PROBLEM LIST

1. Acute Pain
2. Nutrition less than body requirements
3. Impaired Physical Mobility
4. Impaired Skin integrity
5. Disturbed Body Image
ACUTE PAIN

Nursing Nursing Objectives Nursing Interventions

Problem with DiagnosisWith Rationale Evaluation
cues Rationale forInterventions  

Acute Pain After 1 hour of Assess severity location and intensity Favorable in determining pain Goal partially
related to nursing of pain(scale of 0–10). Note management needs and met. After
inflammatory intervention, precipitating factors and nonverbal pain effectiveness of the program. an hour of
process client will be cues. nursing
and able to verbalize intervention,
destruction pain is relieved client
of from 8/10 Recommend or provide a firm mattress Soft and sagging mattress, large verbalized pain
the to2/10. or bedboard, small pillow. Elevate pillows prevent maintenance of was controlled
joint.Rational linens with bed cradle as needed. proper body alignment, placing with pain scale
e: Joint pain After 1 hours of health stress on affected joints. of 5/10.After
is due to teaching clientwill be Elevation of bed linens reduces 3 hoursof
prostaglandin able to:Identify 5 pain pressure on inflamed or painful health
release, management joints teaching, client
edema, and techniques such as, was able to
synovial guided- identify 5
inflammation imagery,controlled outof 5 pain
and breathing,progressive Suggest patient assume a position of Rests painful joints and managemen
destruction relaxation, and comfort while in bed or sitting in a maintains a neutral position. t techniques.
visualization. Perform chair. Promote bedrest as indicated. Note: Use of splints can Client was able
through return Place and monitor use of pillows, decrease pain and may to perform
demonstration sandbags and splints, reduce damage to joint; 3out of 5 pain
the 5 pain management however, prolonged managemen
techniques for inactivity can result in loss of t techniques.
lifetime use.
joint mobility and function.

Encourage frequent changes of Prevents general fatigue and

position. Assist the patient to move in joint stiffness. Stabilizes joint,
bed, supporting affected joints above decreasing joint movement
and below, avoiding jerky movements and associated pain.

Duration more accurately

Monitor the duration, not the intensity, reflects the disease’s severity.
of morning stiffness.

Heat
Recommend that patient take a warm promotes muscle relaxation
bath or shower upon arising or at and mobility, decreases pain,
bedtime. Apply warm, moist and relieves morning
compresses to affected joints several stiffness. Sensitivity to heat
times a day. Monitor water temperature
of compress, baths. may be diminished and
dermal injury may occur.

Provide gentle massage Promotes relaxation and

reduces muscle tension

Refocuses attention,
Involve in diversional activities
provides stimulation and
appropriate for individual situation.
enhances self-esteem and
feelings of general well-
being.

Promotes relaxation, reduces

Medicate before planned activities muscle tension and spasms,
and exercises as indicated. facilitating participation in
therapy.

A new class of medication,

 Give Celecoxib 200 mg capsule as COX-2 inhibitors interfere
needed for pain with prostaglandin
production, similarly to
NSAIDs, but are less likely to
harm the stomach lining or
kidneys. May be used in
combination with other
medications.

this medication is used to

relieve joint pain from
arthritis.  belongs to a class
Apply Diclofenac 1% Gel to affected of drugs known as
joint 4 times a day nonsteroidal anti-
inflammatory drugs.

 This medication will

lessen the inflammation,
methotrexate can improve
Give Methotrexate 2.5 mg tablet /tab
symptoms of Psoriatic
3 tabs in AM and 2 Tabs im PM .
Arthritis. This
includes swelling and
sensitivity in the joints.
Methotrexate can also
prevent PsA from getting
worse. This lowers the
 chance of long-term joint
damage.

