Rheumatoid Arthritis Nursing Diagnosis and Nursing Care Plan

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Rheumatoid Arthritis Nursing Care Plans Diagnosis and Interventions

Rheumatoid Arthritis NCLEX Review and Nursing Care Plans

Rheumatoid arthritis (RA) is an inflammatory disorder that primarily affects the joints, but can also damage the skin, lungs, eyes, and the cardiovascular system.

It is long-term autoimmune disorder that happens when the immune system attacks the tissues that line the joints even if there is no infection in the site.

Rheumatoid arthritis is caused by joint swelling and joint stiffness which can result to joint deformity and bone erosion.

Signs and Symptoms of Rheumatoid Arthritis

  • Swelling of the joints
  • Joint stiffness and/or pain – worse during the mornings or after being inactive such as taking a nap or watching TV
  • Warm sensation on the affected joints
  • Loss of appetite
  • Fatigue
  • Deformed joints, especially in the fingers and toes

Causes and Risk Factors for Rheumatoid Arthritis

The immune system mistakenly attacks the membrane lining of the joints known as the synovium.

This causes inflammation and thickening of the synovium.

Eventually, the cartilage and bone inside the joint are destroyed, and the tendons and ligaments experience weakening and stretching, which are the reasons why rheumatoid arthritis patients have deformed joints in the fingers and toes.

The root cause of the autoimmune attack to the joints is still unknown, although experts are looking at the strong possibility of RA being a genetic disorder.

The risk factors for RA include age (usually starts in 40s), sex (women are more at risk than men); family history, smoking, obesity, and exposure to silica or asbestos.

Complications of Rheumatoid Arthritis

  1. Rheumatoid nodules. RA puts a person at risk of developing rheumatoid nodules, which are firm clumps of tissue that form around the elbows, or other pressure points. They can be dangerous as these nodules can also form in the lungs. If they rupture in the lungs, collapsed lung may follow.
  2. Osteoporosis and fractures. Aside from the affected joints, the nearby bones can eventually weaken, making the patient at a high risk for developing fractures.
  3. Sjogren’s syndrome. RA patients are at risk for developing this disorder, which reduces the moisture in the eyes and oral mucosa, resulting to dryness.
  4. Carpal tunnel syndrome. The wrists may also be affected by RA, causing them to be inflamed and compress the median nerve that innervates the hand and fingers.

Diagnosis of Rheumatoid Arthritis

  • Physical exam – to check for the signs and symptoms such as joint redness, swelling, or warmth, as well as muscular strength and reflex exams
  • Blood tests – Complete blood count to check for increased ESR and CRP; specific blood tests for rheumatoid factor and anti-CCP antibodies
  • Imaging – X-ray of the affected joints; MRI and ultrasound to determine the severity

Treatment for Rheumatoid Arthritis

  1. Medications. Depending on the severity of RA, doctors can prescribe:
  2. Nonsteroidal anti-inflammatory drugs (NSAIDs) – to reduce inflammation and relieve pain
  3. Steroids – to slow down the damage of the joints, reducing inflammation and pain
  4. Disease-modifying antirheumatic drugs (DMARDs) – to slow down RA progression, reducing the risk for permanent tissue and joint damage
  5. Biologic response modifiers – DMARDs that target specific parts of the immune system that stimulates the inflammation
  6. Surgery. If the medications do not work, the doctor may recommend surgery to resolve joint damage. This includes synovectomy (removal of the inflamed synovium), tendon repair, and joint fusion (for realignment and stabilization of the affected joint).
  7. Physical therapy. This is an important part of the treatment regimen for RA and includes a physical therapist who can guide the patient with effective exercises to maintain the flexibility of the joints.

Nursing Diagnosis for Rheumatoid Arthritis

Nursing Care Plan for Rheumatoid Arthritis 1

Nursing Diagnosis: Pain related to joint inflammation secondary to rheumatoid arthritis, as evidenced by pain score of 10 out of 10, guarding sign on the affected fingers, restlessness, and irritability

Desired Outcome: The patient will report a pain score of 0 out of 10.

Rheumatoid Arthritis Nursing InterventionsRationales
Assess the patient’s vital signs. Ask the patient to rate the pain from 0 to 10 and describe the pain he/she is experiencing.To create a baseline set of observations for the patient. The 10-point pain scale is a globally recognized pain rating tool that is both accurate and effective.
Administer analgesics/ pain medications as prescribed. Administer other prescribed medications for rheumatoid arthritis.To provide pain relief to the patient. The medications for RA include: Nonsteroidal anti-inflammatory drugs (NSAIDs) – to reduce inflammation and relieve painSteroids – to slow down the damage of the joints, reducing inflammation and pain Disease-modifying antirheumatic drugs (DMARDs) – to slow down RA progression, reducing the risk for permanent tissue and joint damageBiologic response modifiers – DMARDs that target specific parts of the immune system that stimulates the inflammation 
Ask the patient to re-rate his/her pain 30 minutes to an hour after administering the analgesic.To assess the effectiveness of treatment.
Provide more analgesics at recommended/prescribed intervals.To promote pain relief and patient comfort without the risk of overdose.
Reposition the patient in his/her comfortable/preferred position. Encourage pursed lip breathing and deep breathing exercises.To promote optimal patient comfort and reduce anxiety/ restlessness.
Refer the patient to a pain specialist as required.To enable to patient to receive more information and specialized care in pain management if needed.

Nursing Care Plan for Rheumatoid Arthritis 2

Nursing Diagnosis: Activity intolerance related to joint inflammation and pain secondary to rheumatoid arthritis, as evidenced by pain score of 8 to 10 out of 10, fatigue, disinterest in ADLs due to pain, verbalization of tiredness and generalized weakness

Desired Outcome: The patient will demonstration active participation in necessary and desired activities and demonstrate increase in activity levels.

Rheumatoid Arthritis Nursing InterventionsRationales
Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.To create a baseline of activity levels and mental status related to acute pain, fatigue and activity intolerance.
Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with 60-90 minutes of undisturbed rest.To gradually increase the patient’s tolerance to physical activity. To prevent triggering of acute pain by allowing the patient to pace activity versus rest.
Administer analgesics as prescribed  prior to exercise/ physical activity. Teach deep breathing exercises and relaxation techniques. Provide adequate ventilation in the room.To provide pain relief before an exercise session. To allow the patient to relax while at rest and to facilitate effective stress management. To allow enough oxygenation in the room.
Refer the patient to physiotherapy / occupational therapy team as required.To provide a more specialized care for the patient in terms of helping him/ her build confidence in increasing daily physical activity.

Other Nursing Diagnosis for Rheumatoid Arthritis

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures. The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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