PANNA DHAI MAA SUBHARTI

NURSING COLLEGE, MEERUT

CASE STUDY
ON
ARTHRITIS

SUBMITTED TO: SUBMITTED BY:

Mr. Anandh Sam Perera Riya Singh

Asso. Professor M.Sc. Nursing I Year

Dept. of Medical Dept. of OBG

Surgical Nursing Batch 2020

PDMSNC PDMSNC

SUBMITTED ON:
 IDENTIFICATION DATA

PATIENT NAME : Mrs. Anjali kumari

AGE : 42 yrs

GENDER : Female

M.R. No. : 21002688

WARD : MICU

ADDRESS : Duhai, Ghaziabad

EDUCATION : Graduate

OCCUPATION : School Teacher

MARITAL STATUS : Married

RELIGION : Hindu

DATE OF ADDMISSION : 25/03/2021

DIAGNOSIS : Arthritis
CHIEF COMPLAINS:

Patient came with the complain of joint pain and stiffness which is getting worsened day by day.
She is facing much problem in movement of her joints. She is facing this problem since last 2
years but has not seen any improvement in condition.

PRESENT MEDICAL HISTORY:

Treatment of arthritis has been started.

PAST MEDICAL HISTORY:

Taking medicine as per symptomatic treatment.

PRESENT SURGICAL HISTORY:

No significant history of any surgery being done.

PAST SURGICAL HISTORY:

No significant history.

SOCIO-ECONOMIC HISTORY:

Patient is living in a pucca house. Electricity facility is available. Source of water is tap water.
She also gave history of good sanitation in his house. There is proper satiation facility available.
All are using a common washroom.
PERSONAL HISTORY:

DIET: Vegetarian

SMOKING: No

ALCOHOL: No

BOWEL &BLADDER: Normal

FAMILY HISTORY:

Patient belongs to middle class family. There are 5 members in her family, patient, her husband,
one son and 2 daughters. Children are not yet married.

S.N NAME OF AGE/SEX EDUCATIO OCCUPATION HEALTH

O FAMILY N STATUS
MEMBERS
1. Anjali kumari 42yrs/F Graduate Teacher Unhealthy
2. Shripal singh 45yrs/M Graduate Patwari Unhealthy
3. Monu 25yrs/M Post -graduate Student Healthy
4. Preeti 22yrs/F B. A Student Healthy
5. Shivani 18yrs/F Bsc Student Healthy

FAMILY MEDICAL HISTORY:

Patient’s husband has continuous back pain since last 2 months and is under treatment. No other
person in family is having any disease condition.

PHYSICAL EXAMINATION
General Appearance

Look- Anxious

Posture- Normal

Health- Unhealthy

Nourishment- Nourished

Consciousness- Conscious

Anthropometric Measurement

Height- 152 cm

Weight- 50 kg

BMI- 22.23

Vital signs

Temperature- 98.4°F

Pulse- 86 beats/min

Respiration- 18 breaths/min

BP- 120/80 mm of Hg

HEAD TO TOE EXAMINATION

Head

Skull- No nodules or masses

Scalp- Clear

Shape- Normal

Size- Normal

Hair- Normally distributed

Eyes

Eyebrows- Evenly distributed

Eyelashes- Equally distributed

Eyelids- Symmetrical

Vision- Normal

Ears

External Ear- Normal

Symmetry- Symmetrical

Hearing- Normal

Nose
Symmetry- Symmetrical

Discharge- Absent

Mouth

Lips- Pink

Teeth- No discoloration

Gums- No retraction

Neck

Lymph Nodes- Not enlarged

Movement- Normal

Chest

Symmetry- Symmetrical

Chest wall- Intact

Abdomen

Inspection- No scars

Palpation- No tenderness, no masses

Percussion- No fluid present

Auscultation- Bowel and bladder normal

Upper Extremities

Symmetry- Symmetrical

Movement- Pain present

Lower Extremities

Symmetry- Symmetrical

Movement- Pain present

INVESTIGATION
INVESTIGATION PATIENT NORMAL REMARKS
VALUE VALUE

Hemoglobin 11.8 gm/dl 12-15 gm/dl Decreased

Platelet 230x103 mm3 150-410x103 mm3 Normal
WBC 9.3x103 mm3 4-10x103 mm3 Normal
Hematocrit 38.0 % 36-46 % Normal
MCV 94 fl 83-99 fl Normal
Neutrophil 80 % 40-70 % Increased
Lymphocyte 18 % 20-40 % Decreased
Urea 28.7 mg/dl 15-36 mg/dl Normal
Creatinine 0.7 mg/dl 0.5-1.0 mg/dl Normal
Na+ 148 mmol/L 137-145 m/L Normal
K+ 4.5 mmol/L 3.5-5.0 m/L Normal
Bilirubin 0.4 mg/dl 0.3-1.3 mg/dl Normal
Glucose 89 mg/dl <200 mg/dl Normal
 MEDICATIONS

