Description
● Overview of the Case:
➣ Patient Profile: 60-year-old female teacher without diabetes.
➣ The main complaints were:
• Five weeks of intermittent fever.
• Five weeks of increasing pain in the right thigh and buttocks.
• Weight reduction during the same time frame.
➣ Features of the pain:
• Mild at first, sporadic, non-traumatic, non-inflammatory;
• progressively increased, resulting in severe discomfort and immobility (bed-bound).
➣ Absence of bowel/bladder dysfunction, paraesthesia, tingling, or numbness.
Clinical Assessment:
➣ General Exam:
• A look of anaemia.
• No hepatosplenomegaly or lymphadenopathy.
• At examination, afebrile, although with a history of sporadic fever.
➣ Musculoskeletal Findings:
• Right buttock soreness in a specific location.
• Right hip pain was reported during compression and distraction testing.
➣ There is no outward oedema, erythema, or indications of inflammation; range of motion is painful and limited.
● Imaging and Radiological Results:
➣ The right hip joint's ultrasound (USG) measurements:
• Moderate joint effusion that shows signs of cartilage interface and double contour, which are indicative of synovial disease.
➣ Both hip joints on MRI (Figure 5):
•Results that are in line with right hip tubercular arthritis.
• There is oedema in the surrounding soft tissues and synovial thickening.
• No signs of abscess development or osteomyelitis.
★ Final Diagnosis:
➣ Right Hip Tubercular Arthritis in an immune-compromised Female.
Protocol
● Handling & Handling:
➣ Antitubercular Therapy (ATT):
• The standard four-drug regimen (Ethambutol, Rifampicin, Pyrazinamide, and Isoniazid) was started.
• Because of osteoarticular involvement, a prolonged duration of 9–12 months is planned.
➣ Supportive measures include physiotherapy and NSAIDs for pain management.
• Exercises for joint mobilisation to avoid stiffness.
• Iron supplements and nutritional support for the treatment of anaemia.
• During ATT, liver function is regularly monitored.
● Nursing Management Strategies and Interventions → Evidence-based nursing interventions that are customised for the patient's tubercular arthritis with functional limitation and chronic inflammation address these problems:
➣ Customised Patient Instruction
In order to prevent relapse or medication resistance, the patient should be educated about tubercular arthritis and the importance of strictly adhering to the entire course of antitubercular therapy (ATT).
• Describe the significance of progressive mobilisation and physiotherapy in preventing joint deformity and stiffness.
• To treat anaemia and promote tissue healing, give advice on a healthy diet, enough protein, and foods high in iron.
• Advice on how to protect joints and, if necessary, how to use assistive technology while recovering.
➣ Drug Administration
• Ensure that ATT medications (Isoniazid, Rifampicin, Pyrazinamide, Ethambutol) are administered accurately and for the recommended time (9–12 months).
• Keep an eye out for adverse drug reactions, particularly hepatotoxicity (from pyrazinamide, isoniazid, and rifampicin) and visual abnormalities (from ethambutol).
• To track compliance, keep a medication record sheet.
• To guarantee the safe continuation of treatment, promote routine liver function tests and recurring clinical evaluation.
➣ Prevention of Infection
• To avoid cross-infection, use the usual measures when receiving wound care or physiotherapy.
•If respiratory symptoms appear, teach the patient and their family how to cough properly and dispose of their sputum safely.
• To reduce the risk of infection during long-term treatment, emphasise personal hygiene and environmental cleanliness.
➣ Pain and Movement Control
• Regularly use a numerical pain scale to quantify pain, and provide prescribed analgesics or non-pharmacological pain management techniques (e.g., relaxation, heat fomentation).
• Under supervision, carry out graded physical therapy to preserve joint range of motion and avoid contractures.
• Until complete weight-bearing is tolerated, assist the patient when walking by using walkers or crutches as necessary.
• Establish rest intervals to prevent joint strain and exhaustion.
➣ Ongoing Nursing Assistance and Monitoring
• Arrange for frequent follow-up appointments to gauge functional recovery, track medication tolerance, and gauge clinical response.
• To ensure that appointments are kept, use SMS or phone reminders.
•Promote self-reporting of symptoms including increasing joint pain, jaundice, or vision issues.
•Work together with doctors and physiotherapists to assess patients' progress and adjust treatment plans as necessary.
➣ Support from Psychologists
• To address anxiety, decreased mobility, and reliance on others for everyday tasks, provide emotional support.
Encourage the patient to stay upbeat and take an active role in their recovery.
•To provide home-based assistance and psychological reinforcement, promote family involvement.
➣ Coordinated and Team-Based Care
•For comprehensive care, work together with physiotherapists, infectious disease experts, orthopaedic surgeons, and dietitians.
• To guarantee that care goals are in sync, take part in interdisciplinary meetings.
Throughout the healing process, keep an eye on adherence, treatment tolerance, and functional results.
Notes
For more details visit https://doi.org/10.1016/j.clinpr.2024.100383