Nursing Clinical Practice Guide
Clinical Scenario: Mr. Johnson, 68, is admitted for hypertension. During your assessment, he mentions his "bad knees" from arthritis keep him from walking much. He says, "The pain is worse when I get up in the morning or after I've been sitting, but if I walk to the mailbox, it feels a little better after a few steps."
Nursing Intervention Strategy:1. Assessment: Perform a focused joint assessment. Use the Pain scale. Ask about his daily activities and what he has tried for pain relief. Assess his gait and need for assistive devices.2. Planning & Implementation: Collaborate with physical therapy. Teach him a simple, seated knee ROM exercise: "Slowly straighten your leg, hold for 5 seconds, then slowly bend it back." Emphasize doing this gently and regularly, not just when in pain. Discuss weight management strategies if applicable.3. Patient Education: Teach the proper use of heat (warm shower in the morning for stiffness) vs. cold (ice pack for 15 min after increased activity for pain). Review safe use of acetaminophen (do not exceed 3000 mg/day).
Patient Safety and Precautions:- 1Exercise Caution:Instruct to stop exercise if it causes sharp, increased pain. "Hurting" is different from mild discomfort from moving a stiff joint.
- 2Medication Safety:Always ask about OTC medication use. Warn against combining multiple products containing acetaminophen.
- 3Fall Risk:Stiffness and pain increase fall risk. Ensure clear pathways and recommend proper footwear.
Nursing Procedure & Medication Flow
Teaching Gentle ROM Exercises:1. Ensure the client is in a comfortable, supported position (sitting in a firm chair).2. Demonstrate the movement slowly on your own limb.3. Guide the client to perform the movement passively, then actively.4. Instruct to perform 5-10 repetitions, 1-2 times daily.5. Evaluate understanding by having the client teach-back the exercise.
Administering/Teaching about NSAIDs:1. Assessment First: Check BUN/Creatinine, ask about history of PUD (Peptic Ulcer Disease) or GI bleed.2. Administration: Give with food or milk. For chronic use, proton pump inhibitors (PPIs) may be co-prescribed.3. Monitoring: Watch for black, tarry stools (melena), epigastric pain, changes in urine output.
A Word from Your Senior Nurse
Remember, for our patients with chronic conditions like osteoarthritis, our goal isn't to cure the disease but to maximize their quality of life and independence. That gentle ROM exercise you teach might seem small, but it's the key to keeping them out of a wheelchair and able to play with their grandkids. On the NCLEX, they're testing your nursing judgment: can you pick the action that promotes health and prevents harm? Always lean towards interventions that empower the patient and maintain function. You've got this!