Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disease involving connective tissue and characterized by destruction and proliferation of the synovial membrane, resulting in joint destruction, ankylosis, and deformity.
Although the cause is unknown, researchers speculate that a virus may initially trigger the body’s immune response, which then becomes chronically activated and turns on itself (autoimmune response). Immunologic mechanisms appear to play an important role in the initiation and perpetuation of the disease in which spontaneous remissions and unpredictable exacerbations occur. RA is a disorder of the immune system and, as such, is a whole-body disease that can extend beyond the joints, affecting other organ systems, such as the skin and eyes.
Nursing Care Plan for Rheumatoid Arthritis | Nursing Priorities
Nursing Care Plan for Rheumatoid arthritis: Nursing Priorities & Discharge GoalsNURSING PRIORITIES
- Alleviate pain.
- Increase mobility.
- Promote positive self-concept.
- Support independence.
- Provide information about disease process/prognosis and treatment needs.
DISCHARGE GOALS
- Pain relieved/controlled.
- Patient is dealing realistically with current situation.
- Patient is managing ADLs by self/with assistance as appropriate.
- Disease process/prognosis and therapeutic regimen understood.
- Plan in place to meet needs after discharge.
Nursing Care Plan for Rheumatoid Arthritis: Nursing Diagnosis
Nursing Care Plan for Rheumatoid Arthritis: Nursing Diagnosis for Rheumatoid Arthritis- Pain, acute/chronic related to Injuring agents: distension of tissues by accumulation of fluid/inflammatory process, destruction of joint.
Nursing Care Plan for Rheumatoid Arthritis: Nursing Intervention with Rationale.
Pain Management (NIC)
Nursing Intervention of Rheumatoid Arthritis: Independent
- Investigate reports of pain, noting location and intensity(scale of 0–10). Note precipitating factors and nonverbal pain cues. Rationale: Helpful in determining pain management needs and effectiveness of program.
- Recommend/provide firm mattress or bedboard, small pillow. Elevate linens with bed cradle as needed. Rationale: Soft/sagging mattress, large pillows prevent maintenance of proper body alignment, placing stress on affected joints. Elevation of bed linens reduces pressure on inflamed/painful joints.
- Suggest patient assume position of comfort while in bed or sitting in chair. Promote bedrest as indicated. Rationale: In severe disease/acute exacerbation, total bedrest may be necessary (until objective and subjective improvements are noted) to limit pain/injury to joint.
- Place/monitor use of pillows, sandbags, trochanter rolls, splints, braces. Rationale: Rests painful joints and maintains neutral position. Note: Use of splints can decrease pain and may reduce damage to joint; however, prolonged inactivity can result in loss of joint mobility/function.
- Encourage frequent changes of position. Assist patient to move in bed, supporting affected joints above and below, avoiding jerky movements. Rationale: Prevents general fatigue and joint stiffness. Stabilizes joint, decreasing joint movement and associated pain.
- Recommend that patient take warm bath or shower on arising and/or at bedtime. Apply warm, moist compresses to affected joints several times a day. Monitor water temperature of compress, baths, and so on. Rationale: Heat promotes muscle relaxation and mobility, decreases pain, and relieves morning stiffness. Sensitivity to heat may be diminished and dermal injury may occur.
- Provide gentle massage. Rationale: Promotes relaxation/reduces muscle tension.
- Encourage use of stress management techniques, e.g., progressive relaxation, biofeedback, visualization, guided imagery, self-hypnosis, and controlled breathing. Provide Therapeutic Touch. Rationale: Promotes relaxation, provides sense of control, and may enhance coping abilities.
- Involve in diversional activities appropriate for individual situation. Rationale: Refocuses attention, provides stimulation, and enhances self-esteem and feelings of general well-being.
- Medicate before planned activities/exercises as indicated. Rationale: Promotes relaxation, reduces muscle tension/spasms, facilitating participation in therapy.
Nursing Care Plan for Rheumatoid Arthritis: Nursing Intervention with Rationale.
Pain Management (NIC)
Nursing Intervention of Rheumatoid Arthritis: Collaborative
1. Administer medications as indicated, e.g.:
- Salicylates, e.g., aspirin (ASA) (Acuprin, Ecotrin, ZORprin); Rationale: ASA exerts an anti-inflammatory and mild analgesic effect, decreasing stiffness and increasing mobility. ASA must be taken regularly to sustain a therapeutic blood level. Research indicates that ASA has the lowest toxicity index of commonly prescribed NSAIDs.
