A school-age child has a diagnosis of juvenile rheumatoid arthritis. What instruction(s) to assist in decreasing the child's joint pain should the nurse provide to the parents?
1. Have the child use elevators of repeated trips up and down stairs.
2. Perform all range-of-motion exercises daily, even if joints are acutely inflamed.
3. Encourage the child to take naps in the afternoon.
4. As soon as the child is awake in the morning, administer an NSAID.
5. Have the child soak in a warm tub for 15 minutes just after arising in the morning.
6. Encourage swimming and pool activities.
Answers: 1, 5, 6
Rheumatoid arthritis may cause chronic, severe joint pain. Using the elevator would decrease joint stress from repetitive movements. Acutely inflamed joints may need temporary rest and immobilization with lightweight splints sometimes prescribed to prevent deformity from muscle spasms and contractures. Moist heat is beneficial, especially in the mornings when the joints are stiff. NSAIDs should be taken after meals and not on an empty stomach. Exercising in a pool allows freedom of movement without weight on the joint. Naps are not encouraged, because they promote stiffness during the day and may interfere with the child sleeping at night.
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