Impaired Physical Mobility

Nursing Nursing Diagnosis Objectives Nursing Interventions Rationale

Problem with cues forInterventions Evaluation
 

Impaired  Client will maintain a Assess

physical Level of activity and
position of function and continuously
mobility exercise depends on
related to pain with monitor degree the progression and
absence/limitation of of joint resolution of the
inflammatory
Objective: contractures. inflammation
process.
•  Client will maintain or and pain.
Reluctance increase the strength
to Maintain bed Systemic rest is
and function of the
attempt
movement. affected and/or rest or chair rest mandatory
• compensatory body when indicated. during acute
Limited part. Schedule exacerbations
range activities and important
 Client will
of motion.
• demonstrate providing throughout all
Decreased techniques/behaviors frequent rest phases of
muscle that enable periods and disease to
strength. uninterrupted
resumption/continuat reduce fatigue,
ion of activities. nighttime sleep. improve
strength.

Assist with active Maintains and

and passive ROM improves joint
and resistive function,
exercises and muscle
isometrics when strength, and
able. general
stamina. Note:
Inadequate
exercise leads
to joint
stiffening,
whereas
excessive
activity can
damage joints.
Encourage
patient to
Maximizes
maintain upright
joint function,
and erect posture
maintains
when sitting,
mobility.
standing,
walking.
Urge the patient
to perform ADLs that can
activities of daily be done
living (ADLs), should be
such as encouraged to
practicing good maximize
hygiene, dressing function.
and feeding
himself.

Discuss and
Helps prevent
provide safety
accidental
needs such as
injuries and
raised chairs and
falls.
toilet seat, use of
handrails in the
tub, shower and
toilet, proper use
of mobility aids
and wheelchair
safety.

Reposition Relieves
frequently using pressure on
adequate tissues and
personnel. promotes
Demonstrate and circulation.
assist with Facilitates self-
transfer care and
techniques and patient’s
use of mobility independence.
aids such as a Proper transfer
walker. techniques
prevent
shearing
abrasions of
the skin.
Position with
Promotes joint
pillows,
stability
sandbags,
(reducing risk
trochanter roll.
of injury) and
Provide joint
maintains
support with
proper joint
splints.
position and
body
alignment,
minimizing
Suggest using a contractures.
small or thin
pillow under the Prevents
neck. flexion of the
neck.
Provide foam or
alternating Decreases
pressure pressure on
mattress. fragile tissues
to reduce risks
of immobility
and
development
of decubitus.
 ADVERTISEMENTS

 Self-narrowed focus
 Distraction behaviors/autonomic responses
 Guarding/protective behavior
Desired Outcomes

 Client will report relieved/controlled of pain.

 Client will appear relaxed, able to sleep/rest and participate in activities appropriately.
 Client will follow the prescribed pharmacological regimen.
 Client will incorporate relaxation skills and diversional activities into the pain control program.
Nursing Interventions Rationale

Consider reports of pain, noting location and

Favorable in determining pain management needs and
intensity (scale of 0–10). Note precipitating factors
effectiveness of the program.
and nonverbal pain cues.
 Nursing Interventions Rationale

Soft and sagging mattress, large pillows prevent maintenance

Recommend or provide a firm mattress or bedboard,
of proper body alignment, placing stress on affected joints.
small pillow. Elevate linens with bed cradle as
Elevation of bed linens reduces pressure on inflamed or
needed.
painful joints.

Suggest patient assume a position of comfort while In severe disease or acute exacerbation, total bedrest may be
in bed or sitting in a chair. Promote bedrest as necessary (until objective and subjective improvements are
indicated. noted) to limit pain or injury to joint.

Rests painful joints and maintains a neutral position. Note:

Place and monitor use of pillows, sandbags, Use of splints can decrease pain and may reduce damage to
trochanter rolls, splints, braces. joint; however, prolonged inactivity can result in loss of joint
mobility and function.

Encourage frequent changes of position. Assist the

Prevents general fatigue and joint stiffness. Stabilizes joint,
patient to move in bed, supporting affected joints
decreasing joint movement and associated pain.
above and below, avoiding jerky movements.

Monitor the duration, not the intensity, of morning

Duration more accurately reflects the disease’s severity.
stiffness.

Recommend that patient take a warm bath or shower Heat promotes muscle relaxation and mobility, decreases
upon arising or at bedtime. Apply warm, moist pain, and relieves morning stiffness. Sensitivity to heat may
 Nursing Interventions Rationale

compresses to affected joints several times a day.

Monitor water temperature of compress, baths, and be diminished and dermal injury may occur
so on.