CHAPTER I THE PROBLEM AND ITS SETTING Every person gets old and when this happens, many

problems in the body occur. Getting old is often associated with having problems with the joint like rheumatism and other forms of the said disease that continually hunts not just aged people but even ordinary people with unfortunate fate of having the rheumatic problems. Rheumatoid arthritis (RA) disorder that is may a affect

chronic, systemic inflammatory

many tissues and organs, but principally attacks synovial joints. The process produces an inflammatory response of the synovium (synovitis) secondary to hyperplasia of

synovial cells, excess synovial fluid, and the development of pannus in process the synovium. to The the pathology destruction of the of disease




cartilage and ankylosis of the joints. Rheumatoid arthritis can also produce diffuse inflammation and in also tissue.

the lungs, pericardium, pleura, nodular lesions, most common

and sclera, in


Although the cause of rheumatoid arthritis is

2. unknown, autoimmunity plays a pivotal role in chronicity

and progression, and RA is considered a systemic autoimmune disease. Home Cures are possible for almost every health

disorder existing in the world. The old age people used to have higher living rates and they lived a healthy life as compared to the modern day human being. The sole logic

behind the fact is that they were dependent on the herbal remedies and home cures and not on the chemically treated drugs. Herbal medicines can be grown in your backyard and using them is as simple as growing them. The home cures have least side effects and they do not obstruct the normal growth of body. The herbal medicines contain all the

essential ingredients to treat any disease and that's why they are becoming more and more popular. Apparently, rheumatism is something that can be taken care of from home. The best point concerning a home remedy is that you have many options and, if you think that a particular ingredient does not suit you, you can try an alternative. You should give each remedy at least a week before trying another. This type of natural treatment

3. avoids the conventional medicine that is used in various treatments done today.

General Objectives This study aimed to determine the alternative and most effective home management practices for rheumatism. As a member of the health care provider aims to provide health teaching to manage this chronic illness effectively. Specific Objectives At the end of ten days of intensive care affiliation the student nurse will be able to: Assess the client and the complication of the disease. Teach to accept the findings as an awareness to

promote Healthy lifestyle and Safety living condition. Teach the client how to manage on her own condition especially at home management. Gain and widen knowledge about the entire disease

process formulate appropriate plan of care for the major.


Client Profile Patient: Address: Age: Gender: Nationality: Religion: Leticia Rullan 201 Brgy. Manacnac Palayan City 60 years old Female Filipino Roman Catholic

Educational Attainment: High School Graduate Occupation: Storekeeper

Family History of Illness The patient’s family has history of hypertension on both side of the family. History of Present Illness The patient was diagnosed with Rheumatoid Arthritis and

Hypertension at Good Samaritan Hospital,4 months ago . Few day prior to consultation at the said hospital she

experienced headache, pain around nape area and stiffness

and joint pain. The doctor submitted her to several test like x-ray, pulse oximeter.

Past and Current Medical Condition Before she was diagnosed with rheumatism she is known to have Hypertension. She was advised to take rest everytime she feels stressed and avoid salty and fatty foods and

strenuous activities. History of Hospitalization and Surgical Operation The patient was hospitalized because of her hypertension and knows she preferred to have monthly check-up to a

private doctor and did not undergo from any surgery. Nutrition and Metabolic Pattern Usual food intake The patient usual fluid intake in the breakfast was 1 cup of rice, egg, and 1 glass of milk. Then in lunch time she preferred pork giniling. In dinner time, she has least food intake ½ cup of rice and pinakbet. Usual Fluid Intake:

Elimination Pattern Urination: She urinate 5 times a day with a yellowish color and has no complaint. Problems with ability to eat: My patient told that she has no problem regarding ability to eat. Supplementation: My patient vitamin was vitaplus. Food restriction: The doctor advised my patient to avoid salty and fatty foods. Activity and Exercise Pattern Usual daily activities: .The usual fluid intake of my patient was 8-10 glasses of water a day. Bowels: My patient has bowel movement a day with a formed stool and no complaint about it.

cooking dish. Limitation of Physical activities: The patient doesn’t engage in heavy work Sleep and Rest Pattern She usually sleeps at around 9pm to 5am with a total of 8 hours of sleep.The usual daily activities of my patient was walkind around their house.1°C P 75 70 73 R 20 20 21 . Vital Signs Wt.5’2 Date 11-14-11 11-15-11 11-17-11 Bp 130/80 mmHg 130/80 mmHg 130/80 mmHg 11-18-11 130/80 mmHg 11-21-11 11-22-11 36°C 70 19 T °C 36°C 36.58kg Ht.

generally with in and Scalp the round upon prominent frontal occipital area Lighter in color Normal than complexion.SUMMARY PRESENTATION OF PATIENT ASESSMENT Body Parts Skull Assessment Findings No tenderness Normal noted palpation. oval Eyes and rounded Slight blurred No decrease visual acuity vision. Hair can be black or brown. pupil Pupils react to light clear. brittle Nor brittle nor brown No involuntary Normal movement shape is noted. Decreased . the no Hair Face scars noted Slight dryness.

