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JIA Nursing Care Notes

Juvenile Idiopathic Arthritis (JIA) 

An admission to hospital may be required at diagnosis as part of initial assessment and treatment or if there is disease flare or suspected infection or as a complication of immunosuppression.

Problem

Nursing support

Stiff swollen joints due to inflammation of the joint and potentially other surrounding structures

Establish which joints may be affected and whether any joints appear swollen. Enquiry about impact on daily life may indicate which joints are affected.

Assess pattern of symptoms – inflamed joints are often stiff in the mornings (early morning stiffness) or after periods of inactivity (called gelling).

Warm bath in the morning can assist with improving joint movement.

Assess activities of daily living to determine which aspects they may need assistance with.

Physiotherapy programme or exercise, movement and or stretching may be required.

Regular pain relief and anti-inflammatory medication (non-steroid anti-inflammatory drugs NSAIDS) may help relieve symptoms.

Liaise with medical team to plan treatment.

Upper limb – hands, wrists, elbows, shoulders affected by arthritis causing loss of function

Enquiry about impact of swollen/stiff painful joints (school, home, play).

May need assistance (dressing, cutting food, brushing teeth, fastening shoes).

An electric or powered toothbrush may be helpful.

Consider writing skills and impact upon education.

Specialist team will advise regarding support required at school.

Occupational therapist may be able to offer specific support and expertise.

Promote independence as much as possible.

Lower limb – feet, ankles, knees, hips affected by arthritis causing loss of function

Careful nursing assessment about impact of swollen/stiff painful joints – school, home, play.

Questioning to include; Is mobility affected? Are they more clumsy, prone to falling? Do they tire more easily? Need to be carried? Can the family cope with this adjustment?

What are the home circumstances? Is the toilet upstairs?

Can they wear comfortable footwear? Often a trainer style is more supportive and comfortable than a fashion shoe.

Does their gait appear affected, do they normally walk to school, has there been a reduction in their normal activities?

Swimming may help improve function and improve muscle strength.

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