ABRA VALLEY COLLEGES

COLLEGE OF NURSING
NCM 116

JOINT
DISORDERS

GROUP-6

PREPARED BY:
VALERA ALDEMAR G.
BOSQUE DEXIE MAE D.
ANGALA EARLYN MAY P.
RAMOS ALLYZA ASHLEY B.
BSN-3
OSTEOARTHRITIS
• INTRODUCTION
❑ Osteoarthritis (OA) is a degenerative joint disease and the most common type of arthritis. Some people
call it degenerative joint disease or “wear and tear” arthritis. This condition is gradual loss of cartilage
between joints and the formation of osteophytes or outgrowth at the margins of the joints. This is what
causes pain and can lead to joint damage.
❑ Once pain and loss of movement function become chronic, people with osteoarthritis often experience
restrictions in participating in meaningful activities, and decreased well-being. In some cases it also
causes reduced function and disability some people are no longer able to do daily tasks or work.
❑ The most commonly affected parts of the body are the hands, knees, hips, and spine, As the damage of
soft tissues in the joint progresses, pain, swelling, and loss of joint motion develops.
❑ Many factors can contribute to developing osteoarthritis, like the history of joint injury or overuse, older
age and being overweight. While this condition is not part of the normal aging process, it is common in
older adults with aging as a risk factors.
❑ According to Maegan Wagner osteoarthritis affects more in woman than in men.
❑ By 40 years of age, 90% of the population has degenerative joint changes in their weight-bearing joints.

• CAUSES/RISK FACTORS
❑ Osteoarthritis happens when the cartilage and other tissues within the joint break down or have a
change in their structure. This does not happen because of simple wear and tear on the joints.
Instead, changes in the tissue can trigger the breakdown, which usually happens gradually over time.
 ❑ Certain factors more likely to develop the disease are:
1. AGING.
o The aging changes observed in the cells and extra cellular matrix of joint tissues likely
increase the susceptibility of older adults to osteoarthritis. Aged chondrocytes responds
poorly to growth factor stimulation and so are unable to maintain homeostasis in the
articular cartilage.
2. BEING OVERWEIGHT OR OBESE.
o Extra weight puts more stress on joints, particularly weight-bearing joints like the hips
and knees. This stress increases the risk of osteoarthritis in that joint. Also, obesity may
also have metabolic effects that increase the risk of osteoarthritis.
3. BONE DEFORMITIES.
o Some people are born with malformed joints or defective cartilage.
4. HISTORY OF INJURY OR SURGERY TO A JOINT.
o History of joint injury represents an important risk factor for posttraumatic osteoarthritis
and is a significant contributor to the rapidly growing percentage of the population with
osteoarthritis.
5. OVERUSE FROM REPETITIVE MOVEMENTS OF THE JOINT.
o Injury or overuse, such as knee bending and repetitive stress on a joint, can damage a
joint and increase the risk of osteoarthritis in that joint.
6. GENDER.
o Women are more likely to develop osteoarthritis than men, especially after age 50.
7. FAMILY HISTORY.
o People who have family members with osteoarthritis are more likely to develop
osteoarthritis.
8. RACE.
o Some Asian populations have lower risk for OA.
9. CERTAIN METABOLIC DISEASES.
o These include diabetes and a condition in which your body has too much iron
(hemochromatosis).

• SIGNS AND SYMPTOMS

o Joint stiffness. Usually lasting less than 30 minutes, in the morning or after resting for a period
of time.
o Pain when using the joint. Which may improve with rest. For some people, in the later stages of
the disease, the pain may be worse at night. Pain can be localized or widespread.
o Tenderness. Your joint might feel tender when you apply light pressure to or near it.
o Loss of flexibility. You might not be able to move your joint through its full range of motion.
o Bone spurs. These extra bits of bone, which feel like hard lumps, can form around the affected
joint.
o Swelling. This might be caused by soft tissue inflammation around the joint.
A. ASSESSMENT
❖ History taking to the patient.
o The history should address the character the gender, age, lifestyle, location, severity, factors
that aggravate or relieve pain, and time (new-onset or recurrent)
❖ Assess pain thoroughly.
o A comprehensive assessment will help us to identifying the underlying cause of pain and the
effectiveness of treatment.
❖ Assess factors that cause pain.
o Pain in osteoarthritis may be associated with specific movements of affected joints.
❖ Assess the patient’s existing knowledge about the disease.
o Evaluating the patient’s understanding and how the patient perceives the management of
osteoarthritis, this will allow us healthcare providers to plan appropriate care and provide
correct patient education.
❖ Assess vital signs of the patient.
o This will help us health care provider detect or monitor medical problems of the patient.
❖ Assess the patient’s weight and body mass index (BMI).
o Obesity increases the mechanical stress in a weight-bearing joint.
❖ Assess the both hands.
o Bony enlargements and shape changes in the finger joints can happen over time.
❖ Assess the knees.
o When walking or moving, you may hear a grinding or scaping noise. Over time, muscle and
ligament weakness can cause the knee to buckle.
❖ Assess the hips.
o You might feel pain and stiffness in the hip joint or in the groin, inner thigh, or buttocks.
Sometimes, the pain from arthritis in the hip can radiate (spread) to the knees. Over time, you
may not be able to move your hip as far as you did in the past.
❖ Assess the spine.
o You may feel stiffness and pain in the neck or lower back. As changes in the spine happen,
some people develop spinal stenosis, which can lead to other symptoms.

B. ANALYSIS/NURSING DIAGNOSIS
❖ Chronic pain related to joint stiffness as evidence by guarding behavior.
❖ Impaired physical mobility related to muscle weakness as evidence by sedentary lifestyle.