Umbilicus non Normal is . tender. Normal no noted palpation Nasal septum normally straight and not perforated tenderness on Neck and Throat Chest Soft. no swollen Normal lymph nodes With expansion Normal and respiration Normal breath sounds No cough Thorax is symmetric Abdomen RR-20 soft.Ear visual activity No drainage No ringing of ears Skin is same color with complexion and accommodation Normal Nose paranasal sinuses No hearing loss and No discharges.

. associated with pain. Angiogenesis in synovial lining Swelling in small joints. warmth and the fingers moisture without swelling No edema lower Extremities Swelling pain of Both legs are symmetric in size the joints No swelling or atrophy CHAPTER II CASE DISCUSSION/PRESENTATION PATHOPHYSIOLOGY Presentation of antigen to T cells T. stiffness and fatigue.midline and inverted with no signs Upper extremities of discoloration Swelling pain of symmetrically even in color.and B-cell proliferation.

Tendon and ligament elasticity and contractile power are lost. and decreased motion with possible rheumatoid nodules.Neutophil accumulation in synovial fluid. No cartilage invasion Warm. the autoimmune reaction primarily occurs in the synovial tissue. swollen. effusion. Chondrocyte activation. pain. Pannus destroy cartilage and erodes the bone. Phagocytosis produces enzymes within the joint. Early pannus invasion. Pathophysiology of my client Sign and symptoms . The enzymes break down collagen causing edema. Muscle fibers undergo degenerative changes. Degradation of cartilage by proteinase. Cell proliferation. medical surgical nursing In RA. and ultimately pannus formation. proliferation of the synovial membrane. Synovitis. Increase in severity of physical sign and symptoms. The consequence is loss of articular surface and joint motion. Figure 1.

Inflammation: Redness. but a family history of RA does not appear to increase an individual's risk. women have a much higher risk of developing osteoporosis Diagnostic Exam . such as the arm. and warmth are the hallmarks of inflammation. particularly in patients without a family history of the disease. Swelling: The area around the affected joint is swollen and puffy. After the age of 65. Female gender. leg. Its range of motion (the extent to which the appendage of the joint. Typically. can move in different directions) may be reduced. Gender Women are more likely to develop RA than men. Risk Factors Age Although rheumatoid arthritis can occur at any age from childhood to old age.Stiffness: The joint does not move as well as it once did. or finger. stiffness is most noticeable in the morning and improves later in the day. Family History Some people may inherit genes that make them more susceptible to developing RA.50. Smoking Heavy long-term smoking is a very strong risk factor for RA. tenderness. onset usually begins between the ages of 30 .

You want to fill your body with good antioxidants. she diagnosed also with rheumatoid arthritis she undergo with an x-ray. Complication Rheumatoid arthritis can affect other parts of the body as well as the joints.When she was hospitalized last year because of hypertension. In the past. It can result in tingling. Some patients with severe disease may then be at higher risk for complications. Because of the degradation of our food supply. The result was she has a rheumatoid arthritis. This condition affects the nerves. Prevention The first step in helping to prevent or reverse arthritis is proper cellular nutrition. but things are more complicated now. . Many patients have weakness of the muscles. Muscle problems. eating a healthy balanced diet full of fruits and veggies is still a good start. good cellular nutrition meant eating the right fruits and veggies every day. Anemia. which involves a decrease in the number of red blood cells. so the free radicals roaming around in your system are neutralized and flushed out of your body before they can do more harm. most often those in the hands and feet. such as the following: Peripheral Neuropathy. numbness. People with RA may develop anemia. or burning. but you need to make sure you're properly supplementing your diet with antioxidants and minerals. Of course. it's harder to get the good antioxidants you need straight from the grocery store.

Relaxation therapy teaches techniques for releasing muscle tension. disease modifying drugs). Research suggests that he chronic inflammation associated with RA may be a factor. lumps under the skin. many of the drugs used to treat it can damage kidneys. anti-tumor necrosis factors. Infections. Some patients develop severe skin complications that include rash. which helps relieve pain. Skin problems are common. Severe skin disease can reflects a more serious case of RA in general. Symptoms include redness of the eye and a gritty sensation. and reduce pain. . Being in water reduces the weight on your joints. Kidney. increase muscle strength. The warmth relaxes your muscles and helps relieve pain. Patients with RA have a higher risk for infections. particularly if they are treated only with immune-suppressing drugs (corticosteroids. and other problems. ulcers. Heart Disease. blisters (which may bleed in some cases). This is an inflammation of the blood vessels in the eye that can result in corneal damage. Nursing Management Physical therapy helps preserve and improve range of motion. particularly on the fingers and under the nails. Hydrotherapy involves exercising or relaxing in warm water. Although rheumatoid arthritis only rarely involves the kidney. Skin Problems.Scleritis and Episcleritis. Patients with RA have increased risk for death from coronary artery disease.

with greater preservation of function. Cold can be applied with ice packs at home. reconstructive surgery and/or joint replacement operations provide the best outcome Rheumatoid arthritis was traditionally treated in the past with a stepwise approach starting with nonsteroidal antiinflammatory drugs (NSAIDs) and progressing through more potent drugs such as glucocorticoids. and biologic response modifiers. because people treated early with DMARDs have better long-term outcomes. less work disability. warm wax.( Medical Surgical Nursing) Medical Management In some cases. DMARDs were avoided early in the disease of their potentially serious side effects and they did not often bring on remission. although moist compresses can be applied at home. or moist compresses. Most of these are done in the medical office. The goal of drug treatment is to induce remission or at least eliminate evidence of disease activity.Both heat and cold treatments can relieve pain and reduce inflammation. Some people's pain responds better to heat and other's to cold. past. DMARDs were reserved for people who showed signs of joint Over time. this strategy was recognized as being faulty. microwaves. and a smaller risk of premature death. In the because because usually damage. DRUG STUDY . diseasemodifying antirheumatic drugs (DMARDs). Heat can be applied by ultrasound. however.

