Rheumatoid Arthritis Patient Education Activity
Babanee
ImmuneRA2.pptxImmune 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