❑ DIAGNOSTIC TEST
➢ X-rays. Cartilage doesn't show up on X-ray images, but cartilage loss is revealed by a narrowing
of the space between the bones in your joint. An X-ray can also show bone spurs around a joint.
➢ Magnetic resonance imaging (MRI). An Magnetic resonance imaging (MRI) uses radio waves
and a strong magnetic field to produce detailed images of bone and soft tissues, including
cartilage.
 ➢ Blood tests. Although there's no blood test for osteoarthritis, certain tests can help rule out other
causes of joint pain, such as rheumatoid arthritis.
➢ Joint fluid analysis. Your doctor might use a needle to draw fluid from an affected joint. The
fluid is then tested for inflammation and to determine whether your pain is caused by gout or an
infection rather than osteoarthritis.

❑ TREATMENT/MANAGEMENT
▪ There is no cure for osteoarthritis, so doctors usually treat osteoarthritis symptoms with various
therapies, which may include:
➢ Physical therapy. A physical therapist can show you exercises to strengthen the muscles around
your joint, increase your flexibility and reduce pain. Regular gentle exercise that you do on your
own, such as swimming or walking, can be equally effective.
➢ Occupational therapy. An occupational therapist can help you discover ways to do everyday
tasks without putting extra stress on your already painful joint. For example, a toothbrush with a
large grip could make brushing your teeth easier if you have osteoarthritis in your hands. A
bench in your shower could help relieve the pain of standing if you have knee osteoarthritis.
➢ Transcutaneous electrical nerve stimulation (TENS). This uses a low-voltage electrical
current to relieve pain. It provides short-term relief for some people with knee and hip
osteoarthritis.

❑ PHARMACOLOGICAL MANAGEMENT
▪ Osteoarthritis can't be reversed, but treatments can reduce pain and help you move better.
➢ Acetaminophen. Acetaminophen (Tylenol) has been shown to help some people with
osteoarthritis who have mild to moderate pain. Taking more than the recommended dose of
acetaminophen can cause liver damage.
➢ Nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter nonsteroidal anti-
inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB) and Naproxen Sodium
(Aleve), taken at the recommended doses, typically relieve osteoarthritis pain.
➢ Duloxetine (Cymbalta). Normally used as an antidepressant, this medication is also approved to
treat chronic pain, including osteoarthritis pain.

❑ SURGICAL MANAGEMENT
➢ Arthroscopic Lavage techniques. Arthroscopic lavage include lavage and debridement of the
knee (e.g., shaving of rough cartilage or smoothening of the degenerated meniscus). In theory,
arthroscopy for OA should relieve symptoms by removing the debris and inflammatory
cytokines that cause synovitis.
➢ Joint arthroplasty. Joint arthroplasty is a well-accepted, safe, and cost-effective method for
treatment of advanced knee OA. Owing to its irreversible nature, joint arthroplasty is
recommended only in patients for whom other treatment modalities have failed or are
contraindicated.
 ➢ Total knee arthroplasty(TKA). Total knee arthroplasty advanced knee osteoarthritis, with more
than one compartment involved and failure of conservative treatments, TKA has been shown to
be a highly effective treatment that results in substantial improvement in patient functioning and
health-related quality of life .

C. PLANNING
❖ The patient will perform activities without discomfort and with minimal supervision.
❖ The patient will adhere to the treatment regimen and exhibit improved symptoms, as evidenced
by reduced pain and stiffness and more active lifestyle.
❖ The patient will report decrease pain scale at a level of 4/10 to 2/10.
❖ The patient will formulate realistic goals and plans in the future.
❖ The patient will identify measures to prevent injury.
❖ The patient will participate in therapy and exercise to improve quality of life.
❖ The client will demonstrate initial adaptation to body changes as evidenced by participating in
self-care activities and positive interactions with others.
❖ The client will use pharmacological and nonpharmacological pain relief strategies.

D. IMPLIMENTATION/INTERVENTION OF CARE OF CLIENTS

1. INDEPENDENT NUSING CARE
a) Apply a hot or cold compress for 30 minutes.
o Heat improves blood flow and reduces pain reflexes. Cold can help reduce inflammation,
pain, and muscle elasticity.
b) Take breaks.
o Joint pain with osteoarthritis often worsens with activity and lessens with rest. The patient
may need to take breaks when working, exercising, or completing tasks.

c) Administer oral and topical pain relief.

o NSAIDs are recommended for OA pain. Over-the-counter topical creams and gels such as
diclofenac are commonly used to relieve arthritic pain.
d) Change positions frequently while maintaining functional alignment.
o Muscle spasms may result from poor body alignment, resulting in increased discomfort.
Aggravated stress to the affected joint may be avoided by implementing corrective
procedures if the client has poor posture.
e) Provide adequate rest periods and assist with developing coping skills.
o Fatigue impairs the ability to cope with discomfort. Pain coping skills training (PCST) helps
the client reconceptualize how thoughts, feelings, and behaviors influence pain and
systematically trains them in skills such as relaxation, and the use of positive coping thoughts
to reduce pain.
f) Provide the appropriate dietary lipids necessary for the client.
 o Reducing the intake of fatty acids by substituting oils rich in unsaturated such as grapeseed,
canola, and olive oils, increasing in intake of oily fish, and a standard daily supplement of
fish oil are beneficial in the modification of dietary lipids.
g) Evaluate the client’s home environment for potential hazards such as loose rugs, poor
lighting, and wobbly furniture.
o Components of physical performance, such as impaired balance and muscle weakness, were
also identified as risk factors for falls in clinical knee osteoarthritis in a recent systematic
review.
h) Emphasize the importance of lose weight to decrease stress on weight-bearing joints.
o Evidence suggests that pacing activities, exercise, and weight reduction are all measures to
promote healthy joints. A 5% weight loss can reduce the stress on joints which can improve
function and decrease pain and disability.
E. EVALUATION
❖ The patient was able to perform activities without discomfort and with minimal supervision.
❖ The patient was able to adhere the treatment regimen and exhibit improved symptoms, as
evidenced by reduced pain and stiffness and a more active lifestyle.
❖ The patient was able to report decreased of pain scale at a level of 4/10 to 2/10.
❖ The patient was able to formulate realistic goals and plans in the future.
❖ The patient was able to identify measures to prevent injury.
❖ The patient was able participate in therapy and exercise to improve mobility.
❖ The client was able to demonstrate initial adaptation to body changes as evidenced by
participating in self-care activities and positive interactions with others.
❖ The client was able to understand the used pharmacological and nonpharmacological pain relief
strategies.