NAME Leflunomide (Activan) 10-20 mg once daily ACTIO N Anal Gesic /anti Pyretic s and muscle relaxa nt Hormo nes and related drugs INDICAT ION Active RA in adult patients CONTRAINDIC ATION Severe deficiency of the immune system SIDE EFFECT Incresase BP. severe hypoproteine mia May be taken with or without food W/draw from long-term therapy gradually. B1. neuralgia Systemic fungal infection Monitor BP. May be taken with or without food (May be taken w/ meals to reduce GI discomfo rt. nausea and vomiting. Watch for rash & other allergic reaction . muscosk eletal . abdominal pain Fluid and elecrtroLyte. water & K.). diarrhea. Pregnancy & lactation. rheumat ic And hema Tologica l disorder s Neuri tis. GIT disturban ces NSG RESPONS IBILITIES Watch for impairment of liver function. Acute intermittent porphyria. Methylprednisol one (medrol) 200 mg/day DOLO-Neurobion Analge Sic/ antiPyreti c and muscle relaxa nt Endocri ne. salt. decompensate d cardiac insufficiency Rarely allergy caused by vit.

• In severe >Incorporate . Independent • • Investig ate reports of pain. noting location and intensit y(scale of 0– 10).NURSING CARE PLAN Rheumatoid Arthritis ASSESSMENT DIAGNOSIS NSG. able to sleep/rest and participate in activities appropriately • >Follow prescribed pharmacologica l regimen. Elevation of bed linens reduces pressure on inflamed/painf ul joints. Note precipit ating factors and nonverba l pain cues. small pillow. large pillows prevent maintenance of proper body alignment. Acute pain r/t distension of tissues by accumulation of fluid. • Guarding /protect ive behavior Restless • ness • Soft/sagging mattress. OBJECTIVES After 2 weeks of nursing intervention the patient will: INTERVENTION RATIONALE SUBJECTIVE: “Napakasakit ng mga kasukasuhan ko” (I'm having severe joint pain) as verbalized by the patient. Elevate linens Helpful in determi ning pain managem ent needs and effecti veness of program >Report pain is relieved/ controlled OBJECTIVE: >Appear relaxed. Recommen d/provid e firm mattress or bedboard . placing stress on affected joints.

Suggest patient assume position of comfort while in bed or sitting in chair. Promote bedrest as indicate d. ASA must be taken Collaborative regularly to sustain a therapeutic blood level. total bedrest may be necessary (until objective and subjective improvements are noted) to limit pain/injury to joint. decreasing stiffness and increasing mobility. disease/acute exacerbation. • Provides sustained heat to reduce pain and improve ROM of affected joints . • • T: P: 100 R: 20 BP: 120/ 80 • ASA exerts an antiinflammatory and mild analgesic effect. Research • Apply ice or indicates that cold packs ASA has the when indicated lowest toxicity index • Assist with of commonly physical prescribed therapies.5˚C • relaxation skills and diversional activities into pain control program with bed cradle as needed. • Cold may relieve pain and swelling during acute episodes.• facial grimacin g pain scale of 7 out of 10 V/S taken as follows 37.

e. e. whirlpool baths.g.g. Ecotrin. ASSESSMEN T DIAGNOSI S PLANNING INTERVENTION RATIONAL E EVALUATI ON .. NSAIDs. ZORprin).. aspirin (ASA) (Acuprin. • Characterist ics of antiinflammatory and immune modifier effects coupled with ability to block metalloprotein ases Administer medications as indicated • Salicylates. paraffin glove.




Rheumatism is .3°C PR -75 RR-19 IMMEDIATELY BEFORE BEDTIME FACILITATI NG TOTAL BODY ENCOURAGE RELAXATION GENTLE ●TO ROM MAXIMIZE EXERCISE EFFECTS OF AFTER HEAT BATH COLLABORA -TIVE: ADMINISTER NIGHTIME ANALGESIC / LONGACTING ANTIINFLAMA TORY DRUGS AS PRESCRIBED ●REDUCES MODERATE INFLAMMATION Foreign Literature In Philippines as well as in many other countries there is a general overview of the health of the population based on a national survey. Therefore it is the time to look at the population risk groups.36.T.

