Symptom: Joint, Swelling

Initial Grading Reminder

CTCAE Criteria for Grading Joint Swelling:

Grade 1: ≤25% loss of ROM (range of motion); decreased ROM limiting athletic activity
Grade 2: >25 – 50% decrease in ROM; limiting instrumental ADLs
Grade 3: >50% decrease in ROM; limiting self-care ADLs; disabling

Assessment and Grading

Characterize the symptom (onset, pace)

Ask the patient:

Is this a new or worsening symptom? When did it start or get worse? Have you had any joint issues in the past? How much worse is it now? Has it developed gradually or suddenly?

Grade the symptom

Ask the patient:

Which joint is bothering you? How unstable is your joint? Can you put weight on it? Do you feel like you need something to stabilize you when you walk, like a cane or walker?

Patient Query Regarding Other Symptoms/Red Flags

Ask the patient:

Have you fallen or felt like you might fall?

Patient Factors to Consider That Affect the Approach to Intervention

Consider the following in individualizing the intervention: Is the patient a good or poor historian? Any language barriers or cognitive deficits? Is the patient reliable (able to carry out treatment recommendations)? Does this patient have alcohol/substance abuse issues? Does the patient have transportation? Is there sufficient caregiver support?

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    Suggested Intervention

    Patients with moderate or worse joint swelling should be seen. Patients with any of the red-flag symptoms should be seen immediately.

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    Nursing Assessment of Potential Causes

    [tab category='ArthralgiasArthritis' header="Arthralgias and Arthritis - Nursing Assessment" tab1='Look' tab2='Listen' tab3='Recognize']

    Differential Diagnosis

    What do you suspect is the cause of the joint swelling?