• PROGNOSIS
❑ In 2019, about 528 million people worldwide were living with osteoarthritis; an increase of 113%
since 1990 (1).
❑ About 73% of people living with osteoarthritis are older than 55 years, and 60% are female (1).
❑ With a prevalence of 365 million, the knee is the most frequently affected joint, followed by the hip
and the hand (2).
❑ 344 million people living with osteoarthritis experience severity levels (moderate or severe) that
could benefit from rehabilitation (3).
❑ With ageing populations and increasing rates of obesity and injury, the prevalence of osteoarthritis is
expected to continue to increase globally. Osteoarthritis is not an evitable consequence of ageing.
❑ Osteoarthritis is more prevalent in older people (about 70% are older than 55), global prevalence is
expected to increase with the ageing of populations.
❑ The prevalence of musculoskeletal complaints was 16.3% (95% CI 8.6-24.0) of the adult population
in a Filipino urban community.
❑ The total prevalence of rheumatic disease is 9.8% (95% CI 8.2-11.4).
 ❑ According to the DOH the prevalence of Osteoarthritis was 4.1% (95% CI 3.3-4.9) and soft tissue
rheumatism 3.8% (95% CI 2.9-4.8).
❑ The prevalence of rheumatoid arthritis, 0.17% (95% CI 0-9.36), was notably low compared to the
prevalence in other developing countries.
❑ Several key prevention strategies have been proposed to prevent osteoarthritis and control the
disease progression. In particular, reducing overuse of joints (related to workload), and promoting
healthy lifestyles (regular physical activity, maintaining a normal body weight) play an important
role.
❑ The typical onset is in the late 40s to mid-50s, although osteoarthritis may also affect younger
people, including athletes and people who sustain joint injury or trauma. About 60% of people living
with osteoarthritis are women.

REFERENCE:
• https://www.nursetogether.com/osteoarthritis-nursing-diagnosis-care-plan/
• https://www.who.int/news-room/fact-
sheets/detail/osteoarthritis#:~:text=Osteoarthritis%20is%20a%20degenerative%20joint,%2C%20hips%
2C%20spine%20and%20hands.
• https://www.cdc.gov/arthritis/types/osteoarthritis.htm#:~:text=Osteoarthritis%20(OA)%20is%20the%20
most,underlying%20bone%20begins%20to%20change.
• https://www.niams.nih.gov/health-
topics/osteoarthritis#:~:text=Osteoarthritis%20is%20a%20degenerative%20joint,a%20short%20period
%20of%20time.
• https://apfmj.biomedcentral.com/articles/10.1186/1447-056X-8-
10#:~:text=Background,health%20services%20more%20patient%2Dcentered.
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3200113/
 GOUT
• INTRODUCTION
❑ Gout is the most common type of inflammatory arthritis. It causes sudden and intense attacks of joint
pain, often in the big toe. It can also strike joints in other toes or the ankle or knee. People with
osteoarthritis in their fingers may experience their first gout attack in their finger joints.
❑ It is characterized by sudden, severe attacks of pain, swelling, redness and tenderness in one or more
joints. It can occur suddenly, often waking you up in the middle of the night with the sensation that
you big toe is on fire. The affected joint is hot, swollen and so tender that even the weight of the
bedsheet on it may seem intolerable.
▪ There are 4 stages to GOUT progression:
• Stage 1. Asymptomatic Gout
❑ The characteristic collection of uric acid crystals in the joint begins with the accumulation of uric
acid in the blood. Uric acid is a natural waste product that is formed when the body breaks down
purines.
• Stage 2. Acute Gout
❑ When uric acid levels in the blood become too high, it can seep out and form crystals in the
spaces around the joints, causing intense pain and swelling. The pain often comes on suddenly
and unexpectedly (thus the term, “attack”) and can last from a few days to a few weeks.
• Stage 3. Intercritical or Interval Gout
❑ After your first gout attack(s) you’ll probably experience a time without symptoms until another
attack occurs, which could be months or even years. The stage during which attacks come at
intervals — short or long — is known as “intercritical” or “interval” gout.
• Stage 4. Chronic Tophaceous Gout
❑ If uric acid levels are not well controlled during the interval stage, gout may progress to its final
and most problematic stage chronic tophaceous gout.
❑ Chronic gout is characterized by accumulations of urate crystals called tophi that can appear as
bumps or nodules under the skin. A tophus can form in a joint, in the bursa that cushions and
protects the joint, in the bones or cartilage and under the skin.
❑ Tophi that form in the small joints of the fingers can cause physical changes and restrict
movement. Tophi in the cartilage and bone can eventually lead to joint damage and deformity,
and tophi under the skin can be unsightly and become infected and sometimes painful.
❑ Other problems that can occur during this chronic stage include painful joints, aching and kidney
stones.
❑ Men are three times more likely than women to develop gout. It tends to affect men after age 40
and women after menopause, when they lose the protective effects of estrogen.
• CAUSES/RISK FACTORS

❑ Gout occurs when urate crystals accumulate in your joint, causing the inflammation and intense pain
gout attack. Urate crystals can form when you have a high levels of uric acid in your blood. Your body
produces uric acid when it breaks down purines substances that are found naturally in your body.