Laskowski of the Mayo Clinic. in cases of rheumatism. red and In general.7/100. of older people ageing in is population accompanied is by constantly Secondly. First. inflammation often damaging to our own tissues.000. Edward R. chronic diseases. you should Acute use ice for is painful joints.2% of Americans will be affected by arthritic disorders.the most frequent in the aged illness United diagnosed more over in population. Projecting to the year 2020. this occurs via reduced blood flow and decreased swelling. adjusted incidence of rheumatoid arthritis in the adult population was 31. The spread of these illnesses will increase in the coming years for several reasons. ice is recommended in order to inhibit inflammation. Finland. Therefore. According to Dr. process. the inflammation is actually doing more damage than the original problem. including musculoskeletal disorders. population rheumatoid Kingdom and than are the 65 years In affected age arthritis. . the trends in demographic changes indicate that the proportion growing. an estimated 18. equivalent to 60 million people. the application of heat or ice may be useful in the healing swollen. 12% of For the with example.

com) Overall. the body's immune response has one primary function: to protect the body from an object that the body does not recognize as a normal object. mayoclinic.com/article/330159-exercises-for-rheumatism/. your blood vessels are forced to dilate and allow more blood to enter the area. Rheumatoid arthritis is an autoimmune disease where the body perceives tissue in the joints as being a foreign object and fights the tissue through an immune response. www. The immune response can be either normal or abnormal. which acts to inhibit your body's natural repair processes. Rheumatoid arthritis has many options available for treatment such as medications and minor surgeries. By applying heat. Inflammation is also one of the body's first responses to infections as the body tries to rush immune cells and cytotoxic chemicals to the infected tissue to defend against the infections or foreign particles. Volume 2 Number 1. Tests for rheumatoid arthritis are rather simple and readily available. (Lethbridge Research Journal. blood flow should be stimulated in order to promote an active healing process.google. if the condition has been present for a significant period of time.) .livestrong. Future advancements are continually being tested in clinical settings to help in improving treatment for rheumatoid arthritis patients. (http://www. 2007.However.com . Arthritis tends to develop inflammation in the joints and their surrounding tissues. Chronic inflammation may lead to the deposition of scar tissue.

swimming. Get the right kind of exercise. but did you also know that there are natural and safe ways to manage and treat rheumatism? There are and a few of these natural remedies are highlighted below. Do not walk or stand when you are in pain. there are many rheumatism sufferers who turn to over-the-counter medications to seek relief. Do you or someone that you love suffer from rheumatoid arthritis? If so. your knees will not be stiff. Especially if they have rheumatism in their knees. Three time a week for 30 minutes at a time is plenty of time for a exercise regime. Know your limitations. Sit down and take a rest for a while. Yes. When it is. these over-the-counter medications will work in most cases. Do not push yourself. and specific are green that highly recommended . Put on a good liniment like icy hot or Ben Gay before you go to sleep. Exercises like bike riding. walking and floor exercises are all good for the joints. the pain and discomfort that is commonly associated with rheumatoid arthritis may be too much to handle. The natural types consumption remedy come for of raw juices is an effective Two and rheumatoid rated arthritis. Make sure you get your doctor's permission before starting any exercise program.There are many alternative methods a person can do to treat their rheumatism. When you awake.

as olive oil that is too hot can result in painful skin burns. however. not like eating Those who do 3 fish are encouraged to examine Omega Fatty Acid supplements.juices. Warm olive oil massaged over the area is another easy and natural way to relieve the What pain is and nice discomfort about this associated with arthritis. rosemary. as well as potato juice. been used to treat the pain In fact. overnight is best. with . sage. be sure to let cool a little. Omega 3 Fatty Acids are found in most fish. The consumption of Omega 3 Fatty Acids are another natural way to treat many of the symptoms of arthritis. Then drink. those with rheumatoid arthritis see and feel the best results. cut a potato into thin slices. potato juice. which are available for sale at most drug stores and health stores. When using warm olive oil. When doing Place the potato slices in a glass of cold water and leave sitting for a few hours. approach is that most individuals already have olive oil in their homes. This natural remedy can provide relief from all forms of arthritis. potato juice has and discomfort commonly For associated with rheumatoid arthritis for years on end. In addition to plain olive oil. so. or garlic can be diluted with olive oil. leave the skin intact.

whether it be through walking or squeezing a stress ball. Baths are another natural way to treat the pain and discomfort often associated with arthritis. but if you know someone who is. In fact. arthritis concerned. cold bathes can result in increased pain. Those diagnosed with arthritis should remain in a warm bath for at least thirty minutes. Those who overexert themselves are likely to experience even more pain and discomfort. The only problem is that those suffering from must proceed with caution where exercise is Moving around. When applied to the impacted area. Unfortunately. warm baths are advised.about ten more parts of olive oil. relief should be felt immediately. but it also important not to over do it. there are a number of natural remedies and home remedies that can be used to seek relief from arthritis. which is not the goal. In addition to a traditional warm bath. you may want to pass these easy and natural remedies onto that person. Small amounts of exercise is another natural way to relieve the pain and discomfort commonly associated with arthritis. When using baths to seek relief. As you can see. many . If you are not suffering from arthritis. can help. many of those suffering from arthritis recommend adding about three or four tablespoons of Epson salt to the bathwater.

