A nurse is caring for a 65-year-old client with osteoarthritis of the hands. Which nursing intervention should be the priority to help manage the client's pain and maintain joint function?
1Encourage gentle range-of-motion exercises and low-impact activities such as swimming or walking✓ 정답
2Recommend complete bed rest to prevent further joint damage
3Apply ice packs to the affected joints for 30 minutes every hour
4Advise the client to take high-dose NSAIDs continuously for maximum pain relief
해설
Gentle range-of-motion exercises and low-impact activities maintain joint mobility and prevent stiffness in osteoarthritis without exacerbating pain. Other options may worsen symptoms or have risks.
Core Nursing ExplanationKey Concept Analysis: This question assesses the management of Osteoarthritis (OA), a degenerative joint disease characterized by the breakdown of articular cartilage, leading to pain, stiffness, and loss of function. The core principle in managing chronic OA is function over rest. While acute inflammation may require rest, prolonged immobility leads to joint stiffness, muscle atrophy, and worsening pain. The priority nursing intervention focuses on maintaining and improving joint function through safe activity.
Answer Rationale: Key Point! The correct answer is to encourage gentle range-of-motion (ROM) exercises and low-impact activities. This is the cornerstone of non-pharmacological management for OA. Gentle ROM exercises help maintain joint flexibility, reduce stiffness, and preserve the strength of surrounding muscles, which provides better joint support. Low-impact activities like swimming or walking promote overall health, cardiovascular fitness, and weight management without placing excessive stress on the weight-bearing joints, thereby reducing pain in the long term.
Distractor Analysis:
Watch out for confusion! Option ②, recommending complete bed rest, is contraindicated for chronic OA. While short-term rest during acute flare-ups is appropriate, prolonged immobility leads to joint contractures, decreased muscle mass, and increased pain and disability.
Option ③, applying ice packs for 30 minutes every hour, is an excessive and potentially harmful regimen. Ice therapy (cryotherapy) is useful for acute inflammation or post-exercise soreness, typically applied for 15-20 minutes at a time. Applying ice for 30 minutes every hour risks tissue damage (frostbite) and is not a sustainable long-term pain management strategy for chronic OA.
Option ④, advising continuous high-dose NSAIDs (Nonsteroidal Anti-inflammatory Drugs), is dangerous. Long-term, high-dose NSAID use carries significant risks, including gastrointestinal bleeding, renal impairment, and increased cardiovascular events. Pain medication for OA should be used at the lowest effective dose for the shortest duration possible, often on an as-needed basis, not continuously at high doses.
Related Concepts: OA management is multimodal, including weight management, physical therapy, assistive devices (e.g., jar openers), pharmacological management (acetaminophen first-line, then topical or oral NSAIDs), and patient education on joint protection techniques (e.g., using larger joints to carry loads).
Nursing Clinical Practice GuideClinical Scenario: You are a nurse in an outpatient clinic. Mrs. Johnson, a 65-year-old retired teacher with OA in her hands and knees, reports increased morning stiffness and pain, making it difficult to prepare her breakfast. She has been avoiding her daily walks due to knee pain.
Nursing Intervention Strategy:
1AssessmentPerform a pain assessment (PQRST). Assess joint function: grip strength, ability to perform ADLs (Activities of Daily Living), and gait. Evaluate her current activity level and fears about movement.
2Education & PlanningEducate on the "move it or lose it" principle for OA. Collaborate to create an activity plan: start with gentle hand ROM exercises (making a fist, spreading fingers) in a warm bath in the morning to reduce stiffness. Schedule short, 10-minute walks after taking her prescribed analgesic. Discuss referral to a physical therapist for a tailored exercise program.
3ImplementationTeach joint protection strategies: use electric can openers, leverage tools, and carry bags with forearms instead of fingers. Reinforce the importance of warming up before activity and using ice packs (15-20 minutes) on knees after walking if they feel warm or swollen.
4EvaluationFollow up in 2 weeks. Is she able to perform her morning routine with less pain? Has she resumed walking? Adjust the plan based on her feedback and tolerance.
Patient Safety and Precautions: Monitor for signs of medication toxicity if the patient is on NSAIDs (e.g., dark stools, abdominal pain). Educate that some pain with new exercises is normal, but sharp, worsening pain is a sign to stop and reassess. Ensure exercises do not overstress the joints.
Nursing Procedure & Medication FlowPatient Education for OA Management:
1Exercise PrescriptionFrequency: Daily ROM exercises. Intensity: To the point of mild stretch, not pain. Time: 5-10 minutes, 2-3 times a day.
2Medication AdministrationIf prescribed oral NSAIDs (e.g., ibuprofen), instruct to take with food or milk to minimize GI upset. Emphasize using the lowest effective dose (e.g., 400mg) only when needed for pain, not on a rigid schedule.
3Thermal TherapyUse heat (warm towels, paraffin wax) for 15-20 minutes to relieve stiffness and muscle spasm, especially before exercise. Use cold (ice packs) for 15-20 minutes to reduce inflammation and numb pain after activity or during acute flare-ups.
A Word from Your Senior Nurse
"Osteoarthritis teaches us a beautiful nursing paradox: sometimes, to reduce pain, you must gently move through it. Our role is to empower patients like Mrs. Johnson, breaking the cycle of 'pain → fear → immobility → more pain.' On the NCLEX, they love to test your understanding of this balance between activity and rest for chronic conditions. Remember, for degenerative diseases, the goal is function. The answer that promotes safe, maintained function is almost always the right one."
Osteoarthritis — A degenerative joint disease involving the breakdown of articular cartilage and underlying bone, leading to pain, stiffness, and loss of function.
Range of Motion (ROM) Exercises — Activities that move a joint through its full spectrum of movement to maintain flexibility, prevent contractures, and reduce stiffness.
Nonsteroidal Anti-inflammatory Drugs — A class of medications (e.g., ibuprofen, naproxen) that reduce pain, fever, and inflammation by inhibiting cyclooxygenase enzymes. Used cautiously in OA due to GI, renal, and CV risks.
Cryotherapy — The therapeutic application of cold to reduce inflammation, swelling, and pain by causing vasoconstriction. Used for acute injury or post-activity soreness.
Activities of Daily Living — Basic self-care tasks such as bathing, dressing, feeding, and toileting. Maintaining the ability to perform ADLs is a primary goal in chronic condition management.