Infectious Arthritis: Nursing Interventions and Concerns

Infectious Arthritis - Nursing Interventions/Concerns (NCLEX/Wolters Kluwer Style)

• Pathophysiology of Infectious Arthritis:

  • Bacteria, viruses, or fungi invade the synovial joint space.
  • Inflammatory response results in pain, swelling, warmth, and redness.
  • Joint destruction can occur if not treated promptly.
  • Common pathogens include Staphylococcus aureus, Neisseria gonorrhoeae, and other organisms.

• Clinical Manifestations:

  • Severe joint pain, often described as excruciating.
  • Swelling and warmth in the affected joint, noticeably increasing over time.
  • Redness and erythema surrounding the affected joint.
  • Limited range of motion and stiffness.
  • Fever, chills, and malaise are possible systemic symptoms.
  • Elevated inflammatory markers (ESR, CRP).
  • Possible leukocytosis.
  • Patients might report recent trauma or invasive procedures.
  • Fever, elevated pulse, and rapid breathing might reflect involvement of other systems.

• Diagnostic Evaluation:

  • History including exposure to potential pathogens, recent trauma, or underlying conditions.
  • Physical examination, focusing on joint range of motion and tenderness.
  • Joint aspiration (arthrocentesis) for gram stain, culture, and cell count assessment.
  • Elevated WBC count in the aspirate strongly suggests infection.
  • X-rays to rule out other conditions.
  • Blood cultures to identify the causative pathogen.
  • Complete blood count (CBC) with differential to evaluate leukocytosis.
  • Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) to measure acute inflammation. High sensitivity C-reactive protein helps identify inflammation earlier and monitors treatment success.

• Nursing Interventions:

  • Pain Management: Administer analgesics (NSAIDs, opioids) per order, and closely monitor for adverse effects. Rotate analgesics to avoid tolerance, including acetaminophen.
  • Immobility:
    • Rest and support the affected joint using splints or braces as prescribed.
    • Ensure safety by repositioning the patient and using assistive devices for mobility as needed.
    • Elevate the affected limb to reduce swelling.
  • Infection Control: Maintaining aseptic technique in wound care (if present), intravenous line, and other procedures. Strict hand hygiene throughout the patient care.
  • Fluid and Electrolyte Balance:
    • Assess for signs and symptoms of dehydration.
    • Monitor intake and output and assess for electrolyte imbalance, which is frequent with fever.
    • Administer prescribed fluids per orders.
  • Nutritional Support: Assess and address nutritional needs due to pain or fever. Consider high-protein, calorie-dense diet with appropriate vitamins in consultation with a registered dietitian for optimal healing.
  • Medication Administration:
    • Monitor for adverse effects of antibiotics, NSAIDs, or corticosteroids.
    • Assess for allergies to various medications.
    • Administer medications as prescribed, documenting timings and responses. Monitor for drug interactions.
  • Monitoring for Complications: Watch for signs of sepsis, such as hypotension, tachycardia, altered mental status, decreased urine output, rapid breathing.
  • Education/Discharge Planning: Educate the patient on medication administration, signs of infection, importance of regular follow-up appointments, ongoing pain management, and disease course/prognosis. Reinforce the importance of completing the entire antibiotic course even if symptoms improve quickly.
  • Emotional Support: Provide emotional support to the patient, considering pain, immobility, and anxiety.
  • Collaboration: Collaborate with the physician, physical therapist, and other healthcare team members for optimal patient care. Advocate for the patient's needs.

• Nursing Care Concerns/Priorities:

  • Acute pain: Addressing pain with appropriate interventions is a priority, as it impacts mobility, sleep, and overall well-being. Prioritize non-pharmacologic pain management techniques.
  • Infection control: Maintaining aseptic technique is crucial for preventing further spread of infection. Proactive measures to prevent cross-contamination are vital in a healthcare environment.
  • Mobility/Immobility: Assess for signs of compromised circulation and maintain appropriate joint positioning. Assess for any muscular atrophy.
  • Fever/systemic symptoms: Assess and monitor body temperature, along with other vital signs, and provide antipyretics as prescribed. Keep in mind that fever might present in various symptoms among patients.
  • Patient education: The patient requires clear instructions regarding medication, potential side effects, and self-care strategies. Document education provided and patient understanding.

Critical Thinking Questions Related to Infectious Arthritis

• What diagnostic tests are most important in identifying infectious arthritis, and why? This includes arthrocentesis as the quickest method to diagnose, and blood cultures are important as blood cultures can identify the exact bacteria causing the problem leading to better treatment.
• How would you differentiate infectious arthritis from other types of arthritis? Consider the rapid onset and severity of symptoms in infectious arthritis.
• What are the potential complications of untreated infectious arthritis? Sepsis, permanent joint damage, and/or systemic infection can occur.
• What are the priorities of care for a patient with infectious arthritis? Pain management, aggressive infection control, and monitoring for complications are priority concerns. Assess and intervene promptly in potential complications.
• How might the patient's personal history contribute to their diagnosis or treatment? Consider if they have travel history or recent surgeries, as certain conditions might increase the risk.
• What interventions can the nurse employ to help maintain a patient's functional abilities while they are experiencing pain and immobility? This includes pain relief and assistive devices to increase mobility.
• What are the signs and symptoms of sepsis that the nurse should monitor for? Rapid breathing, altered mental status, decreased urine output, and hypotension.

Explore nursing interventions and concerns related to infectious arthritis. Learn about the pathophysiology, caused by bacteria, viruses, or fungi invading the synovial joint space, leading to inflammation, pain, and potential joint damage. Understand the clinical manifestations, including severe joint pain, swelling, warmth, and systemic symptoms.