com) Local Literature Holistic tropical center Healing of in the Philippines AM Located on the a to island using Cebu. We do not offer “out-patient” short-term care. classes. . mud/water/sun therapies.google.knrn. and Wellness is holistic healing natural therapy overcome disease and achieve total health and well-being.html. outings and games. we prefer to call the people who come here “students” because they are here not only to be cured but also to experience how to remain healthy and disease-free for the rest of their lives.individuals are unaware of natural remedies and their many benefits. water cleansing. meditation and vegetarian complemented by music. and include detoxification. We also teach our students the keys to life-long health through diet. herbal colon cleansing.org/natural-remedies-for-arthritis. and exercise. Our naturopathy treatments courses run between 12 days and 4 weeks or more. Rather than use the word “patient”. fasting. art. Philippines. These are the practice of yoga.(http://www. alternative medicines. www.

Mandaue. OUR MAIN THERAPIES .to cure themselves through a system of natural therapy without depending on medicines to become physically fit. stress and disease . the Ananda Marga Wellness Center is the country’s center. meditation and vegetarian diet. but we also teach them the path to life-long health. exercise. the practice of yoga.The Wellness Center Situated in a quiet neighborhood of Pagsabungan. We do not only assist our students in their healing. in-patient natural therapy program. first It affordable a stay-in holistic alternative healing practices approach to health through various natural therapies. mentally relaxed and fully conscious to learn new healthy systems of eating. drinking water and harmonious thought We offer a complete systematic. Cebu.to overcome problems caused by excess fat. EMPOWERS PEOPLE . Daily activities are not only therapeutic but also entertaining and educative.

treadmill. which is superior to any leading absorbs colon toxins cleansing from the herbal products. It is vital for getting a new start in your life..our unique SUPER HERBAL DETOX.various individually prescribed treatments include MUD PACK applying hygienic mud to specific areas of need. swimming (at a nearby pool). with a particular effect on lower body and lung problems . or in some cases to the whole body both absorbing toxins and attracting healing blood STEAMBATH to sweat out toxins. . vegetables and other light vegetarian food).a nutritious. while keeping the face in fresh air (not like sauna.an exercise program with a wide range: a) gentle YOGA POSTURES walking for and the mild glands and nerves b) SLOW EXERCISE games c) VIGOROUS EXERCISE of of brisk walking & running. ultimately from the entire body. which compels one to breathe in toxic air) HOT FOOTBATH also to sweat out toxins. delicious DIET of alkaline food (fruits. aerobic dance and active games . freeing the digestive system from its normal burdens so the body can naturally heal itself . It not but only also digestive system.

our best physical treatment for releasing stress WARM CIDER VINEGAR BATH done only just before sleeping for those who have difficulty to sleep.COLEMA (in between COLonic machine and EnEMA) internally cleansing the intestines SPINAL BATH to cool the spine only. to cleanse toxins . for fixed number of minutes and during a fixed interval HIPBATH attracting healing blood to the lower internal organs including the digestive organs and the female organs HOT WATER BAGS AND ICE PACKS depending on whether one needs heat for relaxation or cold for healing . 3 to 4 litres or more daily. directed at specific areas of the needy body. enabling nerves to thoroughly relax HYDRO BUBBLE BATH with 300 jets of warm or hot water.WATER-DRINKING SYSTEM. with water or oil massage according to need.MENTAL EXERCISE & MEDITATION (including deep relaxation and visualization) to convert stress into calm positivism . together with aromatic oils SYSTEMATIC SUNBATH alternating in and out of the sun.

www. The rheumatoid factor has been and still is for now more than 50 years the only autoreactivity that is clinically applied in the diagnosis of RA. none of the autoreactivities correlates with a distinct clinical feature or course of disease. none of the known RA-associated autoreactivities is present in all RA patients and none of them occurs exclusively in RA. Nevertheless. broths. But.. Therefore. their discovery was always on the search for the one and only autoreactivity that causes RA.org/?p=92.com) Autoreactivity plays a major role in the pathogenesis of RA. This includes also immune reactivities directed against xenogenic antigens. This well reflects the current way of thinking that a single antigen or a single cause drives an individual into disease.google. Thus. It is about time to say goodbye to the idea that a single antigen or . fruits and/or vegetables for several days.a graduated program of specialized ELIMINATION DIETS & FASTING on juices. Although by now many other autoantigens and autoreactivities have been described. RA has often been postulated to consist of various immunological subentities with similar clinical symptoms.(http://manilasector. the observed sensitivities and specificities are well below 100%.

