Nicole Pavich

Analysis:
The client exhibits pain, impaired physical mobility, and activity intolerance
all of which are secondary to arthritis. The client was diagnosed with arthritis 15
years prior and has been living with the manifestations of the disease ever since.
The definition of chronic pain is unpleasant sensory and emotional
experience arising from actual or potential tissue damage or described in terms of
damage; sudden or slow onset of any intensity from mild to severe, constant or
recurring without an anticipated or predictable end and duration of greater than 6
months: (Doenges, Moorhouse & Murr, 2008, p.503). One of the defining
characteristics of chronic pain that the client exhibits are vocal reports of pain of the
manifestations associated with pain, as the client states, Every morning I wake up
and the pain in my joints is almost unbearable until I take my daily medications, but
as they day goes on the pain gets worse, even at night. Other defining
characteristics of chronic pain that the client exhibits is self-stated fatigue during
ADLs and with that altered ability to continue previous activities (Doenges,
Moorhouse & Murr, 2008). Another defining characteristic of chronic pain is
increase vital signs (Doenges, Moorhouse & Murr, 2008). The client has been
hypertensive for the past 5 years, which may be related to her inability to engage in
activity due to this chronic pain that prevents the adverse effects of hypertension.
The client reported that she often feels weak/tired when walking to the bathroom
or getting the mail. The client also reported that she has trouble falling asleep at
night because of the pain. The client exhibited protective and guarding behavior, as
she would sporadically massage the joints of her hand for what appeared to be
temporary relief of pain during interviewing which validated her pain. It is
important that patients are taught therapeutic techniques. Such as in home
exercises and soothing muscle-relaxing techniques. (Impaired Physical Mobility,
Gulanick & Myers, 2008).
Impaired physical mobility is defined as limitation in independent,
purposeful, and physical movement of the body or one or more extremities
(Doenges, Moorhouse & Murr, 2008, p. 457). Report of pain and discomfort
((Doenges, Moorhouse & Murr, 2008) is one of the defining characteristics of
impaired physical mobility. As previously stated, the client reported that everyday
she wakes up with unbearable pain and as the day progresses the pain gets worse
which limits her ability to perform many ADLs. The client has restricted and slowed
movement as it takes her long periods of time to accomplish small tasks, which
some tasks she simply cannot do such as grab pictures on the top shelf to dust
them. The client has to use a long pole with a claw-like object on the end to take
hold of objects she once could grasp. The client displayed protective behavior as
shown by careful, slow ambulation with use of any nearby surface for support when
available. It is common for elders with activity intolerance to develop a slowed
reaction time, which they often compensate for with exceptional cautiousness, such
like the client exhibited (Berman, Snyder, Kozier & Erb, 2008, p. 411). She states she
is often dependant on her husband to now do many things she once could so such as
cook and fold the laundry.
The client appears to have a desire to make behavioral modifications to her
lifestyle that would aid in decreasing chronic pain and increasing her activity
tolerance. She has a very good support system in her family and states that her
family is extremely close. She knows she always have their support. Her husband
still works three times a week, but on the days that he is off he is willing to help her,
states the client. Her sister also lives down the street and could aid in anything she
needed. The client is slightly overweight, but wishes to work on weight reduction to
aid in controlling her chronic pain as well.
Nursing Diagnoses:
Chronic pain related to accumulation of fluid in and degeneration of joints
secondary to arthritis as manifested by clients verbal reports of daily pain.
Impaired physical mobility related to pain and degeneration of joints
secondary to arthritis as manifested by clients verbal report of reluctance to
attempt movement, dependence on others for assistance, and inability to manage
ADLs.
Planning:
Long Term Goal: The client will verbalize and demonstrate control of
pain/discomfort and report an increase in activity tolerance within three months.
Short Term Goal #1: The client will institute behavioral modifications of
lifestyle and appropriately utilize restorative techniques after being taught by nurse
these modifications and techniques to decrease pain and promote activity within
two weeks.
Nursing Intervention #1: Nurse will encourage the use of non-
pharmacological methods of pain control such and hot and cold application to the
site of pain at least twice daily once in the morning, once at night, mid exercise at
least 3 times weekly, and the use of massage and muscle strengthening exercises at
least twice daily.
Nursing Intervention #2: Nurse will promote assistive devices, such as a
walker or crutches to enhance ability to participate in activities.
Nursing Intervention #3: Nurse will have client keep a record of diet,
exercise, use of daily therapeutic techniques, and personal evaluation of pain for
two weeks to evaluate if behavioral modifications are properly implemented and
effective for pain management.
Short Term Goal #2: Client will be able to demonstrate mobility of hands and
knees with decreased pain and be able to perform everyday house hold tasks
without unbearable pain by going to physical therapy three times a week for six
months.
Nursing Intervention #1: Nurse will have patient go to physical therapy
three times a week to keep the patient consistently mobile and decrease her stated
pain.
Nursing Intervention #2: Nurse will evaluate patients pain two times a week
and record patients success of decreased pain. Nurse will educate and teach patient
in simpler in home exercise for patient to do when resting.
Nursing Intervention #3: Nurse will educate and communicate with patient
on the topic of arthritis and how to deal with the disease physically and
psychologically and record weekly the attitude of the patient and the increase
progress associated increased mobility.