❑ Purines are also found in certain foods, including red meat and organ meats, such as liver. Purine-rich
seafood include anchovies, sardines, mussels, scallops, trout and tuna. Alcoholic beverages, especially
beer and drinks sweetened with fruit sugar (fructose) promote higher level of uric acid.
❑ Normally, uric acid dissolves in your blood and passes through your kidney into your urine. But
sometimes either your body produces too much uric acid or your kidneys excrete too little uric acid.
When this happens, uric acid can build up, forming a sharp, needlelike urate crystals in a joint or
surrounding tissue that cause pain, inflammation and swelling.
▪ Several factors increase the likelihood of the blood uric acid level rising and gout developing. These
include the following:
1. Gender.
o Gout is more common among men than among women.
2. Family history.
o Gout often runs in families and there may be a genetic predisposition to developing
hyperuricemia and gout.
3. Older age.
o Gout rarely occurs in children and is more common among middle-aged adults and the
elderly.
4. Overweight.
o The larger a person is, the more urate they produce each day meaning overweight or obesity
can mean too much urate is produced for the kidneys to process effectively.
5. Purine-rich foods.
o Eating foods that are rich in purines can lead to hyperuricemia and trigger gout.
6. Alcohol.
o A high alcohol intake can increase the risk of hyperuricemia, since alcohol can interfere with
urate excretion.
7. Medications.
o Medical disorders that affect kidney function and therefore the elimination of uric acid can
cause gout. Some medications may also raise the risk of developing gout.
• SIGNS AND SYMPTOMS
❑ The sign and symptoms of gout almost always occur suddenly, and often at night. They include:
o Intense joint pain. Gout usually affects the big toe, but can occur in any joint. Other commonly
affected joints include the ankles, knees, elbows, wrists and fingers. The pain likely to be most
severe within the first four to 12 hours after it begins.
o Lingering discomfort. After the most severe pain subsides, some joint discomfort may last from
few days to a few weeks. Later attacks are likely to last longer and affect more joints.
o Inflammation and redness. The affected joint or joints become swollen, tender, warm and red.
o Limited range of motion. As a gout progresses, you may not be able to move your joints
normally.

A. ASSESSMENT
❖ Asses pain characteristics and location.
o Gout can be diagnosed during flare when the joint is painful and swollen. It is important to
identify which joints are affected to optimize the treatment plan.
❖ Joint examination.
o Perform a thorough examination of affected joints, assessing for swelling, redness, warmth,
and limited range of motion.
❖ Patient history.
o Obtain a detailed medical history, with a focus of previous gout attacks, family history of
gout, and any existing comorbidities.
❖ Dietary assessment.
o Assess the patient’s dietary habits, particularly the intake of purine rich foods and alcohol, to
identify potential triggers for gout attacks.
❖ Uric acid levels.
o Monitor serum uric acid levels through blood test to determine the extent of hyperuricemia
and guide treatment strategies.
❖ Lifestyle factors.
o Evaluate lifestyle factors such as physical activities, stress levels, and hydration, as they can
influence the frequency and severity of gout attacks.
❖ Medication history.
o Review the patient’s current medications, including any prescribed medications, over-the-
counter drugs, and herbal supplement, as some may exacerbate or contribute gout.

B. ANALYSIS/ NURSING DIAGNOSIS

❖ Impaired physical mobility related to joint tenderness as evidence by slowed movement.
❖ Deficient knowledge related to misinformation as evidence by inaccurate statements about a
topic.
❖ Acute pain related to inflammatory process as evidence by reddened and swollen joints.
❑ DIAGNOSTIC TEST
➢ X-rays. X-rays can be used to diagnose gout by showing the presence of uric acid crystals within the
joint. If there is suspicion of gout, an X-ray can be used to confirm the diagnosis and determine if
any joint damage is present. X-rays can also be used to monitor the progress of the disease and the
effectiveness of treatments.
➢ Ultrasound. Ultrasound imaging is a non-invasive modality that uses high-frequency sound waves
to create images of the body’s internal structures. It is commonly used in the assessment of gout
because it can detect joint effusions and typhoid (gouty deposits) in joints. It is particularly useful in
the early stages of gout when joint pain is intermittent and clinical signs may not be prominent.
➢ Magnetic resonance imaging (MRI). MRI (Magnetic Resonance Imaging) is a non-invasive
medical imaging technique that uses a combination of magnetic fields and radio waves to create
detailed images of the internal structures of the body. MRI is commonly used in the evaluation of
gout because it can detect joint effusions and typhoid, which are characteristic signs of gout. MRI
can also assist in the differential diagnosis of gout and other forms of arthritis.
➢ CT (computed tomography) scan specifically a dual-energy CT scan. CT (Computed Tomography)
scan is a non-invasive medical imaging technique that uses computers and X-rays to create cross-
sectional images of the body, allowing physicians to view internal structures and organs in great
detail. CT scan is commonly used in the evaluation of gout as it can detect uric acid crystals in joints
and show joint damage caused by gout. It can also help to differentiate gout from other forms of
arthritis.
▪ Other common tests to diagnose gout include:
➢ Blood tests to measure the uric acid in your blood.
➢ Joint aspiration using a needle to remove a sample of fluid from inside a joint.

❑ TREATMENT AND MEDICATION

▪ There’s no cure for gout. You’ll experience fewer attacks once you work with a healthcare provider
to find treatments that manage your symptoms and lower your uric acid levels.

❑ LIFESTYLE AND DIET

➢ Reduce or even eliminate your intake of meat and shellfish, both of which can raise uric acid
levels.
➢ Cut back on alcohol and foods or drinks made with high-fructose corn syrup, like soft drinks.
➢ Drink plenty of water every day. Dehydration increases uric acid levels.
➢ Manage your weight, as gout is linked with excess weight and obesity.

❑ PHARMACOLOGICAL MANAGEMENT
▪ Your healthcare provider might suggest medications to help manage your symptoms, including:
➢ NSAIDs: Over-the-counter (OTC) NSAIDs, like ibuprofen and naproxen, can reduce pain and
swelling during a gout attack. Some people with kidney disease, stomach ulcers and other health
problems shouldn’t take NSAIDs. Talk to your provider before taking NSAIDs.
 ➢ Colchicine: Colchicine is a prescription medication that can reduce inflammation and pain if you
take it within 24 hours of a gout attack.
➢ Corticosteroids: Corticosteroids are prescription medications that reduce inflammation. Your
provider might prescribe oral (by mouth) pills. They may also inject corticosteroids into your
affected joints or into a muscle near your joint (intramuscularly).