60(1):1-1) Foreign Studies Recent studies using tumor necrosis factor-alpha inhibitors.immunoreactvity causes and maintains rheumatoid arthritis. have shown that patients demonstrate . The entirety of the known RA-associated reactivities and (auto)antigens is presented in detail. both alone and in combination with other medications. the Saantigen. cytokines. In this paper we present RA as the clinical outcome of an immune system that has shifted from a healthy to an autoimmune steady state. The accumulation of factor--involving autoreactivities. calpastatin. (Z Rheumatol. collagen and the shared HLA-DR epitope. citrulline. This is accomplished by many different reactivities and autoreactivities that occur either in parallel or one after the other. The major RArelevant autoantigens comprise BiP. p205. calreticulin. IgG. hnRNP A2. environmental and genetic factors--that challenge the normal regulatory mechanisms of the immune system lead to a regulatory catastrophe. 2007 Feb.

or . A number of surveys use. in the previous year. Background Surveys have suggested medicines that (CAM) use is of high complementary and and alternative increasing worldwide..significant improvement based on American College of Rheumatology criteria (Felson et al. including CAM. CAM Some general with population definitive surveys among patients rheumatologic diagnoses attending hospital clinics. Longitudinal studies in the UK between 1993 and 1999. 1995 and 2001 and between 1998 and 2006 and in the USA between 1990 and 1997 have confirmed the trend.2006) Respondents to a population pain survey who had reported having musculoskeletal pain in the survey and who had consulted 12 and about months their as pain as in primary care to in the previous research well to an consenting further was agreeing interview. GPs are the conventional medical practitioners most frequently consulted for chronic pain in the UK. have of been these conducted were in the UK to explore surveys. Information gathered about their pain and the use of all treatments for pain. CAM is most commonly used for chronic pain and in particular musculoskeletal pain and is often used in combination with conventional therapies.

for informing effective pain management in primary care and because of potential safety issues related to CAM use. We focus wanted to address these pain issues with who particular are using on musculoskeletal sufferers primary care in the UK. We have therefore investigated the pattern of CAM use in a sample of chronic musculoskeletal . We are not aware of previous surveys of primary care patients that have enquired about the perceived helpfulness of treatments for from the patients' perspectives.surveys of healthcare professionals exploring their patients' use of CAM and access to it. Evidence suggests that users do not necessarily access CAM through primary care and also they are often reluctant to inform their doctors of their use of these treatments. seeking This is important understanding healthcare behaviour among chronic pain sufferers. might under-represented among primary care patients. We are not aware of surveys conducted in the UK that have directly explored CAM use among primary care patients who suffer from chronic musculoskeletal pain. Figures on access to CAM through primary care and on health have professionals' provision actual of CAM CAM. surveys targeted healthcare professionals rather than patients. In primary care in the UK. use therefore.

5% for women. For those 15 years and .com An alternative treatment approach for RA has emerged in the area of biologic therapies. Biologic response modifiers are a group of agents that consist of molecules produced by cells of the immune system or by cells that participate in the inflammatory reaction.2006) Local Study In initiating a community oriented programme for the control of rheumatic disease (COPCORD). 1685 people of all ages from a rural area in the Philippines were questioned by primary health care workers (PHW) for limb and spinal rheumatic pain and disability. This was based on the idea that this than group the will have selectively more severe have problems general population because they sought health care and because chronic musculoskeletal pain is often unresponsive to conventional primary care treatment http://www. The total complaint rate was 15.pain patients who were consulting primary care in the UK. (Koopman.google. Our hypothesis was that this group of patients would have a higher prevalence of CAM use than general population samples or pain sufferers generally.3% for men and 18.

neck and the trapezius muscle.5% for those 15 years and older.com) The Study of Active Controlled Monotherapy Used for Rheumatoid Arthritis. One quarter of those with pain had received medical attention and the remainder.4% for for pain the The Philippines for Lawrence's population.older present the at age the and adjusted time 22. An IL-6 Inhibitor (SAMURAI) study demonstrated that. massage. most common rheumatic pain sites in this community were knee.springerlink.[21] In addition. various faith and/or self-treatment methods.com/content/gg813l16x4690623/. preliminary results reported from the Tocilizumab Safety and the Prevention of Structural Joint Damage (LITHE) study showed that.[22] In the present study. (http://www. X-ray images at baseline and at Week 52 of tocilizumab treatment were available for 149 of 232 patients. compared with MTX alone. lumbar spine. allowing us to evaluate the radiographic effect of tocilizumab. tocilizumab plus MTX treatment resulted in significantly less progression of joint destruction. The disability rate was 4. compared with DMARDs. tocilizumab monotherapy significantly inhibited progression of structural damage in Japanese RA patients. the duration of disease in patients enrolled in this study . www. As stated above.google. herbal treatment.6% rheumatic of survey pain were UK rates 28.

4 years. Although further research is needed. not only in patients treated without TNF inhibitors. in which we reported a disease duration of ~8 years and mean estimated yearly progression of 8. Considering the results of the impact on radiographic and clinical response to infliximab therapy concomitant with methotrexate in patients with rheumatoid arthritis by trough serum level in a dose escalating (RISING) study. Irrespective of these severe conditions. our findings suggest that the pathological condition of RA is dependent on TNF.3) at baseline. we found that tocilizumab inhibits the radiographic damage. but also in those treated with TNF inhibitors. The good results obtained with tocilizumab are consistent with those of both domestic and foreign studies.was 12.1) the present study included patients with remarkably severe clinical features with long disease duration and progressive joint destruction. and estimated yearly progression was significantly high. ( http://www. Surprisingly. the 95% inhibitory effect of tocilizumab indicates how powerful its inhibition of joint destruction is.com/viewarticle/750779_4) .8 (1.1 (9.medscape. with 20.

it is done to obtain a higher response rate with respondents. Questionnaire aim research for to gather information for purposes of surveys. important to remember that for any questionnaire really effective it has to be designed well. Survey Home Visits and Questionnaires. The student nurse interview the client by asking the questions in the questionnaire prepared by the Clinical Instructor. analysis or even to market corroborate other research findings. survey study. questionnaires. especially children. Interview is used to collect form facts. They are one of the It is to be cheapest and most feasible ways of gathering data. are structured interviews more in than their oral simplest sometimes little questionnaires. To answer the research problems the student nurse used a non-experimental design.CHAPTER III METHODS AND PROCEDURE FOR DATA GATHERING DATA GATHERING TECHNIQUE The Data Gathering Technique used is Interview. who might not be literate or capable of correctly completing a complex .

