nursing assigment

Student Name:

Put your name here

Disorder/Disease:

Rheumatoid Arthritis

Alterations in Health (Diagnosis)

Pathophysiology Related to Client Problem

Health Promotion and Disease Prevention

The medical diagnosis I would see is osteoarthritis. The nursing diagnosis would be impaired physical mobility related to the restricted joint movement as evidenced by the limited range of motion on the knee joint

It's an autoimmune disorder that causes the body's immune system to attack the joints' synovial membrane. This makes it to hypertrophy and inflames, with time the cartilage of the bone and the joint is destroyed, causing a lot of pain (Scott et al.,.2018)

Avoid some triggers of the body's immune system such as cigarette smoke

Prevent infections such as Epstein Barr virus and Rubella virus

ASSESSMENT

Risk Factors

Expected Findings

Genetic factors, those with the human leukocyte antigen, contribute much to the development of the disease.

An infectious virus such Rubella and Epstein Barr virus, this is due to the occasional flu-like symptoms that precede the rheumatoid arthritis

Sex hormones also contribute to the development of the disease since most women get the disease more than men

Hyperprolactinemia is a risk factor too.

Acute onset of fever, myalgia, arthralgia, and weakness of the joints.

Polyarthritis which is symmetric and most experienced in the hands and the feet

Deterioration of the articulation of the joints which is progressive

Involvement of other parts of the system such as the muscles

Difficult in performing activities of daily living.

Laboratory Tests

Diagnostic Procedures

Erythrocyte sedimentation rate (ESR) (80-100) and C reactive protein are usually present; they are the markers of inflammation

Complete Blood Count shows anemia of chronic disease and relates to the activity of the disease

Mild leukocytosis

Leukopenia is usually present too

Radiography, X-ray of the hands and feet to show disease progression

MRI shows fine details on the lesions of the hands and the feet (Scott et al.,.2018)

Ultrasonography to show the effusions at the joints and also enables a clear view of tendon sheaths

PATIENT-CENTERED CARE

Nursing Care

Medications

Client Education

Pain management by giving analgesics

Massage and application of cold or heat

Turning of the patient, having a foam mattress to prevent bedsores

Administration of the rheumatoid medications and anti-inflammatory medications as prescribed by the physician

Patient education on the nature of the disease and the changes that may come about

Assessment of the need for occupational therapy and physiotherapy

Facilitate self-care for the patient

Disease-modifying anti rheumatoid drugs such as hydroxychloroquine, azathioprine, cyclosporine, among others the drugs slow the progression of the disease, prevent the destruction of the joints, and to avoid loss of the function of the limbs

TNF inhibitors such as infliximab, Adalimumab, these drugs bind to TNF and prevent its interactions.

Some of the biology DMARDS such as Rituximab is used when combined with methotrexate (Pisetsky, 2017)

The client should know that the condition is chronic and that it's progressive.

Adherence to the treatment is critical, and that the client should rest most of the time

They should also ensure that they don't sleep in one position for long to maintain skin integrity

The need for occupational therapy and the need for physiotherapy and counseling since the disease may cause loss of function and disfigure or cause disability

Therapeutic Procedures

Interprofessional Care

There some surgical procedures such as the use of orthotics and splints to reduce the pain and inflammation of the joints

Synovectomy whereby the surgeon removes the affected tissue to ease the symptoms (Smolen et al.,2016)

Arthrodesis whereby the affected joint is removed, and the bones are fused

Occupation therapy is involved because the patient may not be able to work again

Physiotherapy to help in the prevention of disability or to disfigure of the limbs

Speech-language pathologists to help in swallowing

Complications

Safety Considerations

Osteoporosis due to some of the medications

Carpal tunnel syndrome

Heart problems if the antibodies against the membranes of the joint reach the heart

Pulmonary fibrosis and also liver disease.

The client is at risk of falling since the joints are weak and there is a limited range of motion; there is a risk of infections, the medications used to alleviate the symptoms, such as methotrexate, lowers the immune system

There is a risk of the impairment of the skin integrity if the patient I bedridden.