatoid factor and enzvmes fibrosis
Pleuritis
Caplan syndrome
Deposition of immune response Valvular
Rheumatoid
lesions nodules
Pericarditis
Inflammation of synovium Myocarditis Felty
syndrome
Amyloidosis (splenomegaly)
Release of lysosomal
free radicals, cytokinase tumor enzymes,
Rheumatoid
necrosis factors . nodules
arachidonic acid and prostaglandin

Destruction of cartilage occurs by chondrocytes Tensosynovitis Carpal

tunnel
syndrome
Release inflammatory molecules
containing tumor necrosis factor y and
interleukin-1 (|L-1) Myositis Raynaud's
phenomenon
Synovial membrane damaged by inflanmation

FLOWCHART 10.11 Pathophysiology of rheumatoid arthritis

Rheumatoid
vasculitis
Clinical Manifestations
Minimal or Relentlessly Progressive
and Marked Deformity (see figure 10.37 A) Peripheral
neuropathy
1. Morning stiffness.
2. Arthritis of three or more joints. Peripheral
edema
3. Arthritis of hand joints.
4. Symmetrical joints.
5. Rheumatoid nodules. FIGURE 10.37 A. Typical deformities of rheumatoid arthritis.
6. Rh factor positive. B. Extraarticular manifestations of rheumatoid arthritis
7. X-ray reveals joint changes.
Extraarticular Manifestations (see figure 10.37 B) Diagnostic Evaluation
1. Patients medical history and physicalexamination.
A 2. Blood tests are done to confirm the diagnosis of
arthritis and monitor disease activity and response to
treatment. It confirms the presence of elevated ESR,
C-Reactive Protein (CRP), rheumatoid factor,
antinuclear antibody and Anti-Cyclic Citrullinated
Boutonniere deformity Peptide antibody (anti-CCP).
Ulnar drift
3. Synovial fluid is collected tocheck for infection.
4. X-ray is also used to confirm joint defornmity.
5. Computed tomography is typically used for
examining joints that are deep in the body and
difficult to assess with conventional X-ray,
especially in the spine or pelvis.
6. MRIis frequently used to discover abnormalities in
Swan neck deformity the soft tissue components of joints (which are
Hallux valgus
 Management Sex onset
Age Clinical Joints
most Features TABLE
Definition
6. 5. 4.
Management
2.
Nursing
1.Encourage 5. 4. 3.Management
2. 1.
commonly
manifestations affected 3. Corticosteroids
Disease-Modifying
include: its (cortisone)
ease areAdvil
NSAIDs invisible
effective
and to
Remove
application.
cold/hot normal
side.
inflammation.
ElevateCompare inflammation,refill
Check
disability Observe
underlying Physiotherapy
generalAssessguidance.
under and Leflunomide
Sulfasalazine
Hydroxychloroquine c b.
Methotrexate
d. a.
10.20 progression.The the
timne, make are
Comparison bangles, the peripheral patient's
to symptoms such on
the
sensation and th e joints used
inflamed cause focal patient X-ray)
affected loss i.e. area
more is to as look
OftenOsteoarthritis rings, pulse, redness, assessment. of health helpful Anti-rheumatic relieve
Ibuprofen, to
reduction.
stress
and Control
Encourage Maintain
"Both pronounced
" " increasing 45 Localized
age. tofingers noted that Abetween
chronic, of
and inflammation. to of determine
for
area function. fo r flexible. DMARDs the
males 90. onlycauses any area
mnovements skin perform to pain. disease
(Heberden's
Most in using sign condition. promote condition
pain non-inflammatory,
pain,hands, one osteoarthritis other
exercise,
activity and with
temperature, warmth, Naproxen,
used to
