Nursing Assessment, Management and Treatment of Autoimmune Diseases
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● Total joint Replacement : This procedure involves the removal of damaged parts of joints and insertion of a prosthesis. Such prostheses are generally made of metal and plastic. Nursing interventions Support for patients with a chronic, potentially disfiguring disease is critical. Nurses need to encourage patients to seek medical help as soon as possible, not only when symptoms first start, but if and when signs and symptoms change. Fami- lies must also be involved in and support healthcare visits (Rebar et al., 2019). In conjunction with the primary health- care provider and other members of the healthcare team, the following sugges- tions for symptom management may be provided by nurses (Mayo Clinic, 2020e): ● Exercise : Staying physically active is essential to strengthening muscles and keeping joints flexible. Physical therapists may be consulted for the recommendation of specific exercises. No exercise program should be initiated without the knowledge and consent of the primary healthcare provider. ● Heat or cold therapy : Warm baths, showers, and heating pads can help to ease pain and joint stiffness. In the event of periods of symptom exacerbation, cold packs rather than heat are recommended to reduce pain and inflammation. ● Joint support : Splints are typically used for joint support. Occupational and physical therapists can recommend the splint that is best suited to individual patient needs. ● Self-help devices : Several self-help devices may be used to facilitate movement and reduce joint stress. Examples include hand grips, long-
| NURSING CONSIDERATION
Biologic DMARDs are typically most effective when paired with a conven- tional DMARD (Mayo Clinic, 2021b). ● Targeted synthetic DMARDs: If conventional DMARDs and biologics are not effective, targeted synthetic DMARDs may be prescribed. An example is tofacitnib (Xeljanz). Therapy Physical and occupational therapies may be prescribed. In addition to keep- ing joints flexible, patients may be taught to use assistive devices that do not stress painful joints and make performing ac- tivities of daily living (ADLs) easier. For example, cutlery with hand grips make cooking and eating easier. Buttonhooks can help to make dressing easier (Mayo Clinic, 2021b). Surgery Various surgical procedures may be per- formed. These include the following (Mayo Clinic, 2021b; Rebar et al., 2019): ● Synovectomy : Synovectomy is the removal of the inflamed lining of joints (synovium). The goal of this surgery can help to reduce pain and improve flexibility of joints. ● Tendon repair : Inflammation and damage to the joints may cause tendons around the joints to rupture or loosen. Repair of the tendons may be possible with this type of procedure. ● Joint fusion : Joint fusion may be performed to stabilize or realign joints for the relief of pain. This procedure
is generally performed when joint replacement is not an appropriate option.
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