❑ SURGICAL MANAGEMENT
▪ There are three main types of surgery for gout include tophi removal, joint fusion, and joint
replacement.
➢ Tophi removal. Tophi removal involves the removal of the painful, infected, or swollen
growths. The procedure consists of cutting a tophus out while keeping as much of the
surrounding tissue intact as possible.
➢ Joint fusion. Joint fusion involves fusing the bones in a joint together. This surgery may cause a
person to lose some mobility, but it should provide some relief from symptoms such as chronic
pain.
➢ Joint replacement. In this procedure, doctors remove the damaged, painful joint and replace it
with an artificial joint. This procedure can help reduce pain and improve mobility. The most
common location for this surgery is the knee.

C. PLANNING
❖ The patient will verbalize the minimal discomfort.
❖ The patient will participate in activities to improve their range of motion.
❖ The patient will explain the disease process and importance of compliance with the treatment
regimen.
❖ The patient will specify two diet recommendations to prevent gout.
❖ The patient will verbalize their medication regimen to treat gout.
❖ The patient will verbalize pain relief and perform activities of daily living without discomfort.
❖ The patient will display an absence of redness, swelling, and warmth to the affected joints.

D. IMPLIMENTATION/INTERVENTION OFCARE OF CLIENT

A. INDEPENDENT NURSING CARE
• Apply cool compresses.
• Nonpharmacologic interventions such as the application of cool compresses and ice can reduce
inflammation and soothe burning sensations.
• Adjust lifestyle behaviors.
• Gout attacks can be minimized by reducing risk factors such as the intake of alcoholic beverages,
sugary drinks, and high-purine foods such as red meats and some seafood.
• Elevate the limb.
• Elevating the affected joint can help reduce inflammation.
• Encourage the use of mobility aids when necessary.
 • Mobility aids like handrails, canes, and shower benches promote patient safety during gout flare-
ups and prevent accidental falls and other injuries.
• Educate the patient about the importance of proper nutrition.
• Since gout can be aggravated by food choices, provide the patient with verbal and written foods
that should be avoided (red meat, bacon, organ meats, sardines) and foods that should be
increased (water, vegetables, whole grains).

B. DEPENDENT NURSING CARE

• Medication Administration. Administer prescribed medications such as nonsteroidal anti-
inflammatory drugs (NSAIDs), colchicine, or corticosteroids as directed to manage pain and
inflammation during acute gout attacks.
• Dietary Modification. Collaborate with a dietitian to help the patient modify their diet, reducing
the intake of purine-rich foods and alcohol. Provide educational resources on gout-friendly
dietary choices.

E. EVALUATION
❑ The patient was able to verbalized minimal discomfort
❑ The patient was able to participate in activities and improve their range of motion.
❑ The patient was able to explain the disease process and importance of compliance with the
treatment regimen.
❑ The patient was able specified two diet recommendations in preventing gout.
❑ The patient was able to verbalized their medication regimen in treating gout.
❑ The patient was able to verbalized pain relief and perform activities of daily living without
discomfort.
❑ The patient was able to displayed an absence of redness, swelling, and warmth to the affected
joints.

• PROGNOSIS
❑ With early gout diagnosis, life-long urate-lowering therapy enables most patients to live a normal
life. For many patients with advanced disease, aggressive lowering of the serum urate level can
resolve tophi and improve joint function. Gout is generally more severe in patients whose initial
symptoms appear before age 30 and whose baseline serum uric acid level is >9mg/dL (0.5 mmol/L).
The high prevalence of metabolic syndrome and cardiovascular disease probably increases mortality
in patients with gout.
❑ Some patients do not improve sufficiently with treatment. The usual reasons includes inadequate
education provided to patients, nonadherence, alcoholism, and mainly undertreatment of the
hyperuricemia by physicians.

REFERENCE:
• https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-
20372897?fbclid=IwAR1r4FtnnZwc8VqmgSOsIS2R4bWk0bX0icRHxcN4ZrmmLX0x4dzLf4R_L7o
• https://www.healthline.com/health/gout?fbclid=IwAR2LSuwlRQEQv9JaZ1ycrFcdq9RGeDubwQQ7am
69g1eKa08Mkgwx02_djxY
• https://www.healthline.com/health/gout?fbclid=IwAR2LSuwlRQEQv9JaZ1ycrFcdq9RGeDubwQQ7am
69g1eKa08Mkgwx02_djxY
• https://www.medicalnewstoday.com/articles/gout-
surgery#:~:text=The%20three%20main%20types%20of,chronic%2C%20inflammatory%20form%20of
%20arthritis.
CARPAL TUNNEL SYNROME
• INTRODUCTION
❑ Carpal tunnel syndrome is an entrapment neuropathy that occurs when the median nerve at the wrist
is compressed by a thickened flexor tendon sheath, skeletal encroachment, edema, or a soft tissue
mass.
❑ Carpal Tunnel Syndrome is commonly caused by repetitive hand and wrist movements, it is also
associated with rheumatoid arthritis, diabetes, acromegaly, hyperthyroidism, or trauma.
❑ Carpal tunnel syndrome is a common condition that causes numbness, tingling, and pain in the hand
and forearm. The condition occurs when one of the major nerves to the hand the median nerve is
squeezed or compressed as it travels through the wrist.
❑ It frequently occurs in women between 30 and 60 years of age. Women going through menopause or
who are taking estrogen or birth control pills have the high risk.

• CAUSES/RISK FACTORS
1. Repetitive Hand and Wrist Movements.
o Engaging in repetitive activities that involve prolonged or forceful hand and wrist
movements, such as typing, assembly line work, or using vibrating tools, can contribute to
the development of CTS.
2. Wrist Injuries or Fractures.
o Trauma to the wrist, such as fractures, sprains, or dislocations, can cause swelling and
inflammation. This inflammation can pressure the median nerve, leading to CTS symptoms
3. Repetitive Hand and Wrist Movements.
o Engaging in repetitive activities that involve prolonged or forceful hand and wrist
movements, such as typing, assembly line work, or using vibrating tools, can contribute to
the development of CTS.
4. Gender.
o Generally more common in woman to develop carpal tunnel syndrome than in men. This
may be because the carpal tunnel area is relatively smaller in women than in men.