with females as deterioration
of stiffness, side pillow, and Try complications. whether
the in spine, accessories. self-care that Drugs
medication. level. rheumatoid of other to muscle and
joint people nodes), the
pain,
of symptoms Proceed may edema.
relieve
affected bony knees and cushion, area identify slow treatment
protection, body unaffected (DMARDs) Motrin,
distal swelling,
have edemaknobs of
slowly capillary activitiesstrength, be
and articular rheumatoid
equally. arthritis. affected Apply from used down
some hips progressing etc. the
not of to of or is
weight features end cartilage.
as with arthritis
joints Complications
control changes disorder " "
BOX disorders.
4. damage
Cardiovascular 3. 2.
Joint 1. 14. 13. 12. 11. 10. 9. 8. 7.
MakeStress Encourage
handrails, take Food
cane.or Encourage Stress ExplainTeach
Advicemedications.
prescribed
Emphasize Rheumatoid Carpel control.
Provide Provide courage
with of 10.7 Administer
Encourage education
Provide DevelopCheckinjury.
from Keep
a
referrals the warm high the the patient
thrheumatoidTeaching
e arthritis
* "Females Children Symmetrical Rheumatoid
Edema, A
arthritis tools tunnel the the
Control "
Balance
Encourage
weight and50. formation,
fever. knuckles.
knees
and systemic,
characterized importance patient importance
in the purpose,
patient health psychological patient
diet therapeutic
patient
shower
to to
iron
need about patient rich about
prescribed edematous
vital
affected nearing erythema, community guidelines arthritis
syndrome.
inflammation
exercise
pick toare to education to signs.
autoimmune, of upencouraged
to to avoid to dosage, the prevention
in
fatigue, joint
by follow objects, relieve
use
practice maintain of
balancing disease carbohydrates to ventilate
increases
medicine takesupport.relationship skin
adolescence.
more involvement
heat, physical for
control
with joint agencies. schedule
stiffness, assistive joint
relaxation
rest. and often pain,inflammation.
up-care.
raised when a and patient onplenty his/her protected
lubricated
and
and pain than
chronic stiffness and
well rest hygiene of
its cervical inflammation.
Adults tenderness,
muscle noted devices
toilet RBCSbalanced management.
emotional and and with on of
stress with
duefluids. and feelings. with
disorder techniques
males. side
and are exercise.
medication.
reduction. between aches, in seat,
myopathy. and proteins.
nodule wrists,
walker
such pain. low. diet. effects time. patient.
and and
stress. infection Provide
20 as of
En
 Factors
Risk Under
4. 3. 2. 1.
Over joints
other
subsequent
deposition ofGout
and Etiology Inflamed
joint Massesuricof tissues.
other
and Arthritis)
olevated Gout
(Gouty
Gout
6. d Obesity.
4. 3. 2. 1. disease
Renal
3. 2.disorders.
4.Myeloproliferative
Endocrine
disorders 1. Cancer5.
Hemolytic
anemias
Psoriasis (tophi)
acid
excretion
Womnen
developing
gout. Alcohol Chronic Family
fromthe Eating Medications
Nephrogenic
Pyrazinamide, Inherited crystals
acid
Uric
is
result Production
Excretion a
FIGURE disorder
uric
high history from
after exposure
consumption enzyme acid
amounts connective
tissues.
and an 10.38 level of
menopause ofdiabetes lead, of of purine
over
body. to gout. chemicals, Uric defects Uric Gout and
lead.
of low mnonosodium
abundant
insipidus. (inflammatory
metabolism
deposition
interferespurine dose Acid Acid