- Nonsalicylates (NSAIDs), e.g., ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), sulindac (Clinoril), prioxicam (Feldene), fenoprofen (Nalfon), diclofenac (Voltaren), ketoprofen (Orudis), ketorolac (Toradol), nabumetone (Relafen); Rationale: These drugs control mild to moderate pain and inflammation by inhibition of prostaglandin synthesis.
- Glucocorticoids, e.g., prednisone (Deltasone), methylprednisolone (Depo-Medrol), dexamethasone (Decadron); Rationale: These drugs modify the immune response and suppress inflammation.
- Disease-modifying antirheumatic drugs (DMARD), e.g., methotrexate (Rheumatrex), hydroxychloroquine (Plaquenil), sulfasalazine (Azulfidine), gold compounds, e.g., auranofin (Ridaura), azathioprine (Imuran), leflunomide (Arava); Rationale: These drugs vary in action, but all reduce pain and swelling, lessening arthritic symptoms rather than eliminating them. Arava (FDA approved in 1998) is the first oral drug shown to slow progression of RA and damage to joints.
- COX-2 inhibitors, e.g., celecoxib (Celebrex), rofecoxib (Vioxx); Rationale: A new class of medication, COX-2 inhibitors interfere with prostaglandin production, similarly to NSAIDs, but are less likely to harm the stomach lining or kidneys. May be used in combination with other medications.
- Biologicals, e.g., etanercept (Enbrel), infliximab (Remicade); Rationale: These injectable drugs are the first genetically engineered medications for arthritis. These anti-TNF compounds block inflammation and rapidly decrease pain and joint swelling. Enbrel is self-injected twice a week and may be used in combination with methotrexate. Remicade is administered IV at 1- to 3-month intervals. Note: Because of concerns about immune function suppression, Enbrel is recommended only for patients who are unable to tolerate methotrexate/failed to respond to at least two other DMARDs.
- Tetracyclines, e.g., minocycline (Minocin); Rationale: Characteristics of anti-inflammatory and immune modifier effects coupled with ability to block metalloproteinases (associated with joint destruction) have resulted in dramatic benefits in research studies.
- D-Penicillamine (Cuprimine); Rationale: May control systemic effects of RA synovitis and scleroderma if other therapies have not been successful. High rate of side effects (e.g., thrombocytopenia, leukopenia, aplastic anemia) necessitates close monitoring. Note: Drug should be given between meals because drug absorption is impaired by food, as well as antacids and iron products.
- Antacids, e.g., misoprostol (Cytotec), omeprezole (Prilosec); Rationale: Given with NSAID agents to minimize gastric irritation/discomfort, reducing risk of GI bleed.
- Codeine-containing medications. Rationale: Although narcotics are generally contraindicated because of chronic nature of condition, short-term use of these products may be required during periods of acute exacerbation to control severe pain.
2. Assist with physical therapies, e.g., paraffin glove, whirlpool baths. Rationale: Provides sustained heat to reduce pain and improve ROM of affected joints.
3. Apply ice or cold packs when indicated. Rationale: Cold may relieve pain and swelling during acute episodes
4. Instruct in use/monitor effect of transcutaneous electrical nerve stimulator (TENS) unit if used. Rationale: Constant low-level electrical stimulus blocks transmission of pain sensations.
5. Assist with other modalities as indicated, e.g., blood filtration. Rationale: Prosorba Column is a device similar to a kidney dialysis machine that removes substances from blood plasma that contribute to joint swelling and pain.
6. Prepare for surgical interventions, e.g., synovectomy, total joint replacement, joint fusion; tunnel release procedures, tendon repair. Rationale: Corrective surgical procedures may be indicated to reduce pain and/or improve joint function, and mobility.
Nursing Care Plan for Rheumatoid Arthritis: Overview; Nursing Care Plan for Rheumatoid arthritis: Nursing Priorities & Discharge Goals; Nursing Care Plan for Rheumatoid Arthritis: Nursing Diagnosis; Nursing Care Plan for Rheumatoid Arthritis: Nursing Intervention with Rationale.
Nursing Care Plan for Rheumatoid Arthritis