MEDICATION DOSE/ ROUTE INDICATIONS SIDE EFFECTS

NAME FREQUENCY

Inj. Ibuprofen 10mg/ml/BD IV Acute or chronic rheumatoid Nausea

arthritis Dyspepsia
Migraine pain Dizziness
Juvenile arthritis Rash
Oral
Tab. Pansec 40 mg/ OD Erosive esophagitis Diarrhea
Hypersecretory conditions Headache
Dizziness
Rash

Inj. Cefixime 250 mg/ BD IV Bacterial Infection Dry mouth

Abdominal Discomfort
Rash
DISEASE CONDITION

INTRODUCTION

Arthritis is defined as inflammation of one or more joints, leading to pain and stiffness that can
worsen with age. There are as many as 100 types of arthritis with distinctive symptoms and
causes. Arthritis affects the joints, the tissue that surrounds the joint and tissue that surrounds the
joint and tissues connected with joints. Arthritis affects more than 180 million people in India.

TYPES

Arthritis is mainly divided into groups which are described below,

 Connective Tissue Disease (CTD): Connective Tissue is the tissue that holds together or
divides other body tissues and organs. Pain in the joints is a common symptom of CTD.
Scleroderma and dermatomyositis are popular examples of CTD.

 Rheumatoid Arthritis: Rheumatoid Arthritis is a chronic autoimmune disease that

affects both the joints of the hand, wrist or knee. It can occur in any age group and often
results in long lasting stiffness and fatigue.

 Metabolic Arthritis: Uric acid is a chemical developed as a body classifies the substance
called purine, which is found in human cells and food. This arthritis creates sudden spikes
of unbearable joint pain and even gout attack.

 Infectious Arthritis: This arthritis is the result of virus or fungus that enters the joint and
stimulates inflammation.
CAUSES

There is no definite cause of arthritis. Causes of arthritis depend upon the particular form of
arthritis. Probable Causes of arthritis are:

 Infection
 Immune system dysfunction
 Injury
 Genetic
 Unusual Metabolism

SYMPTOMS

 Swelling: Arthritis causes an abnormal enlargement of a part of the body. This is due to
the accumulation of fluid.
 Pain: The feeling of constant pain in the many parts of the body.
 Stiffness: Stiffness in the muscle upon waking up, or sitting at one place for long, upon
waking up in the morning or after sitting at a desk. One may feel stiffness in finger, wrist,
elbow, knees, ankles, shoulder or in any other joint.
 Fever, chills, fatigue, loss of appetite and headaches are some other common symptoms
of arthritis.

DIAGNOSIS

Diagnosis of the arthritis disease is done, to know its current and past status. The combination of
radiography, laboratory test and physical examination may be carried out. Diagnostic tests to
diagnose arthritis include:

 Ultrasound
 MRI
 Blood Culture
  Joint X-Ray
 Tear Test
 Thyroid Function Test
 Uric Acid Test

TREATMENT FOR ARTHRITIS

Arthritis can be treated by following methods:

 Medication
 Joint Replacement Surgery
 Physical Therapies
 Joint Assistive Aids
 Weight Loss
NURSING DIAGNOSIS

 Acute pain related to disease condition as evidenced by verbalization.

 Impaired physical mobility related to pain as manifested by observation.

 Disturbed body image related to impaired mobility as evidenced by observation.

 Self- care deficit related to pain as evidenced by verbalization.

 Risk for injury related to disease condition as evidenced by observation.

 Deficient knowledge related to disease condition as evidenced by verbalization.