are e.g.
aspirin,
higher
riskat rich Diuretics, accumulation
and
urate characterized
of
with food. arthritis) urate
etc.
uric crystals in
Ethanol,
joints
acid by
of in

Arthritis
Gouty
Acute Manifestations
Clinical Pathophysiology
2. 1.
Generally
upperOther
metatarsophalangeal
extremities. joint.
FLOWCHART
FIGURE
joints
Deposition of
affects 10.39 Increased
can Decreased
excretion
renal
10.12 Increased
synthesis
purine Alcohol "
Purinehigh
A
be Effects (hyperuricemia)
one uric dietary
affected, Pathophysiology uric GOUT
joints: Pain acid
of acid
gout that
into in intake
the
such
Commonly on Pain (tophil)the Kidney
joints
Strange
around
Iumps stones elbows
wrists,
andlor Pain rapidly the blood of:
the in in joints
as the knees, worsens of
ankle, body gout
big
the toe ankles,
knee,
first
 Management
Nursing
6. 5. 4. 3. 2. 1. 3. 2.anemia
nausea,
Adverse
4. therapy. Management
3. Management
Medical
3. Evaluation
Diagnostic Arthritis
Chronic
Gouty
resulting Encourage formation.
Avoid Assist
competeweight excretion
Elevate Encourage serum
1.
Administer Low-purine Take hypoxanthine
Avoid Corticosteroids
Allopurinol
sorption
2.
Uricosuric swelling.
1. 5. hours
4. 24 2. 1. 2. 1. Severe pain. Fever.
5. 4. 3. 948
Sulfinpyrazone, attack.NSAIDs withX-ray CBC Culture 100,000ml. bony tissues.
Synovial arthritis.Arthritis soft
and
Deposits surrounding Pain,
measures and
vomiting,
lossrapid with uric of side diagnosis ofand
with
in
and alcohol. other
deformities warmth,
of of for ESR-elevated. urine of
affected synovial can
increased results avoidanceADLs. pain acid effects It of
weight protect adequate
uric diet blood
anorexia,
(Zyloprim) uric drugs may WBC produce uric
uric levels. to and acid.
acute
of for the
acid in affected relieving gives reduce they be count acid erythema
acid for
xanthine gout.joints uric
that
affected
production
uric for loss of dyscrasias. given
attacks fluid
fluid interferes such bone in
alcohol. only obesity. allergic theseinterferes acid.
and
excretion
acid by and
medication show to can can
joints. and
fasting joint intake to Probenecid
and as by infections. ruleout erosions around
a drugs range resemble
levels.
during
to
minor reactions, uric orally to changes
of with with relieve swelling
decrease
from because
chemicals to as are acid. at from and joints,
first assist decrease conversion tubular
the prescribed. headache,
hemolytic onset pain consistent
rheumatoid
subsequent
2,000 of
body, rapid attack. stone
cartilage tissues,
that with reab ofand
in of an to
Diagnosis
Nursing 5. 4.Assessment Nursing
1.Nursing
5. 4.
movement.
3. 2. 1. 3. 2. "
BOX Complications
2. 1. major
alcohol, over
precipitating The 9. 8. 7.
Anxiety High Altered
Activity Pain Assess
EnquireAssessAssess
Monitor symptoms
worsen. ifconsumed
Instruct in to
Instruct Instruct
ordered.
diet,if
Instruct Teach
Review several
prevent
the apply area diets.
starvation
Avoid Avoid
Receive 10.8 Recurrent Kidney
urinary
stones.
indulgence extremity
patient subsides.
Avoid Provide
adviced.
beenhas
Review
related medical
risk Care kidneys,
patient during excessive
patient patient patient Teaching
the fasting,
related nutritional patient's
patient'spatient's
the patientlotion
intolerance patient touching absolute food
factorsshould
of daily bed
patient's gouttimes tracts
stones:
inflammation to level Plan which acute during gout: events, until
joint
and tothat to to and rest
guidelines attacks each medication in
to about keep avoid of containing
anxiety eating of family avoid family
alcohol
attacks. with knowledge Some patientsUrate the that be the
therapeutic movement. pain vital of can at
skin
chronic (e.g. able the rest
related
pattern Arthritis lead least
accumulation irritation year.
in intake may acute
sleeping to immobilization in
to joint until
intake.
level. habits, andsigns. contact to moist. how stages for patients people crystals Surgery
related 2
patients Medications with usdemonstrate
e cause pain purines,
to quality kidney litres of
to about of or the
regimen. related joint occupation.
pattern. the to: may (aspirin,
health of of
prepare
gout. with with gout MI).calories, an moving pain
subsides. ADULI
to damage. stones. uric fluidinflamed may ifMEOICAL
disease. of of experiences
recurrent causing attack, of
to life. care
acid a the diuretics) low-purine
an
should low gout may collect knowledge
purines
restricted provider, crystals area affected the acute SURGICAC
purine including
be
and help kidney in affected
gout. gout attack NURSINO
to the and and diet
of
 Nursing Planning
3.Nursing
2.Goals1
Comfort
PromoteLevel Conserve
Energy Relieve
Pain
3. 2. 1. 3. 2. 5. 4. 3. 1.
4. 1. temperature.
Gradually
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