Edivence based practice

hersurgical site. I was unable to give her any pain medication for the purpose of relieving her pain

because bulk of her pain medications were being administered intravenously, which my clinical

instructor previously reminded me of not administering any medication via such routes to my

assigned patient. However, after her pain calmed down, I was able to assess the surgical dressing

which was found to be intact with no drainage. The patient was alert and oriented times three to

person, place, and time and further assessment done by me proved positive with normal

sounds of both heart and lungs with no sound of crackles or wheezes from the heart. Other

cares including transferring the patient to pee using a beside commode, bladder scanning and

peri cares were also completed as scheduled.

Nursing Assessments/Interventions

Rheumatoid arthritis is a long-term condition characterized by pain, lethargy, and changes in

functional ability. It is a multi-system disease requiring long-term treatment with disease-

modifying drugs.

The diagnosis of RA is derived from a skilled clinical evaluation and examination of the individual

in secondary care, including a concise history of signs and symptoms and visual assessment of the

distribution of swollen painful joints supported by radiographic, hematological and biochemical

investigations. Systemic inflammation is often detected by an elevation in acute phase proteins,

such as CRP. This is useful in diagnostics and to determine efficacy of treatment and disease

progression.

The diagnostic issues are only the beginning of the management plan; there is still much to be

done, from a nursing perspective. The natural course of the disease varies and short-term changes

need to be considered in the context of the overall assessments. The clinical assessment will:

Inform management and guide diagnosis. Identify specific prognostic indicators that will defi ne

treatment strategies. Focus on a patient-centered approach. Management of early RA requires an

assessment to support. Time for the individual to discuss their anxieties and needs in the context

of a holistic assessment, e.g. adjusting to diagnosis, expectations and beliefs, social support,

psychological aspects, other comorbidities, work-related issues, relationships. Information,

support, and advice about RA, pharmacological and nonpharmacological options, risks, and

benefits of treatment and monitoring.

An assessment of pain (using a Visual Analogue Scale, VAS) and symptom control should be

implemented.

Section 2

Pathophysiology of Rheumatoid Arthritis

Rheumatoid arthritis occurs when a patient’s immune system attacks the synoviumthe lining of

the membranes that surround your joints. The resulting inflammation thickens the synovium,

which can eventually destroy the cartilage and bone within the joint.

The tendons and ligaments that hold the joint together weaken and stretch. Gradually, the joint

loses its shape and alignment.

Doctors don't know what starts this process, although a genetic component appears likely. While

your genes don't actually cause rheumatoid arthritis, they can make you more susceptible to

environmental factorssuch as infection with certain viruses and bacteria — that may trigger

the disease.This inflammatory disease develops because of a combination of genetic and

environmental factors, such as smoking and diet. It is unclear what the genetic link is, but it is

thought that having a relative with the condition increases your chance of developing the

condition.

Section 3

Best Practices Standards of Nursing Care related to Rheumatoid Arthritis

Expected Assessment Findings

While the same joints on both sides of the body is a typical finding in RA patients who have had

the disease for a long time, early in the disease only a few joints may be affected and there may

not be symmetrical involvement at this stage. The nurse will feel the patient’s joints to determine

if there is any swelling from inflammation or bony enlargement that may be a sign of arthritis.

Early signs of RA can be typically found in the hands, with swelling that occurs symmetrically

(both sides of the body), in the metacarpophalangeal (MCP) joints and proximal interphalangeal

(PIP) joints. These joints will be painful and tender to the touch and the range of motion will be

restricted.

Diffuse swelling of the ankle may also be a sign of RA. The nurse will look for signs of knee

involvement, including a thickening or swelling of the joint, with restriction of movement.

Involvement of the hips tends to occur later in the course of RA, and may be associated with pain

in the thigh, lower back, or groin, and restriction of movement that affects gait.

The joints of the cervical spine may be affected by RA, causing stiffness and pain in the neck.

