Rheumatoid Arthritis Patient Education Activity

profileBabanee
ImmuneRA2.pptx

Immune System: Rheumatoid Arthritis

Adult Health 2 Teaching Team

1

RA: autoimmune disease that starts in synovial tissue

2

3

4

Swan neck deformity

Ulnar deviation

Rheumatoid nodules

5

Diagnostic and Monitoring Labs

Lab Normal Range Change in RA
Anti-CCP antibodies positive
Rheumatoid factor antibody 1:20 or less 1:40 to 1:60 for diagnosis
Erythrocyte sed rate (ESR) < 20 20 to 40 = mild 40 to 70 = moderate 70 to 150 = severe
C-reactive protein < 1.00 elevated
Anti-nuclear antibody (ANA) negative positive
WBCs Elevated during exacerbation
RBCs decreased

6

Diagnostic Procedures

X-rays

Arthrocentesis

7

Medication Action Nursing Implications
NSAIDs Anti-inflammatory, analgesic, anti-pyretic Admin w/ food Teach s/s of GI bleeding and precautions Avoid concurrent use of salicylates Monitor for fluid retention, hypertension, and renal dysfunction
Corticosteroids (prednisone) Anti-inflammatory (for acute flares or advanced disease only) Short-term; tapered off. Monitor weight and blood pressure AEs are cataracts, osteoporosis, hyperglycemia, GI distress
DMARDs (all suppress immune system)
methotrexate Teratogenic; should use contraception or abstinence Teach s/s of infection avoid alcohol due to liver effects lab monitoring (liver, kidney)
hydroxychloroquine Report vision changes Ophthalamic exams q 6-12 months May cause GI upset; take with food
leflunomide Lab monitoring (liver enzymes) Teach reporting of hair loss or diarrhea Teratogenic; should use contraception or abstinence

8

RA Complications

9

Sjogren’s syndrome

Secondary osteoporosis

Vasculitis

Respiratory

Cardiac

Infection

Nursing Management

10

Pain and discomfort

Warm showers for morning stiffness

Heat for pain (paraffin baths for hands), stiffness

Cold for swelling

Alternative pain relief practices

Maintain Mobility

PT/OT referral

Promote and reinforce assistive device use

Low impact exercise and ROM

Resting acutely inflamed joints

Splinting affected joints

Nursing Management Goals

11

Fatigue

Sleep routine

Pacing/alternating activities w/ rest

Maintain nutrition

Dietary consult

Vitamins, protein, iron

Small frequent meals

Supplements, as prescribed