Nursing Interventions
Although RA can cause difficulties completing ADLs, it is important to encourage _____ in those who have been diagnosed.
Independence
Do not jump in to assist a patient diagnosed with this condition in daily activities unless they request help or are at risk of injuring themselves.
When inflammation is present, this can be applied for pain relief until the inflammation lessens.
Ice packs
The ice pack should not be too heavy, small bags of frozen peas or corn work well.
This test is used to visualize joint changes and deformities.
X-Ray
Pain and stiffness is typically caused by periods of ______ and is relieved with ______.
This class of drugs is typically used to reduce pain and inflammation and can be obtained over the counter.
NSAIDs
Eating can become difficult for those with RA due to mobility issues. These are easier to grasp and manipulate than standard utensils.
Adaptive utensils with thick handles.
Heavy plastic cups with handles (opposed to styrofoam or paper cups).
As the disease progresses or severe exacerbations occur these professionals may be needed to provide education and adaptations for the client to remain as independent as possible, or regain ability to complete some tasks through adaptations and exercise.
Physical and Occupational Therapy
The test for rheumatoid factor (RF) measures the presence of unusual antibodies of immunoglobulins. This result is typical for those with RA.
A positive titer (greater than 1:80) is typical for many patients with RA.
Look at those vitals!
B/P: 156/92
Temp.: 100.4
Resp.:24
HR: 106
____ is a typical finding for a patient with RA.
Temp.: 100.4; low grade fever is a typical finding for a patient with RA.
Methotrexate is an immunosuppressive drug, what should the nurse teach the patient before administering this medication for the first time?
Patients taking methotrexate should avoid large crowds of people and those who are sick. Due to its suppression of the immune system, patients taking this drug are are at increased risk of infection.
When a patient is taking NSAIDs regularly, it is important to assess for this complication.
Drug related blood loss/GI bleeding. Stools should be assessed, if they are black and tarry, NSAIDs should be held and the physician should be notified.
Patients typically experience stiffness and discomfort in the morning, this typically helps to relieve stiffness and reduce pain.
Hot showers are effective in aiding in morning stiffness and late stage pain.
It is recommended to use a shower instead of a tub as they are easier to get in and out of. Non skid mats, shower chairs, hand rails, and walk in showers are recommended to reduce the risk of falls.
Most chronic diseases cause mild to moderate anemia, therefore, this lab test should be monitored.
CBC should be monitored for low hemoglobin, hematocrit, and red blood cell count.
Your patient reports that she is consuming large amounts of caffeine to get through the day. This may indicate the common symptom of ______ typically seen in RA.
Fatigue
Prednisone is typically prescribed for fast acting anti-inflammatory and immunosuppressive effects at high doses for short durations, or as a chronic low dose. This medication should be discontinued by...
This drug should be slowly tapered off, patients should be educated to avoid stopping this medication abruptly.
A patient reports increased levels of fatigue and has a result, is having a difficult time completing daily tasks. How should the nurse educate this patient?
Setting Priorities - "What activities are the most important for you to get done?" "Try making a list of the tasks you need to accomplish starting with the most important items, let's do those first."
Allowing Rest Periods - "How can we structure your day to give you a break between tasks?"
Pacing Activities - "It sounds like you have a lot of things you need to get done, how can we spread those tasks out across the week?" "It sounds like showering requires a lot of work now, what if we installed a shower chair to help you conserve some energy?"
Obtaining Assistance When Needed - "It is important to have people who can help you when you need it when you go home, do you have somebody who is able to be there for you?"
Due to the age at which RA is typically diagnosed, it is important to evaluate the patient's ability to continue this.
RA is typically diagnosed between the ages of 30 and 50. As a progressive disease, it can cause difficulty in working. It is important to educate the client on what activities they may have to cut back on in their work life such as heavy lifting or high impact activities. They may need to discuss a lighter workload with their employer or file for disability with their company and Social Security. This can cause stress and poor self esteem as their physical limitations increase, they may benefit from education on stress reduction techniques.
The newest laboratory test used in diagnostic testing for this condition is very specific and sensitive in detecting early RA. It is also a marker for aggressive and erosive late stage disease.
anticyclic citrullinated peptide (anti-CCP)
A patient with RA comes in for a follow up appointment.
Reports consuming one cup of coffee a day with a cup of fruit for breakfast.
Reports that she is walking for 30 minutes 3 days/week.
She continues to take Naproxen 375mg twice a day.
1st visit: 144lb 2nd visit: 141lb
Which finding(s) indicate that her RA is advancing and what is the name of the manifestation causing it?
Weight loss of 2-3lbs indicates anorexia.
Disease-modifying antirheumatic drugs (DMARDs) are typically prescribed initially (soon after diagnosis), with this purpose in mind.
These drugs are given to slow the progression of the disease and should therefore be started as early in the disease process as possible.
Patients may experience poor self esteem as a result of body changes and difficulty in doing daily tasks. What nursing interventions may enhance self esteem?
Use patience and understanding.
Remain realistic in discussing goals and emphasize their strengths.
Identify previously successful coping strategies.
If necessary, consult with mental health professionals or religious leaders to help patients cope.
These patients feel they can emotionally cope with their disease and are able to and more comfortable with discussing treatment options with their primary care provider.
Patients who have been educated regarding rheumatoid arthritis and are knowledgeable regarding the condition.
This is an invasive diagnostic procedure used for patients with joint swelling from excess synovial fluid. Local anesthetic is used, a large gauge needle is inserted into the joint, synovial fluid is aspirated and examined in the lab.
Arthrocentesis
Fluid is examined for inflammatory cells and rheumatoid factors. It is typical to see increased WBCs and cloudiness.
After this test, patients should use ice and rest the joint for 24 hours. Acetaminophen is typically used to ease discomfort.
This is seen when the joints in the wrist and hand shift so the fingers bend toward the outside of the forearm.
Ulnar drift
These injections are administered in joints to temporarily relieve local inflammation and pain.
Cortisone injections.
Patients should ice and rest the joints for 24 hours after administration, oral analgesics may be given PRN as ordered.