Nursing Older People with Arthritis and other Rheumatological Conditions (Perspectives in Nursing Management and Care for Older Adults)

Foreword
Preface
	Nursing Older People with Arthritis and Other Rheumatological Conditions
Contents
Part I: Arthritis and Other Rheumatological Conditions
	1: Osteoarthritis
		1.1	 Learning Outcomes
		1.2	 Introduction
		1.3	 Defining Osteoarthritis
		1.4	 Risk Factors for Osteoarthritis
			1.4.1	 Person-Level Risk Factors
			1.4.2	 Joint-Level Risk Factors
		1.5	 Impact of Osteoarthritis
		1.6	 Diagnosis
		1.7	 Signs and Symptoms
		1.8	 Investigations to Assist in the Diagnosis and Management of OA
			1.8.1	 X-Rays
				1.8.1.1	 Computed Tomography (CT) Bone Scan Imaging
				1.8.1.2	 Ultrasound Scan
				1.8.1.3	 Magnetic Resonance Imaging (MRI)
				1.8.1.4	 Laboratory Tests
		1.9	 Treatments and Their Efficacy
			1.9.1	 Conservative Management
			1.9.2	 Surgical Options of Management
				1.9.2.1	 Hip Resurfacing
				1.9.2.2	 Osteotomy
				1.9.2.3	 Total Joint Replacement
		1.10	 Research in Osteoarthritis
		1.11	 Self-Assessment
		References
			Further Reading
	2: Rheumatoid Arthritis
		2.1	 Learning Outcomes
		2.2	 Cause
		2.3	 Diagnosis
		2.4	 The Pharmacological Treatment of RA
		2.5	 Signs, Symptoms, and Assessment
			2.5.1	 Pain
			2.5.2	 Fatigue
			2.5.3	 Sleep
		2.6	 Management
			2.6.1	 Patient Education
			2.6.2	 Physical Activity, Physical Therapy, and Occupational Therapy
			2.6.3	 Psychosocial Support
			2.6.4	 Outpatient Follow-Up
		2.7	 Comorbidities Associated with the Condition
			2.7.1	 Cardiovascular Disease
			2.7.2	 Vaccinations
			2.7.3	 Osteoporosis
		2.8	 Self-Assessment
		References
			Further Reading
	3: Gout
		3.1	 Learning Outcomes
		3.2	 Introduction
		3.3	 Defining Gout
		3.4	 Risk Factors
		3.5	 Signs and Symptoms of Gout
		3.6	 Diagnosing Gout
		3.7	 Gout and Associated Comorbidities
		3.8	 Treatments for Gout
			3.8.1	 Urate Lowering Therapy (ULT)
				3.8.1.1	 Allopurinol
				3.8.1.2	 Febuxostat
				3.8.1.3	 Uricosuric Drugs
				3.8.1.4	 Flare Prophylaxis
			3.8.2	 Managing Flares
				3.8.2.1	 NSAIDs
				3.8.2.2	 Steroids
				3.8.2.3	 Colchicine
		3.9	 The British Society of Rheumatology Guideline
			3.9.1	 Management of Acute Flares
			3.9.2	 Modification of Lifestyle and Risk Factors
			3.9.3	 Optimal Use of Urate-Lowering Therapy
		3.10	 The Role for the Healthcare Professional
		3.11	 Self-Assessment
		References
			Further Reading
	4: Polymyalgia Rheumatica
		4.1	 Learning Outcomes
		4.2	 Introduction to PMR
			4.2.1	 PMR and Giant Cell Arteritis (GCA)
		4.3	 Aetiology
		4.4	 Pathogenesis
		4.5	 Incidence and Prevalence
		4.6	 Clinical Presentation: Signs and Symptoms
			4.6.1	 Clinical Presentation in GCA
		4.7	 Diagnosis
		4.8	 Investigations
			4.8.1	 Blood Tests
			4.8.2	 Imaging
			4.8.3	 GCA Investigations
		4.9	 Medical Management
		4.10	 The Nursing Assessment
		4.11	 The Nurses Role in Management of PMR
			4.11.1	 Holistic Management Approach
			4.11.2	 Symptom Management
			4.11.3	 Medication Education
			4.11.4	 Patient Education
			4.11.5	 Multi-disciplinary Team Referrals
		4.12	 Prognosis and Relapse
		4.13	 Self-Assessment
		References
			Further Reading
	5: Osteoporosis and Fractures
		5.1	 Learning Outcomes
		5.2	 Introduction to Osteoporosis and Osteoporotic Fracture
		5.3	 Cause
		5.4	 Diagnosis
		5.5	 Signs and Symptoms
		5.6	 Risk Factors
		5.7	 Investigations
		5.8	 Management
		5.9	 Managing and Preventing Falls
		5.10	 Self-Assessment
		5.11	 Suggested Further Study
		References
Part II: Aspects of Care and Management
	6: Managing Fatigue
		6.1	 Learning Outcomes
		6.2	 Introduction
		6.3	 Defining Fatigue
		6.4	 Prevalence of Fatigue in Rheumatic Disease
		6.5	 Causes and Predictors of Fatigue
			6.5.1	 Inflammation
			6.5.2	 Pain and Function
			6.5.3	 Other Chronic/Long-Term Conditions and Medications
			6.5.4	 Mood
			6.5.5	 Sleep Disturbance
			6.5.6	 Illness Perceptions
			6.5.7	 Age-Related Physiological Changes
			6.5.8	 Age
			6.5.9	 Gender
		6.6	 Assessment of Fatigue
			6.6.1	 Self-Reported Outcome Measures for Fatigue
				6.6.1.1	 Single Item Scales
				6.6.1.2	 Multidimensional Self-Assessment Questionnaires
		6.7	 Investigations for Fatigue
		6.8	 Management of Fatigue
