Presented by:
Stacia Gibson-Forde
Ayesha Harte
Olivia Edwards
Rommece Sobers
Roxzanne Clarke
Gloria Jones
Scenario
Arthritis
A sixty-five, (65) year old female client, has been
diagnosed with Arthritis and has been hospitalized for
an evaluation of her increasing inability to move.
Investigations have been done to differentiate between
Rheumatoid Arthritis and Osteoarthritis. She has been
prescribed aspirin to relieve the pain and has been
taking large doses. The client experiences pain,
swelling and deformities in her knees, hip and fingers,
and unsteady gait. The client tells the nurse, “I can’t
seem to do my household chores anymore without
becoming tired. My knees hurt whenever I walk; it’s
difficult for me to get around my house and yard.”
Objectives
Define Arthritis, Rheumatoid Arthritis and Osteoarthritis
State how rheumatoid arthritis and osteoarthritis relate to
each other
Identify the possible causes for arthritis
Identify the clinical manifestations for the condition as
presented in an elderly client
Explain how the process of ageing impacts on the
development of four (4) clinical manifestations for the client
in the scenario
Describe two (2) complications of arthritis
Objectives (cont’d)
State appropriate nursing interventions for the elderly client
with arthritis under the following needs:
Nutrition
Elimination
Rest, Activity and Comfort
Safety and Protection
Psychology
What is Arthritis?
Arthritis is a term used to mean any disorder
featuring pain and stiffness of the joints. There are
over one hundred (100) types of arthritis. The most
common forms are:
Rheumatoid Arthritis
Osteoarthritis
What is Rheumatoid Arthritis
Rheumatoid Arthritis is a chronic joint disease that
damages the joint or joints of the body. The damages
are caused by inflammation of the joint lining tissue.
What is Osteoarthritis
Osteoarthritis is known as wear and tear arthritis. . It is
known to breakdown the cartilage in the joints and
can occur in any joint in the body.
Osteoarthritis & Rheumatoid
Arthritis
Rheumatoid arthritis and osteoarthritis are two
different types of arthritis. Both conditions are
often confused due to similar characteristics.
Osteoarthritis & Rheumatoid
Arthritis
The similarities between rheumatoid arthritis and
osteoarthritis include:
Symptoms:
Joint pain
Stiffness
Redness
Warmth
Swelling
Diagnostics:
X-ray
Arthrocentesis (Synovial Fluid Analysis)
Osteoarthritis & Rheumatoid
Arthritis (cont’d)
Treatment:
Heat & cold therapy
Medications:
Non- steroidal anti-inflammatory drugs
(NSAIDS)
Analgesics
Surgery:
Arthroplasty
Arthrodesis
Osteoarthritis vs. Rheumatoid
Arthritis
The differences between rheumatoid arthritis and
osteoarthritis include:
The age at which the condition begins
Osteoarthritis is more common than
rheumatoid arthritis
The speed of onset
Causes behind joint symptoms
Joint symptoms
Patterns of joints that are affected
Duration of morning stiffness
Osteoarthritis vs. Rheumatoid
Arthritis (cont’d)
Presence of symptoms affecting the whole body
Laboratory tests
Treatment
Gender
Possible Causes for Arthritis
Age
Infection to the joint
Injury to the joint
Family history
Smoking
Physically demanding occupation
Overactive immune system
Weight distribution
Gender
Medical conditions
Clinical Manifestations For Arthritis
As Presented In An Elderly Client
Pain
Swelling
Deformities in the knees, hip and fingers
Unsteady gait
Tiredness/ lack of energy
How The Process Of Ageing Impacts On
The Development Of Clinical
Manifestations
Unsteady gait
Pain
Deformities in knees, hip and fingers
Swelling
Two (2) Complications of
Rheumatoid Arthritis
Widespread inflammation
Joint damage
Complication of Osteoarthritis
Stress Fractures
Bone death
Appropriate Nursing Interventions
For The Elderly Client: Nutrition
1. Assess patient's height and weight
2. Assess for signs of poor nutritional intake
3. Obtain a nutritional history
4. Consider weight loss if the patient is overweight
5. Refer patient to nutritionist
6. Include more fruits and vegetables into the diet
7. Intake of foods rich in essential minerals such as calcium and
omega 3 fatty acids. These foods include: dairy - yogurt,
cheese, milk. Green vegetables - broccoli, kale, spinach. Fish
- Fresh cod, herring, mackerel, salmon and sardines. Also flax
and pumpkin seeds, olive oil, avocados.
Appropriate Nursing Interventions
For The Elderly Client: Nutrition
(cont’d)
8. Consider the use of fresh herbs as an alternative to sodium
and spices in meals.
9. Providing a pleasant environment for eating.
10. Assess pain level prior to meal time.
11. Provide good oral hygiene and dentition.
12. Encourage companionship at meal times.
13. Refer to occupational therapist for adaptive devices.
14. Encourage exercise as tolerated.
Appropriate Nursing Interventions For
The Elderly Client: Elimination
1. Encourage patient to wear elastic/ Velcro pants/skirts
2. Place patient closer to the bathroom facility
3. Provide assistive devices
4. Keep corridors and bathroom well lit at night
Appropriate Nursing Interventions For
The Elderly Client: Rest, Activity and
Comfort
1. Monitor and assess the degree of joint inflammation and
pain
2. Assist with active and passive range of motion exercises
3. Advise patient to perform exercises in the sea 0r pool
4. Assist with activities of daily living
5. Position with pillow, splints or braces
6. Administer anti-inflammatory medication and disease-
modifying antirheumatic drugs (DMARDs)
7. Reposition patient frequently every two (2) hours
8. Provide foam or air mattress
9. Maintain bed rest
Appropriate Nursing Interventions For
The Elderly Client: Safety & Protection
1. Check laboratory data (erythrocyte sedimentation test, hematocrit
test, red blood cell count, serum immunology antinuclear antibody
test, complement test, c-reactive protein test, immunoglobulin
electrophoresis, rheumatoid factor)
2. Recommend or provide firm mattress
3. Provide a small or thin under neck pillow
4. Suggest patient assume position of comfort while in bed or
sitting in chair. Promote bed rest as indicated
5. Place and monitor use of pillows, sand bags, Trochanter rolls,
splints and braces
6. Monitor water temperature of compresses and baths
7. Reposition frequently using adequate personnel.
8. Demonstrate and assist with transfer techniques and use of
mobility aids such as wheelchairs and canes
Appropriate Nursing Interventions For
The Elderly Client: Psychological
1. Encourage client to verbalize any concerns about the disease
regarding daily living.
2. Encourage client to have a balanced diet
3. Discuss with the client, her perception of how family members
or significant other perceives her limitations.
4. Involve client in planning care & scheduling activities.
5. Develop a plan for managing symptoms & enlisting support of
family & friends to promote daily functions.
6. Set limits on maladaptive behaviour assist client to identify
positive behaviours that will aid in coping with the condition.
7. Note any withdrawn behaviour, denial or overly concern with
body changes
8. Refer to social worker after identifying a need of further
assistance with daily coping.