Nursing Interventions

The primary complaint of patients with RA is the intense pain and stiffness of the joints. Manage chronic pain and breakthrough pain as necessary. As the disease progresses, it may be difficult for patients to perform activities of daily living 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. Assess and manage chronic and acute pain by

supporting the patient’s legs on pillow supports, apply warm compresses to loosen stiff joints, and administer as needed pain medications.

As the patients continue to be in pain, they often want to turn to comfort foods. The nurse should therefore assist the patients to make healthy diet choices, avoiding alcohol and smoking. Encourage hydration and allow the patients to also consult with nutritionists regarding an anti-inflammatory diet.

Expected Outcomes

As with other chronic diseases, no cure is available for most types of arthritis including rheumatoid arthritis. Furthermore, the course of the disease is often unpredictable, and the symptoms can vary from day to day or even from hour to hour. Because of the nature of pain and disability, the partial and inconsistent effects of treatment, and the unpredictability that people with arthritis face on a daily basis, education programs for patients have become a complement to traditional medical treatment. These programs have given people with arthritis the strategies and tools necessary to make daily decisions to cope with the disease

There's no permanent dietary cure for arthritis. Certain foods have the capability of fighting inflammation and boosting the immune system. It's therefore critical to have a healthy eating plan in place to rid you of the painful symptoms. Anti-inflammatory foods, like those found in Mediterranean diets, help a great deal in soothing the pain and controlling your weight while at the same time decreasing the risk of cardiovascular disease. Nurses in the community are charged with the responsibilities of helping patients with rheumatoid arthritis achieve the ultimate goals of remission or low disease activities.

Health Promotion Activities

Regular physical activity, defined as any bodily movement resulting in energy expenditure, is

associated with a reduction of morbidity and mortality in the general population. In patients with

rheumatoid arthritis, physical activity has also various disease-specific benefits such as improved

functional abilityand reduction of pain. A considerable number of rheumatoid arthritis patients,

however, do notexperience these health benefits. It has been found that the total amount of time

spent on physical activity is lower in RA patients and they spent less time on moderate-intensity

activities compared to the general population.Lifestyle changes can't cure rheumatoid arthritis

, but can help manage the condition, and decrease discomfort and disability. It's important to

find a balance to maintain as much of a normal life as possible.Based on the patient’s individual

needs, a nurse must encourage and assist him or her to establish health behaviors and activities

that promote rest and exercise, reduce stress, and encourage independence.

Conclusion

Knowledge of the disease process and drug therapy has led to a change in the way that health

professionals and patients with RA manage their disease. There is some evidence that underpins

The nursing care of these patients but much remains to be explored. What is known is that the

research undertaken to date shows that specialist nurses can manage these patients effectively,

and that the addition of nursing care makes a positive difference to the patient's outcome.

However, RA is a multifaceted illness and patients do need access to members of a

multidisciplinary team to ensure that all their needs are met. Nurses working in this specialty

area require a range of skills and in-depth knowledge of the disease to perform the complex care

that comprises rheumatology nursing.

References:

Aletaha D, Smolen JS. Assessment of the patient with rheumatoid arthritis and the measurement of outcomes. In: Hochberg MC, Gravallese EM, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, eds. Rheumatology. 7th ed. Philadelphia, PA: Elsevier; 2019: chap 101.

Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 2010;62(9):2569-81.

Anderson J, Caplan L, Yazdany J, et al. Rheumatoid arthritis disease activity measures: American College of Rheumatology recommendations for use in clinical practice. Arthritis Care Res (Hoboken). 2012;64(5):640-647. PMID: 22473918 www.ncbi.nlm.nih.gov/pubmed/22473918.

Brasington RD, Miner JJ. Clinical features of rheumatoid arthritis. In: Hochberg MC, Gravallese EM, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, eds. Rheumatology. 7th ed. Philadelphia, PA: Elsevier; 2019: chap 94.