Student Nurses Community

NURSING CARE PLAN Rheumatoid Arthritis ASSESSMENT SUBJECTIVE: Napakasakit ng mga kasukasuhan ko (I'm having severe joint pain) as verba i!e" b# the patient$ DIAGNOSIS 5(ute pain r't "istension o* tissues b# a((umu ation o* * ui"$ IN ERENCE "estru(tion an" pro i*eration o* the s#novia membrane 6oint "estru(tion7 ank# osis7 an" "e*ormit# PLANNING 5*ter 4 hours o* nursing intervention the patient .i : INTER!ENTION Independent RATIONALE E!ALUATION &oa met7 patient has Verba i!e re ie* o* pain$

%BJECTIVE: &uar"ing'prote(tive behavior )est essness *a(ia grima(ing pain s(a e o* + out o* , V'S taken as *o o.s T: /+$01C 2: ,-): 3B2: ,3-' 4"istension o* tissues b# a((umu ation o* * ui"'in* ammator# pro(ess a(ute pain

Investigate reports o* pain7 noting o(ation an" intensit#;s(a e o* 8)eport pain is -<,-)$ Note re ieve"'(ontro e"$ pre(ipitating *a(tors an" nonverba pain 85ppear re a9e"7 (ues$ ab e to s eep'rest an" parti(ipate in )e(ommen"'provi"e a(tivities *irm mattress or appropriate # be"boar"7 sma pi o.$ E evate inens .ith be" 8:o o. (ra" e as nee"e"$ pres(ribe" pharma(o ogi(a regimen$ 8In(orporate re a9ation ski s an" "iversiona a(tivities into pain (ontro program

=e p*u in "etermining pain management nee"s an" e**e(tiveness o* 8>emonstrate" program re a9e" bo"# posture an" be ab e to s eep'rest appropriate #$ So*t'sagging mattress7 arge pi o.s prevent maintenan(e o* proper bo"# a ignment7 p a(ing stress on a**e(te" 6oints$ E evation o* be" inens re"u(es pressure on in* ame"'pain*u 6oints$ In severe "isease'a(ute e9a(erbation7 tota be"rest ma# be ne(essar# ;unti ob6e(tive an" sub6e(tive improvements are note") to imit pain'in6ur# to 6oint$

Suggest patient assume position o* (om*ort .hi e in be" or sitting in (hair$ 2romote be"rest as in"i(ate"$

Collaborative 5pp # i(e or (o " pa(ks .hen in"i(ate" Co " ma# re ieve pain an" s.e ing "uring a(ute episo"es$

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2rovi"es sustaine" heat to re"u(e pain an" improve )%A o* a**e(te" 6oints

$ 5ssist .ith ph#si(a therapies7 e$g$7 para**in g ove7 .hir poo baths$

5"minister me"i(ations as in"i(ate" Sa i(# ates7 e$g$7 aspirin ;5S5) ;5(uprin7 E(otrin7 ?%)prin)@

5S5 e9erts an antiBin* ammator# an" mi " ana gesi( e**e(t7 "e(reasing sti**ness an" in(reasing mobi it#$ 5S5 must be taken regu ar # to sustain a therapeuti( b oo" eve $ )esear(h in"i(ates that 5S5 has the o.est to9i(it# in"e9 o* (ommon # pres(ribe" NS5I>s$ Chara(teristi(s o* antiBin* ammator# an" immune mo"i*ier e**e(ts (oup e" .ith abi it# to b o(k meta oproteinases

Tetra(#( ines7 e$g$7 mino(#( ine ;Aino(in)@

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Nursing Interventions and Rational - Nursing Care Plan for Rheumatoid Arthritis 1. Record complaints of pain, record the location and intensity (scale 0-10). Write down the factors that accelerate and signs of pain - non-verbal. Rational: o assist in determining the need for pain management and program effectiveness. !. "ive a hard mattress, a small pillow. #levate the bed linen as needed. Rational: a soft mattress, pillow that wo$ld prevent maintenance of proper body alignment, placing stress on the %oints that h$rt. #levation of the bed linen lowering the press$re in the inflamed %oints & pain. '. (lace & monitor the $se of pillows, sandbags, splint, brace. Rational: Resting sore %oints and maintain a ne$tral position. he $se of the brace can red$ce pain and can red$ce damage to the %oints. ). *dvise to change position fre+$ently. ,elp to move in bed, prop %oint pain above and below, avoid %er-y movements. Rationale: (revent the occ$rrence of general fatig$e and %oint stiffness. .tabili/e %oints, red$ce the movement & pain in the %oints. 0. 1nstr$ct the patient to a warm bath or shower at the time awa-e and & or at bedtime. (rovide a warm washcloth compress for sore %oints several times a day. 2onitor the temperat$re of the water compresses, baths, and so on. Rational: he heat increases m$scle rela3ation, and mobility, red$ce pain and stiffness in the morning release. .ensitivity to heat can be removed and dermal wo$nd can be healed. 4. "ive a gentle massage Rationale: 1ncrease rela3ation & red$cing pain. 5. #nco$rage the $se of stress management techni+$es, s$ch as progressive rela3ation, therape$tic to$ch, biofeed bac-, vis$ali/ation, g$idelines imagination, self hypnosis, and breath control. Rationale: 1ncrease rela3ation, provide a sense of control and may enhance coping abilities. 6. #ngage in activities appropriate entertainment for individ$al sit$ations. Rationale: 7oc$sing attention bac-, providing stim$lation, and increased self-confidence and feeling healthy. 8. "ive dr$g before the activity & planned e3ercise as directed. Rationale: 1ncreasing reala-sasi, red$ce m$scle tension & spasm, ma-ing it easier to participate in therapy.

Student Nurses Community 10. 9ollaboration: "ive medications as directed. Rational: *s an anti-inflammatory and mild analgesic effect in red$cing stiffness and increasing mobility. 11. "ive ice-cold compress if needed Rational: he cold can relieve pain and swelling d$ring the ac$te period

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ered.; (rovide emotional s$pport and reass$rance to help the patient cope with limited mobility. #nco$rage the patient to perform as m$ch self-care as his immobility and pain allow. o help promote sleep, ad%$st pain medications to allow for ma3im$m rest. ,elp the patient identify techni+$es and activities that promote rest and rela3ation. 7or %oints in hand, provide hot soa-s and paraffin dips to relieve pain as ordered. 9hec- cr$tches, cane, braces, or wal-er for proper fit. *ssess the patient<s pain patterns. Watch for s-in irritation ca$sed by prolonged $se of assistive devices. 1nstr$ct the patient to plan for ade+$ate rest d$ring the day. 1nstr$ct the patient to ta-e medications e3actly as prescribe