RA is an autoimmune disease where the immune system mistakenly targets and attacks the joint linings causing uncontrolled inflammation of the synovium. Joints on both sides of the body (bilateral) are affected, primarily the hands, wrists and knees. RA is characterized by bone erosion and joint deformity. As the disease progresses other joints may be affected symmetrically. Chronic inflammation and degenerative changes are the hallmark aspects of RA.
Doctors are still unsure as to what triggers RA, but it appears to be at least partially genetic in nature. This genetic predisposition makes the patient more susceptible to environmental factors like viruses and bacteria that may trigger the initial inflammation. Once the inflammation begins, the synovial fluid thickens and the tendons and ligaments weaken and stretch, resulting in the joint losing its shape and alignment.
While there is no cure, the goal of treatment is to manage the symptoms and slow disease progression. Medication, physical or occupational therapy and possibly surgery may be necessary.
Rheumatoid Arthritis (RA) Nursing Care Plan
- Joint stiffness, symmetrical
- Joint pain
- Warmth of joints
- Joint edema
- Deformity of joints
- Weight loss
Nursing Interventions and Rationales
- Assess and manage chronic and acute pain
- Pillow supports
- Warm compresses to loosen stiff joints/relax muscles
- Cold compresses to numb pain and reduce swelling
- Administer PRN pain meds
The primary complaint of patients with RA is the intense pain and stiffness of the joints. Manage chronic pain and breakthrough pain as necessary.
- Administer medications appropriately
- NSAIDs are given to reduce inflammation and ease pain
- Steroids (prednisone) is often given to reduce inflammation and slow joint damage
- DMARDs (methotrexate, hydroxychloroquine) are disease-modifying antirheumatic drugs that are given to slow the progression of RA and save the joints and tissues from permanent damage
- Biologic agents (rituximab, adalimumab) are biologic response modifiers and work by targeting parts of the immune system that trigger inflammation.
As the disease progresses, it may be difficult for patients to perform ADLs such as feeding themselves or combing their hair; provide tools such as eating utensils or toothbrushes with larger grips to encourage patients to remain independent.
- Cluster care, promote rest
Fatigue is a common symptom of RA. Cluster care and promote rest as necessary
- Promote positive self-image
Patients with joint deformities may experience a negative body image
- Encourage activity / exercise
Patients fatigue easily, but daily exercise can help loosen joints. Encourage activity as tolerated.
- Nutrition and lifestyle education
- Healthy diet
- Avoid alcohol
- Quit smoking
When patients are in pain, they often want to turn to comfort foods. Help patients make healthy diet choices, avoiding alcohol and smoking.
Patients can also consult with a nutritionist regarding an anti-inflammatory diet.
Cornell Note-Taking System Instructions:
- Record: During the lecture, use the note-taking column to record the lecture using telegraphic sentences.
- Questions: As soon after class as possible, formulate questions based onthe notes in the right-hand column. Writing questions helps to clarifymeanings, reveal relationships, establish continuity, and strengthenmemory. Also, the writing of questions sets up a perfect stage for exam-studying later.
- Recite: Cover the note-taking column with a sheet of paper. Then, looking at the questions or cue-words in the question and cue column only, say aloud, in your own words, the answers to the questions, facts, or ideas indicated by the cue-words.
- Reflect: Reflect on the material by asking yourself questions, for example: “What’s the significance of these facts? What principle are they based on? How can I apply them? How do they fit in with what I already know? What’s beyond them?
- Review: Spend at least ten minutes every week reviewing all your previous notes. If you do, you’ll retain a great deal for current use, as well as, for the exam.
For more information, visit www.nursing.com/cornell