5. Obesity.
 o Being obese is a risk factor for carpal tunnel syndrome.
6. Workplace factors.
o Working with vibrating tools or on an assembly line that requires repeated movements that
flex the wrist may create pressure on the median nerve.
7. Heredity.
o This is likely an important factor. The carpal tunnel may be naturally smaller in some people,
or there may be anatomic differences that change the amount of space for the nerve and these
traits can run in families.
8. Health conditions.
o Diabetes, rheumatoid arthritis, and thyroid gland imbalance are conditions that are associated
with carpal tunnel syndrome.

• SIGNS AND SYMPTOMS

❑ Tingling or numbness. May notice tingling and numbness in the fingers or hand. Usually the
thumb and index, middle or ring fingers are affected, but not the little finger.
❑ Weakness. May experience weakness in the hand and drop objects. This may be due to the
numbness in the hand or weakness of the thumb’s pinching muscles, which are also controlled by
the median nerve
❑ Dropping things. Due to weakness, numbness, or a loss of proprioception (awareness of where
your hand is in space).
❑ Occasional shock. Like sensations that radiate to the thumb and index, middle, and ring fingers.

A. ASSESSMENT
❖ Ask the patient about nocturnal pain.
o Commonest cause of hand at night.
❖ Take family history.
o Abnormally small size of carpal tunnel runs in families.
❖ Assess the patient’s presenting symptoms.
o Such as pain, numbness, tingling, and weakness in the affected hand and fingers.
❖ Evaluate the patient’s daily tasks.
o Including their ability to perform daily tasks, work-related activities, and hobbies that may be
impacted by CTS.
❖ Assess the patient’s pain level using appropriate pain assessment tools.
❖ Press down or tap along the median nerve of the palm side of the patient wrist and hand.
o This is to see if it causes any tingling into your fingers (Tinel's sign).
❖ Bend and hold the wrists of the patient in a flexed position.
o This is to test for numbness or tingling in your hands.

B. ANALYSIS/ NURSING DIAGNOSIS

❖ Chronic pain related to nerve compression as evidence by inflammation of the wrist.
❖ Impaired Physical Mobility related to hand and finger weakness as evidence by dropping things.
❑ DIAGNOSTIC TEST
➢ Tinel’s sign. The physician taps over the median nerve at the wrist to see if it produces a tingling
sensation in the fingers.
➢ Phalen’s test. The patient rests his or her elbows on a table and allow the wrist to fall forward
freely. The more quickly symptoms appear, the more severe the carpal tunnel syndrome.
➢ Physical exam. Your healthcare professional tests the feeling in the fingers and the strength of
the muscles in the hand.
➢ X-rays. During an X-ray, high frequency beams of light are used to create pictures of the side of
the body. If you have limited wrist motion, an X-ray may be used to exclude other causes of
wrist pain, such as arthritis, recent trauma, or past injuries.
➢ MRI Scans. Your Doctor may order an MRI, Which uses a magnetic field and radio waves to
create two or three-dimensional pictures of the hand and wrist.
➢ Ultrasound. Your Doctor may use ultrasound to evaluate the soft tissues of the carpal tunnel and
the median nerve. During an ultrasound, high frequency sound waves bounce off parts of the
wrist and hand, capturing the returning ’echoes’ as images.
➢ Electromyogram. Electrical testing of median nerve function can detect the presence, location,
and extent of carpal tunnel syndrome and help your doctor to determine the most effective
treatment.

❑ TREATMENT AND MEDICATION

➢ Nonsurgical therapy. If the condition is diagnosed early, nonsurgical methods may help
improve carpal tunnel syndrome, including:
➢ Wrist splinting. Relieve pressure aggravated by wrist flexion: worn at night, and during day if
symptomatic.
➢ Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, such as ibuprofen (Advil, Motrin
IB, others), may help relieve pain from carpal tunnel syndrome in the short term. There isn't
evidence, however, that these medicines improve carpal tunnel syndrome.
➢ Corticosteroids. Corticosteroids decrease inflammation and swelling, which relieves pressure on
the median nerve. Oral corticosteroids aren't considered as effective as corticosteroid injections
for treating carpal tunnel syndrome.

❑ SURGICAL MANAGEMENT
▪ Surgery may be appropriate if symptoms are severe or don't respond to other treatments. The goal of
carpal tunnel surgery is to relieve pressure by cutting the ligament pressing on the median nerve.
➢ Endoscopic surgery. A surgeon uses a telescope-like device with a tiny camera called an
endoscope. This allows the surgeon to see inside the carpal tunnel. The surgeon cuts the ligament
through one or two small incisions in the hand or wrist. Endoscopic surgery may result in less
pain than does open surgery in the first few days or weeks after surgery.
➢ Open surgery. A surgeon makes a cut, also called an incision, in the palm of the hand over the
carpal tunnel and cuts through the ligament to free the nerve.
C. PLANNING
❑ The patient will verbalize the minimal discomfort.
❑ The patient will explain the disease process and importance of compliance with the treatment
regimen.
❑ The patient will participate in therapy and exercise to improve quality of life.
❑ The patient will report decrease pain scale at a level of 4/10 to 3/10.
❑ The patient will verbalize his/her expectations regarding the course of pain treatment and his
intended treatment outcomes.
❑ The patient will know on how to control and prevent recurrence of carpal tunnel syndrome in the
future.
❑ The patient will engage to do work, leisure activities, and social interactions.