The student nurse also brought instruments for assessment of the client’s present condition. the student After gaining the Barangay Captain’s approval nurse first visited one of the respondents house which became her client. We also gathered that Barangay Manacnac have a total population of 1652 and total house hold of 457. Basic instruments such as thermometer. ADMINISTRATION OF INSTRUMENT The student nurses of Nueva Ecija University of Science and Technology together with their Clinical Instructors first asked for the permission of the Barangay Captain before conducting their case study. the information acquired serves as the primary information about the client for the case study.questionnaire. BP cuff and sphygmomanometer was used to assess the client’s vital signs. LOCALE OF THE STUDY History of Manacnac . Weighing scale was also used to get the client’s weight. She gather information by means of an interview. certain questions were asked about the client’s profile and her past and present medical status.

Joson. Nang panahong iyon may isang dayuhan na nanggaling sa Novaliches Q. ang nag interas na bumili ng lupa sa nasabing barangay at dito na rin siya nanirahan. taong 1953 si Ginoong Anong Simanero ang naging kapitan sa lugar na ito.C. Ang lugar na ito ay may gulod na ang makikita ay puro mga damo at talahib maliban lamang sa piggery na pag-aari ng mga Wycoco. Cucio at kanyang Vice Mayor na si Felipe Bautista ay nahalal bilang unang subsequent local official. Kung iyong makikita ang Barangay na ito. para kang nasa isang bundok na malayo sa kabayanan.Sina Mayor Elpidio O. Nueva Ecija na may kaunting populasyon. Tanong 1965 ng mapagpasyahan ng kongreso ng Pilipinas na ang Palayan City ang magiging bagong kapital ng Nueva Ecija. na sakop ang Manacnac ay dating sitio ng Maligaya ng Laur. Ayon sa kasaysayan. Nag-donate ng . Romulo V. Siya ay si Ginoong Pedro Valenzuela. 1965 ang inaguration ng City Government sa Palayan napagpasyahan ito ni ex-official Mayor Eduardo L. December 5. Taong 1966 nang naging Kapitan si G. Sandoval sa Barangay Manacnac noong ang barangay na ito ay sakop parin ng Laur.Ang kabisera ng lalawigan ng Nueva Ecija ay ang lungsod ng Palayan. Dito matatagpuan ang Barangay Manacnac.

pumapasol ang mga batang nag-aaral noon dito. Taong 1972 nang dahil sa ordinansang pinasa bg Sanggunian. Sandoval. may pamilyang 131 nang sumapit ang EDSA Revolution taong 1986 itinalaga ni Kgg. Ang barangay Manacnac ay naging isang barangay sa Palayan City at nang panahong iyon ay kapitan parin si Ginoong Sandoval. Fajardo na OIC ng Palayan City at Vice si Flor Agustib na kasalukuyang kapitan parin si Romulo V. Taong 1976 tumaas muli ang populasyon ng barangay mula sa bilang na 662 ay naging 852 at may bilang na 128 ang bubong ng bahay.kalahating hektaryang lupa para sa eskwelahan ng Cabanatuan City at Atate. Presidente Aquino si Don Pacifico M. .

http://changingminds. They typically start with people in the street. Purposive sampling is non-probability and hence can be subject to bias and error.htm) .org/explanations/research/sampling/purposive_samplin g. first approaching only 'likely suspects' and then starting with questions that reject people who do not suit.LOCATION MAP Sampling Design Purposive sampling starts with a purpose in mind and the sample is thus selected to include people of interest and exclude those who do not suit the purpose. This is also true for marketing researchers who are seeking support for their product. This method is popular with newspapers and magazines which want to make a particular point.

4. That the most common problems encountered in physical aspect of the respondents is pain. anemia. The most common is home wearing management pajamas when it comes is to the physical aspect because that simplest way to prevent too much exposure to cold climate.CHAPTER IV CONCLUSION AND RECOMMENDATION CONCLUSIONS In the light of above findings of the study. and decreased number of friends. 3. The most common problem encountered in economical is shortage of money followed by delayed pension. anxiety and fear. The most common problem encountered in emotional aspect is feeling helplessness followed by loneliness. change of employment. 5. . The most common problem encountered in social aspect is delaying on immediate job or meeting followed by withdrawing from social activities. eating disorder. the following conclusions were arrived at: 1. early retirement. 2. weight loss. followed by fatigue.