ASSESSMENT NURSING GOAL INTERVENTIO RATIONAL IMPLEMNTATION EVALUATION
DIAGNOSIS N
SUBJECTIVE Acute pain To reduce To assess the patient’s To make Assessed patient’s Pain reduced to
DATA: related to the joints condition. baseline for condition. much extent.
Patient says, “I disease pain. care.
am having pain condition as
in joints.” evidenced by To identify the area of So that Identified area of
verbalization. pain. treatment can pain.
be decided.
OBJECTIVE
DATA: To get reference of a To provide Reference being done
I observed that physiotherapist. physiotherapy. from a
patient is having physiotherapist.
joint pain.
Educate the patient to To improve the Educated the patient
do mild exercises. movements. for mild exercises.

Provide medications To reduce the Provided medications

as per doctor’s order. pain. for pain as per
doctor’s order.
ASSESSMENT NURSING GOAL INTERVENTIO RATIONAL IMPLEMNTATION EVALUATION
DIAGNOSIS N
SUBJECTIVE Impaired To start To assess the patient’s To make Patient condition She is able to
DATA: physical some condition. baseline for assessed. make
Patient says, “I mobility related movement care. movements.
am not able to to pain as in joints.
move my joints manifested by To motivate the To provide Motivated the patient
properly.” observation. patient to make some support. to make some
movements. movements.

OBJECTIVE To ask to do mild To make Asked to do mild

DATA: exercises. movements exercises.
I observed that better.
patient is not To provide nutritious To give energy. Provided nutritious
able to make diet. diet.
movement in
her joints. To take medications To heal Given medications on
on time. quickly. time.
ASSESSMENT NURSING GOAL INTERVENTIO RATIONAL IMPLEMNTATION EVALUATION
DIAGNOSIS N
SUBJECTIVE Disturbed body To To assess the To make Patient’s condition Body image
DATA: image related to improve condition of patient. baseline for assessed. maintained to
Patient says, “ impaired body care. much extent.
My body mobility as posture.
structure or evidenced by To give psychological To improve the Psychological support
image has also observation. support. patient given to patient.
been changed condition.
due to To educate patient to To improve Patient educated to do
movement do mild exercise. body image. mild exercises.
problem”
To suggest to try to To maintain Suggested to move in
OBJECTIVE move in normal body her body normal body posture.
DATA: posture. image.
I observer
disturbed body To advice to take To get well Advised to take
image. medications in time. soon. medications on time.
 HEALTH EDUCATION

 Manage your symptoms:

 Rest your painful joint so it can heal. The healthcare provider may recommend
crutches or a walker if the affected joint is in a leg.

 Apply ice or heat to the joint. Both can help decrease swelling and pain. Ice may also
help prevent tissue damage. Use an ice pack, or put crushed ice in a plastic bag. Cover it
with a towel and place it on your joint for 15 to 20 minutes every hour or as directed. You
can apply heat for 20 minutes every 2 hours. Heat treatment includes hot packs or heat
lamps.

 Elevate your joint. Elevation helps reduce swelling and pain. Raise your joint above the
level of your heart as often as you can. Prop your painful joint on pillows to keep it above
your heart comfortably.

 Medications

 You may need to take other medicines every day to prevent arthritis from getting worse.
The healthcare providers will help you understand all your medicines and when to take
them. It is important to take the medicines as directed, even if you start to feel better. You
can continue to have joint damage and inflammation even if you do not feel it.

 Diet
 Eat a variety of healthy foods. Healthy foods include fruits, vegetables, whole-grain
breads, low-fat dairy products, beans, lean meats, and fish.
 Ask if you need to be on a special diet. A diet rich in calcium and vitamin D may
decrease your risk of osteoporosis.
 Food high in calcium include milk, cheese, broccoli, and tofu. Vitamin D may be
found in meat, fish, fortified milk, cereal and bread.

 Maintain a healthy weight. 

 Wear flat or low-heeled shoes.
 Do not smoke. 
 BIBLIOGRAPHY

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Philadelphia,2007:1100-1103
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Medical Surgical Nursing. 10th ed. Williams &Willkins publications New Delhi:452-462.
3. Wesley RL. Nursing theories and Models. 2 ed Pensylvania spring house 1994:66-74.
4. Black MJ. Medical Surgical Nursing-Clinical Management of positive outcomes.6th ed
New Delhi, Elsevier India Pvt ltd2003: 543-548.
5. https://www.drugs.com/cg/arthritis-aftercare-instructions.html