D. IMPLIMENTATION/INTERVENTION OF CARE OF CLIENTS

❖ Instruct patient to rotate the wrists and stretch the palms and fingers.
❖ Instruct patient to do exercises to keep the nerve mobile.
❖ Emphasize the importance of wearing a wrist splint, especially at night, can help keep the wrist
in a neutral position and alleviate pressure on the median nerve.
❖ Instruct patient to avoid certain activities that can make severe symptoms.
❖ Administer prescribed analgesics and teach patient relaxation techniques.
❖ Advice patient to do activities to reduce strain on the wrists.
❖ Advice patient on a balance diet to support nerve health and to reduce inflammation.
❖ Educate patient regarding about carpal tunnel syndrome to help and improved quality of life.

E. EVALUATION
❖ The patient was able verbalize the minimal discomfort.
❖ The patient was able to explain the disease process and importance of compliance with the
treatment regimen.
❖ The patient was able to participate in therapy and exercise to improve quality of life.
❖ The patient was able to report decreased pain scale at a level of 4/10 to 3/10.
❖ The patient was able to verbalized his/her expectations regarding the course of pain treatment
and his intended treatment outcomes.
❖ The patient was able to know on how to control and prevent recurrence of carpal tunnel
syndrome in the future.
❖ The patient was able to engage to do work, leisure activities, and social interactions.

• PROGNOSIS
❑ Carpal tunnel syndrome (CTS) is one of the most common upper limb compression neuropathies .
CTS account for approximately 90% of all entrapment neuropathies. It is due to an entrapment of
the median nerve in the carpal tunnel at the wrist
 ❑ The incidence and prevalence varies, 0.125% – 1% and 5 – 16%, depending upon the criteria
used for the diagnosis. It is a condition of middle-aged individuals and affects females more
often than males.
❑ In the first population based study, Stevens and other noted that the mean age at diagnosis was
50 years for men and 51 years for women.
❑ Although unlikely, untreated carpal tunnel syndrome can lead to permanent nerve damage,
disability and loss of hand function.

REFERENCE:
• https://www.studocu.com/ph/document/university-of-cagayan-valley/community-health-nursing/carpal-
tunnel-syndrome/84923320?fbclid=IwAR1sydszWslZ2z3keA-
XO6Bm8dlf4iDqyFiK0uxfg5DqZPt7p6QPuaNSd3g
• https://www.scribd.com/presentation/48337502/Carpal-Tunnel-
Syndrome?fbclid=IwAR0BQCe0PoLRR7vC_pxE4SyrDLRYdN9NrZKNhoj2hl-aRG5JlZdOw7Lw17
• https://www.mayoclinic.org/diseases-conditions/carpal-tunnel-syndrome/symptoms-causes/syc-
20355603
• https://my.clevelandclinic.org/health/diseases/4005-carpal-tunnel-syndrome
• https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/carpal-tunnel-
release#:~:text=There%20are%202%20types%20of,wrist%20to%20do%20the%20surgery.&text=The%
20other%20method%20is%20endoscopic,a%20tiny%20incision%20(cut).
LOWER BACK PAINS
• INTRODUCTION
❑ Low back pain (Lumbago) describes pain between the lower edge of the ribs and the buttock. It can
last for a short time (acute), a little longer (sub-acute) or a long time (chronic). It can affect anyone.
❑ LBP makes it hard to move and can affect quality of life and mental well-being. It can limit work
activities and engagement with family and friends.
❑ LBP can be specific or non-specific. Specific LBP is pain that is caused by a certain disease or
structural problem in the spine, or when the pain radiates from another part of the body.
❑ Non-specific LBP is when it isn’t possible to identify a specific disease or structural reason to
explain the pain. LBP is non-specific in about 90% of cases.

• CAUSES/RISK FACTORS
1. Having osteoporosis.
o The spine's vertebrae can develop painful breaks if the bones become porous and brittle.
2. Age.
o Back pain is more common with age, starting around age 30 or 40.
3. Lack of exercise.
o Weak, unused muscles in the back and abdomen might lead to back pain.
4. Excess weight.
o Excess body weight puts extra stress on the back.
5. Diseases.
o Some types of arthritis and cancer can contribute to back pain.
6. Improper lifting.
o Using the back instead of the legs can lead to back pain.
7. Smoking.
o Smokers have increased rates of back pain. This may occur because smoking causes coughing,
which can lead to herniated disks. Smoking also can decrease blood flow to the spine and
increase the risk of osteoporosis.
 8. Psychological conditions.
o People prone to depression and anxiety appear to have a greater risk of back pain. Stress can
cause muscle tension, which can contribute to back pain.

• SIGNS AND SYMPTOMS

❑ Stiffness. It may be tough to move or straighten your back. Getting up from a seated position
may take a while, and you might feel like you need to walk or stretch to loosen up. You may
notice decreased range of motion.
❑ Posture problems. Many people with back pain find it hard to stand up straight. You may stand
“crooked” or bent, with your torso off to the side rather than aligned with your spine. Your lower
back may look flat instead of curved.
❑ Muscle spasms. After a strain, muscles in the lower back can spasm or contract
uncontrollably. Muscle spasms can cause extreme pain and make it difficult or impossible to
stand, walk or move.

A. ASSESSMENT
❖ Physical Examination.
o The physical examination is not as important as the history in identifying secondary
causes of acute low back pain. Nevertheless, certain aspects of the physical examination
are considered important.
❖ GAIT AND POSTURE.
o Observation of the patient's walk and overall posture is suggested for all patients with
low back pain. Scoliosis may be functional and may indicate underlying muscle spasm or
neurogenic involvement.
❖ RANGE OF MOTION.
o The examiner should record the patient's forward flexion, extension, lateral flexion and
lateral rotation of the upper torso. Pain with forward flexion is the most common
response and usually reflects mechanical causes. If pain is induced by back extension,
spinal stenosis should be considered
❖ PALPATION OR PERCUSSION OF THE SPINE.
o Point tenderness over the spine with palpation or percussion may indicate fracture or an
infection involving the spine. Palpating the paraspinous region may help delineate tender
areas or muscle spasm.
❖ HEEL-TOE WALK AND SQUAT AND RISE
o A patient unable to walk heel to toe, and squat and rise may have severe cauda equina
syndrome or neurologic compromise.
❖ PALPATE THE PATIENT TO THE SCIATIC NOTCH
o Tenderness over the sciatic notch with radiation to the leg often indicates irritation of the
sciatic nerve or nerve roots.
❖ STRAIGHT LEG RAISING TEST
 o With the patient in the supine position, each leg is raised separately until pain occurs. The
angle between the bed and the leg should be recorded. Pain occurring when the angle is
between 30 and 60 degrees is a provocative sign of nerve root irritation.
❖ REFLEXES AND MOTOR AND SENSORY TESTING
o Testing knee and ankle reflexes in patients with radicular symptoms often helps
determine the level of spinal cord compromise. An altered knee or ankle reflex alone
does not suggest the need for invasive management because this finding is generally
transient and fully reversible