All remedies they choose. taking steam bathing. applying hot compress on the affected area. 8. white flower and Betet were used as home remedies. Maintaining proper body position is the simplest way to prevent further deterioration of the cartilages that’s why it prevents too much pain. eating food rich in omega 3 fatty acids and fish oil such as canned tuna etc. wearing stocky net/socks. massage the affected area. elevating their legs. and taking extra supplement. talbos ng kamote. attending aerobics exercise at least twice a week. avoiding eating food rich in . Pain reliever medications were prescribed because of effectiveness of drug followed by taking over the counter medicine. Followed by eating green leafy vegetables like malungay. the most effective remedies is efficascent oil followed by pau linament oil.. and applying cold packs on affected area. 6. 10. Home management for eating disorder the most convenient is eating fruits and vegetables because they can acquired it immediately and affordable to their backyards. always engage in brisk walking every morning.Followed by sleeping 8 hours a day. 9. Followed by avoiding heavy works.

and going to mall with their relatives.. sitaw. . 2. and drinking at least one glass of milk a day. and playing chess with their friends. nuts.uric acid such as mongo. going to amusement park. gizzards. Relatives must provide knowledge to the elderly with regards to home remedies and proper practices because old aged are easily forget their activities. The home management in social aspect is watching television because they divert their attention to forget the pain. Practices vary according to the individual but tasked could be done with encouragement. They should also practice to limit eating rich in uric acid such as monggo. RECOMMENDATIONS The researchers of the study hereby recommend that: 1. because the crystals of uric acid are deposited in the joints that causing pain. gizzards etc. Followed by playing with their grandson. reading books and newspaper. Patient should able to manage their activity daily living to lessen the factor that can cause Rheumatism to occur. 11. sitaw.

com/health/autoimmunediseases /rheumatoid-arthritis/ra-diagnosis. inc.php article 5 Galanes feb 2006/ www.com .com article 1 Puzas January 2006 www. eleventh edition 2008 Cacanindin. A Beginner Journey Into Professional Nursing.google.3.knrn.org/?p=92. Patient should have awareness about Rheumatism by discussing this home management and affective practices as the primary prevention for further deteriorations of body functions. http://manilasector.com.com. 839 EDSA South Triangle. http://www./2007 aricle3 klopp .google.com. Quezon city Concise Oxford English Dictionary eleventh edition Seeley.livestrong.rheumatismworldhealthorganization http://www.Nursing research : study notes and guide. Stephens.THEORETICAL FOUNDATION OF NURSING. http:// www.html/2005 article7 Gulanik www. first edition 2008 Brunner & Suddarth’s Textbook of Medical-Surgical Nursing.org/natural-remedies-forarthritis. 2010.google. by C&E Publishing.google.com/article/330159exercises-for-rheumatism/ mayoclinic. the disease process of Rheumatism BIBLIOGRAPHY Bautista Joy. & Tate Essentials Physiology sixth edition 2007.disabled-world. Of Anatomy And www.

http://www. Girlie Tayao. RN.com. for the motivation and overwhelming encouragement. I want to offer sincerest gratitude to my clinical instructor.google. Mrs.com/content/gg813l16x4690623/. who was supported and guided me throughout my case study. First and foremost. . Google. and for her patience and understanding in checking my case. for the humble sharing of her knowledge and experiences.ww. dec 2009 ACKNOWLEDGEMENT As a student nurse wish to acknowledge and express their deep appreciation and gratitude for the kind assistance given by numerous people who helped them in the preparation of this case study.com www.springerlink.

Eppie DC. RN. the God almighty who has given His great mercy and blessings for the years of study of the researchers and who has given them a great privilege to be His children. Christian Gabuya for her wholehearted assistance and suggestions. Mrs. Ph. Bugarin. RM. Lastly and most importantly.To my staffing.D for her valuable contribution to this study. Angelica P. To the personnel of Barangay Manacnac Palayan City for providing necessary information to my research in conducting this study. Mr. Bravo . To the Dean of College of Nursing.

Bravo TABLE OF CONTENS . I hardships. So. Angelica P. made this efforts humble piece of work a successful one. with love and respect. I dedicate this priceless output to the following persons: To my clinical instructor Mrs. sleepless trials. Girlie Tayao RN who lend her helping hands to guide me in the success of this study. all the and challenges. To my loving parents who always extend their best love and care that serve as their inspiration in my studies. this work would have been in vain. knowledge and abilities for my staffing who always give their everlasting without Him.DEDICATION After sufferings. to the Lord Jesus Christ who is the divine source of their strength. nights. To support. To all of them. Above all. I am humbly dedicate this piece of work.

vi I.Pag es Title ……………………………………………………………………………………………………………………………………………i Acknowledgement …………………………………………………………………………………………………………………ii Dedication …………………………………………………………………………………………………………………………… iii Table of Contents ………………………………………………………………………………………………………. THE PROBLEM AND ITS SETTING Introduction ………………………………………………………………………………………………………… 1 General Objectives ………………………………………………………………………… 4 Specific Objectives ……………………………………………………………………………… 4 Client’s Profile Foreign Studies …………………………………………………………………………………………………… 21 Local Studies ……………………………………………………………………………………………………… 24 .

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