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NURSING CARE PLAN Rheumatoid Arthritis ASSESSMENT SUBJECTIVE: Napakasakit ng mga kasukasuhan ko (I'm having severe joint pain) as verbalized by the patient. DIAGNOSIS Acute pain r/t distension of tissues by accumulation of fluid. INFERENCE destruction and proliferation of the synovial membrane joint destruction, ankylosis, and deformity PLANNING After 8 hours of nursing intervention the patient will: >Report pain is relieved/controlled. >Appear relaxed, able to sleep/rest and participate in activities appropriately >Follow prescribed pharmacological regimen. >Incorporate relaxation skills and diversional activities into pain control program INTERVENTION Independent Investigate reports of pain, noting location and intensity(scale of 010). Note precipitating factors and nonverbal pain cues. Recommend/pr ovide firm mattress or bedboard, small pillow. Elevate linens with bed cradle as needed. Helpful in determinin g pain managem ent needs and effectiven ess of program RATIONALE EVALUATION Goal met, patient has Verbalize relief of pain. >Demonstrated relaxed body posture and be able to sleep/rest appropriately.

OBJECTIVE: Guarding/prot ective behavior Restlessness facial grimacing pain scale of 7 out of 10 V/S taken as follows acute pain distension of tissues by accumulation of fluid/inflammatory process

Soft/sagging mattress, large pillows prevent maintenance of proper body alignment, placing stress on affected joints. Elevation of bed linens reduces pressure on inflamed/painful joints. In severe disease/acute exacerbation, total bedrest may be necessary (until objective and subjective improvements are noted) to limit pain/injury to joint.

T: 37.5C P: 100 R: 20 BP: 120/ 80

Suggest patient assume position of comfort while in bed or sitting in chair. Promote bedrest as indicated.

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Cold may relieve pain and swelling during acute episodes. Provides sustained heat to reduce pain and improve ROM of affected joints

Collaborative Apply ice or cold packs when indicated . Assist with physical therapies, e.g., paraffin glove, whirlpool baths.

Administer medications as indicated Salicylates, e.g., aspirin (ASA) (Acuprin, Ecotrin, ZORprin);

ASA exerts an anti-inflammatory and mild analgesic effect, decreasing stiffness and increasing mobility. ASA must be taken regularly to sustain a therapeutic blood level. Research indicates that ASA has the lowest toxicity index of commonly prescribed NSAIDs. Characteristics of anti-inflammatory and immune modifier effects coupled with ability to block metalloproteinases

Tetracyclines, e.g., minocycline (Minocin);

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