B. ANALYSIS/ NURSING DIAGNOSIS

❖ Chronic pain related to inflammation of the lumbar as evidence by patient consistent lower back pain.
❑ DIAGNOSTIC TEST
➢ Spine X-ray, which uses radiation to produce images of bones.
➢ MRI, -which uses a magnet and radio waves to create pictures of bones, muscles, tendons and
other soft tissues.
➢ CT scan, - which uses X-rays and a computer to create 3D images of bones and soft tissues.
➢ Electromyography (EMG) to test nerves and muscles and check for neuropathy(nerve damage),
which can cause tingling or numbness in your legs. Depending on the cause of pain, health care
provider may also order blood tests or urine tests. Blood tests can detect genetic markers for
some conditions that cause back pain (such as ankylosing spondylitis). Urine tests check for
kidney stones, which cause pain in the flank (the sides of the low back).

❑ TREATMENT AND MEDICATION

➢ Medications. Health care provider may recommend nonsteroidal anti-inflammatory drugs
(NSAIDs) or prescription drugs to relieve pain. Other medications relax muscles and prevent
back spasms.
➢ Physical therapy (PT). PT can strengthen muscles so they can support your spine. PT also
improves flexibility and helps you avoid another injury.
➢ Hands-on manipulation. Several “hands-on” treatments can relax tight muscles, reduce pain
and improve posture and alignment. Depending on the cause of pain, you may need osteopathic
manipulation or chiropractic adjustments. Massage therapy can also help with back pain relief
and restore function.
➢ Injections. Your provider uses a needle to inject medication into the area that’s causing
pain. Steroid injections relieve pain and reduce inflammation.

❑ SURGICAL MANAGEMENT
▪ Some injuries and conditions need surgical repair. There are several types of surgery for low back
pain, including:
➢ Lumbar spine surgery. Lumbar spine surgery is an invasive treatment that involves the physical
removal, repair, or readjustment of spinal structures to treat injuries, diseases, and/or deformities
 affecting the spine between one or more of the lumbar vertebrae (L1-S1) spinal motion
segments.
➢ Lumbar Laminectomy. Lumbar laminectomy is a procedure that involves removing bone to
relieve excess pressure on the spinal nerve(s) in the lower back or lumbar spine. Laminectomy
removes the roof of the vertebrae to allow space for nerves exiting the spine.
➢ Spinal Fusion. The spinal fusion procedure involves placing bone grafts between adjacent spinal
vertebrae to join the two structures together. When appropriate, we may use minimally invasive
surgical techniques.

C.PLANNING
❖ The patient will verbalize his/her expectations regarding the course of pain treatment and his
intended treatment outcomes.
❖ The patient will identify five non invasive pain relief methods to aid pain management.
❖ The patient will verbalize on how to take the back pain medication prescribed for him/her as needed.
❖ The patient will demonstrate the use of appropriate diversional activities and relaxation.
❖ The patient will describe satisfactory of pain control at a level of 6/10 to 3/10.
❖ Patient will display improvement in mood, and coping with work.

D.IMPLIMENTATION/INTERVENTION OF CARE OF CLIENTS

A. INDEPENDENT NURSING CARE
• Apply hot and cold compress.
• Pharmacologic pain management as ordered.
• Instruct the patient to report pain before it become severe.
• Educate the patient regarding the disease lower back pain.
• Assist the patient in positioning in the bed or in standing.
• Provide comfort measures like massage, and cool packs)
• Provide comfort and pillows in positioning in the bed.
• Provide gentle exercise.
• Assess the patients pain scale and perception.

E. EVALUATION
❖ The patient was able to verbalized the expectations regarding the course of pain treatment and
intended treatment outcomes.
❖ The patient was able to identify five non invasive pain relief methods to aid pain management.
❖ The patient was able to verbalized on how to take the back pain medication prescribed for him/her as
needed.
❖ The patient was able to demonstrate the use of appropriate diversional activities and relaxation.
❖ The patient was able to described satisfactory of pain control at a level of 6/10 to 3/10.
❖ Patient was able to display improvement in mood, and coping.
 • PROGNOSIS
❑ Most people with back strains and sprains recover and do not have long-term health issues. But
many people will have another episode within a year.
❑ Some people have chronic back pain that doesn’t get better after several weeks. Older people
with degenerative conditions such as arthritis and osteoporosis may have symptoms that get
worse over time.
❑ Surgery and other treatments are effective at helping people with a range of injuries and
conditions live pain-free.
REFERENCE :
• https://www.mayoclinic.org/diseases-conditions/back-pain/symptoms-causes/syc-
20369906?fbclid=IwAR1jdJk8ZWQYPwn5hiOa_FmiCGbDHK-
bFE9B0umLdvkRASh1E5LgCERkAa0
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3414626/?fbclid=IwAR1sydszWslZ2z3keA-
XO6Bm8dlf4iDqyFiK0uxfg5DqZPt7p6QPuaNSd3g
• https://nurseslabs.com/acute-pain/?fbclid=IwAR1l5OqihamtpcvuYxjTItd8PN20gmnp575-b2y9Wa--
yk6LlEMaanVsMmw
• https://www.spine-health.com/treatment/back-surgery/lumbar-spine-surgery
• https://ctbackcenter.com/surgical-treatment-for-lower-back-pain-relief/