Arthritis nursing issues and measures paper

There are common cognitive misunderstandings on the patient side such as "pain relief is cure" and "excessive rest/excessive exercise". On the nursing side, there are adaptability defects in homogenized plans that ignore individual differences. On the system side, there is a lack of a full-cycle follow-up mechanism from the acute phase to the remission phase. The corresponding effective solution is not a unified "medication + exercise" instruction, but the establishment of a personalized care system of "stratified assessment - dynamic adjustment - doctor-patient joint decision-making", in which patient self-management is weighted higher than the role of clinical intervention.

Speaking of misunderstandings, the 72-year-old Aunt Zhang I met at a community free clinic last month is a very typical example. She has suffered from knee osteoarthritis for three years. When she gets pain, she puts on some plasters and takes two ibuprofen pills. Once the pain subsides, she dances for two hours. Last month, she was in so much pain that she couldn't walk. When she checked, there was effusion in the joint cavity and severe synovial edema. Her thoughts are particularly representative: "It's good if the joints don't hurt. Is there anything wrong if I exercise more and exercise more?"

You may ask, why do some people say that we need to move more and others say that we need to rest when we have arthritis? This is actually a long-standing difference of opinion in the clinical field: the traditional orthopedic school prefers to reduce joint load in the acute stage to avoid increased wear and tear; the sports medicine school emphasizes early strength training of peripheral muscles to avoid disuse atrophy of muscles and increase joint pressure. Both views are supported by evidence-based evidence, but the applicable scenarios are different - in the acute stage, when the joints are red, swollen, hot and painful, you must move less, and in the remission stage, when there is no obvious pain, you must exercise targeted muscles. However, many patients only listen to what they want to believe. Those who want to move take the statement "need to exercise" as an edict, and those who don't want to move use the excuse of "need to rest" to lie down every day. In the end, they are the ones who suffer. Oh, by the way, there are still many people who believe in the folk remedies of "applying plasters to eliminate bone spurs" or "medicinal wine to cure arthritis". In the past six months, I have encountered three people who applied folk remedies to cause skin allergies and ulcers. Everyone should be careful. Degenerative arthritis is irreversible. There is currently no "radical cure", and all claims that it can be cured are scams.

After talking about the issues on the patient side, there are actually areas where our medical care is not done properly. In the past few years, many hospitals' arthritis care manuals used a unified template: "walk 5,000 steps slowly and do straight leg raises 100 times a day." It sounds standard, but it does not take individual differences into account at all. I previously managed a 40-year-old programmer patient who weighed 190 pounds. After he was diagnosed with knee arthritis, he followed the manual and walked 5,000 steps a week. The pain was so severe that he could not even go to work. Later, the plan was adjusted for him. He would first practice quadriceps exercises with leg extensions and seated postures, combined with weight control. After his weight dropped to 160 kilograms, he would slowly increase his steps from 1,000 steps a day. In less than three months, his pain score dropped from 6 points to 1 point. This is also a controversial point in the nursing community today: the evidence-based nursing school advocates formulating unified standards in strict accordance with the guidelines to minimize the probability of errors; the individualized nursing school believes that joint function assessment and body composition testing must be done first, and even the plan must be combined with the patient's daily habits to achieve better results. Nowadays, large hospitals are basically moving in the direction of individualization, but primary medical institutions have insufficient manpower and it is difficult to conduct detailed assessments for each patient. This is also a very real dilemma.

Another issue that is easily overlooked is the lack of full-cycle management. Many patients are left alone after seeing the outpatient clinic and leaving the hospital. They only come back to the hospital when the pain is unbearable. In fact, arthritis is a chronic disease. There are usually signs before the onset of arthritis: for example, the temperature changes during the change of seasons, walking too much in a row, and gaining several pounds recently. If early intervention can be carried out, it will not develop into an acute attack. Our community conducted a small pilot last year and created exclusive files for 30 patients with osteoarthritis, who were followed up once a month. Patients could ask questions in the WeChat group at any time, and nurses would adjust the care plan according to the situation. Over the past year, the number of annual acute attacks of these 30 patients dropped from an average of 4.2 to 1.3, and medical expenses were reduced by nearly 60%. But the problem is also obvious: 30 patients take up nearly one-third of a nurse's working time. Now community nurses are already busy and cannot spread it on a large scale.

As for the specific nursing measures, it is not as complicated as everyone thinks. First of all, you must understand your arthritis type and stage. The care logic for rheumatoid arthritis is completely different from that of osteoarthritis. The requirements for the acute phase and the remission phase are also very different. Don’t just follow the online tutorials. Don’t be too resistant to painkillers. Taking NSAIDs for 3-5 days in the acute phase will have very few side effects. On the contrary, taking them will cause the inflammation to continue to damage the joints. But don’t treat painkillers like candy. If you feel pain, just take them without checking for a month or two. This will really hurt your stomach and kidneys. I have followed hundreds of arthritis patients myself, and I have found that the people who recover best are never those who strictly follow the guidelines, but those who observe their body's reactions: Some people find that it hurts to walk up and down stairs without pain, so they try to take the elevator and avoid climbing stairs; some people find that wearing fleece knee pads hardly hurts in winter, so they wear them every autumn; others lose 10 pounds and their joint pain is more than half better, so they concentrate on controlling their weight. These small personalized details are more effective than any standardized care plan.

To put it bluntly, the core of arthritis care is never "doing it according to standards", but "finding a rhythm that suits you." Now the academic community is also exploring lighter solutions, such as using AI tools to assess patients at home and automatically adjust care plans. Maybe in a few years, grassroots patients will also be able to enjoy personalized care services. Of course, the premise is that everyone should abandon those wrong perceptions first, don't act blindly or forcefully, and communicate with doctors and nurses if you have any problems, which is better than anything else.