			6.8.1	 Non-pharmacological Interventions for Fatigue Management
				6.8.1.1	 The 4 ‘Ps’
				6.8.1.2	 Cognitive Interventions
				6.8.1.3	 Physical Activity and Exercise
				6.8.1.4	 Patient Education and Self-Management Programmes
				6.8.1.5	 Sleep
			6.8.2	 Pharmacological Treatment
		6.9	 Self-Assessment
		References
			Further Reading
	7: Pain Management
		7.1	 Learning Outcomes
		7.2	 Introduction
		7.3	 Defining Pain
		7.4	 Pain Mechanisms
			7.4.1	 Pain Messages
			7.4.2	 C Fibres and A Delta Fibres
			7.4.3	 Pain Gate Theory
		7.5	 Assessment
		7.6	 Guidelines for Pain Assessment and Management
		7.7	 Assessment Scales for Pain
			7.7.1	 Self-Report Outcome Measures for the Older Person
		7.8	 Pain Management: Pharmacological
			7.8.1	 Paracetamol
			7.8.2	 Topical Treatments
			7.8.3	 Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
			7.8.4	 Opioids
			7.8.5	 Tricyclic Antidepressants and Anti-Epileptic Drugs
			7.8.6	 Intra-Articular Corticosteroid Injections
		7.9	 Non-Pharmacological Interventions for Pain Management
			7.9.1	 Education Programmes
			7.9.2	 Exercise
			7.9.3	 Pacing and Goal Setting
			7.9.4	 Transcutaneous Electrical Nerve Stimulation (TENS)
			7.9.5	 Cognitive Behavioural Therapy (CBT)
			7.9.6	 Orthoses
			7.9.7	 Hot and Cold Therapies
			7.9.8	 Sleep
		7.10	 Self-Assessment
		References
			Further Reading
	8: The Psychological and Social Impact of Arthritis
		8.1	 Learning Outcomes
		8.2	 Introduction
			8.2.1	 Considering the ‘Biopsychosocial’
		8.3	 Low Mood
			8.3.1	 How Do I Recognise Depression?
			8.3.2	 Depression in Older Adults
		8.4	 Body Image and Sexual Relationships
			8.4.1	 Sexual Relationships
			8.4.2	 Assessing Body Image
		8.5	 Social Roles, Valued Activities and Social Support
			8.5.1	 Social Roles
			8.5.2	 Social Support
			8.5.3	 Valued Activities
		8.6	 Self-Assessment
		8.7	 Suggested Further Reading/Study
		References
	9: Drug Therapy
		9.1	 Learning Outcomes
		9.2	 Introduction
			9.2.1	 Pharmacological Management of Arthritis
			9.2.2	 Pharmacokinetics and Pharmacodynamics in the Older Person
		9.3	 Analgesia
			9.3.1	 Non-opioid Analgesics
			9.3.2	 Compound Analgesics
			9.3.3	 Opioid Drugs
			9.3.4	 Adjuvant Therapies
			9.3.5	 Topical Analgesics
		9.4	 Non-steroidal Anti-Inflammatory Drugs (NSAIDs)
		9.5	 Disease-Modifying Anti-Rheumatic Drugs (DMARDs)
			9.5.1	 Traditional DMARDs
				9.5.1.1	 Methotrexate
				9.5.1.2	 Sulfasalazine
				9.5.1.3	 Hydroxychloroquine
				9.5.1.4	 Leflunomide
			9.5.2	 Targeted Synthetic DMARDs
			9.5.3	 Biologic DMARDs
		9.6	 Corticosteroids
		9.7	 Self-Assessment
		References
			Further Reading
	10: Optimising Function
		10.1	 Learning Outcomes
		10.2	 Introduction
		10.3	 The Case for Exercise
		10.4	 How to Exercise and Increase Activity Safely
		10.5	 Promoting Activity in Older People Recovering from Injury/Surgery or Requiring Surgery
		10.6	 The Role of the Multi-Disciplinary Team
		10.7	 Factors that Can Impact on Function
		10.8	 The Impact of Mood on Function
		10.9	 The Role of Voluntary Services
		10.10	 Conclusion
		10.11	 Self-Assessment
		References
			Further Reading
	11: The Foot
		11.1	 Learning Outcomes
		11.2	 Introduction
		11.3	 Rheumatoid Arthritis and the Feet
		11.4	 Systemic Lupus Erythematosus and the Feet
		11.5	 Management of Foot Problems
		11.6	 Patient Education Related to Foot Health
		11.7	 Foot Orthoses
		11.8	 Footwear
		11.9	 Management of Callus
		11.10	 Foot Ulceration
		11.11	 Management of Nail Conditions
		11.12	 Steroid Injection Therapy
		11.13	 Foot Surgery
		11.14	 Summary
		11.15	 Self-Assessment
		References
			Further Reading
	12: Self-Management
		12.1	 Learning Outcomes
		12.2	 Introduction
		12.3	 Defining Self-Management
		12.4	 Self-Management Support
			12.4.1	 Access to Support
			12.4.2	 Person-Centred Care
			12.4.3	 Self-Efficacy
			12.4.4	 Patient Engagement
			12.4.5	 Family Engagement
			12.4.6	 Professional Engagement
		12.5	 Self-Management Tools and Techniques
			12.5.1	 Action Planning and Goal Setting
			12.5.2	 Patient Activation
			12.5.3	 Motivational Interviewing
			12.5.4	 Health Coaching
			12.5.5	 Communication
		12.6	 Self-Management Interventions
		12.7	 Self-Assessment (Suggested Further Study)
		References
			Further Reading