Question

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Client Profile:

N.M is a 36-year-old overweight female who has Rheumatoid Arthritis (RA).  When her symptoms began to interfere with her daily activities she sought medical help.

Subjective Assessment Data:

• Complains of pain in the morning when waking up
• Has painful, stiff hands and feet
• Feels tired all of the time
• Reports low grade fever
• Takes naproxen (Aleve) 220mg twice daily
• Wears a copper bracelet on the advice of a neighbor

Objective Assessment Data:

• Hands show mild ulnar deformities and puffiness
• Temp: 100 degrees F
• Admitted to the hospital for examination and comprehensive treatment plan
• Medication:  Methotrexate (Rheumatrex) therapy to be initiated.

Discuss and answer the following questions.

1. Based upon the assessment data presented, what are five (5) priority nursing diagnosis?

2. Identify at least two (2) healthcare professionals and their roles that the nurse would collaborate with?

3. How should the nurse explain the pathophysiology of joint Rheumatoid Arthritis to N.M.?

Answer 1

Nursing diagnosis

1) Acute pain related to disease condetion as evidenced by verbal response and dull facial expression .

2) Altered body temperature related to diseases processas evidenced by temperature of

patient is 100 degree faranheet .

3) Impaired physical mobility related to pain as evidenced by stiff hands and feet .

4) Disturbed Body Image related to disease process as evidenced by mild ulnar deformities and puffiness.

5) Deficient Knowledge related to the management of disease as evidenced by wearinga copper bracelet as per the advice of a neighbour.

Helth care professionals

2)2a) Dietician

Dietician can help the patient to  stay as healthy as possible and avoid malnutrition.

A dietitian can review your diet and make suggestions on changes that can give you more balanced nutrition, as well as recommend supplements.

a) The patients with RA, have to add folic acid, vitamin C, vitamin D, vitamin B6, vitamin B12, vitamin E, calcium, magnesium, zinc and selenium in their diet.

b) Increased intake of antioxidants such as selenium and vitamin E may decrease free-radical damage to joint linings, which diminish swelling and pain.

2b)  RheumatologyPhysiotherapists

Key role for physiotherapists in assessing, monitoring and prescribing exercise for people with RA.

Physiotherapists can help by teaching and encouraging safe stretching and strengthening exercises; to increase movement and strength, allowing better function.

Physiotherapists will also analyse the way you stand and walk, looking for whether it may be necessary to suggest, for example, balance exercises, insoles to reduce pain and restore good foot posture, or even a walking aid.

Physiotherapists will also have access to a hydrotherapy pool, where patients can do strengthening exercises while the water supports their joints.

Fatigue management and pain relief will also be considered and non-drug treatment recommended.

3) Pathophysiology

RA is characterised by synovitis with thickening of the sinovial lining and infiltration by inflammatory cells.

Generation of new synovial blood vessels is induced by angiogenic cytokines

Activated endothelial cells produce adhesionmolecules(vascular cell adhesion molecule-1)(VACM-1)

Which expedite extravasation of leukocytes into the synovium.

The sinovium proliferates and grows out over the surface of cartilage, producing a tumour like mass called "pannus"

Pannus destoys the articular cartilage and subchondral bone,producing bony erosions.