SANAANI, NUR-FATIMA,M

NCM-114J

(NURSING CARE PLAN) NCP

Assessment Nursing Nursing Intervention Implementation Evaluation

diagnosis outcome
Subjective Acute pain related After 8 hours of  Consider reports of After 8 hours of
“Hindi ako pwede to distension of nursing care, pain, noting location  Considered nursing care,
tumayo o umupo ng tissues by the patient will and intensity. Note reports of pain, patient will
matagal dahil sasakit accumulation of incorporate nonverbal pain cues. noting location incorporate
ang tuhod ko,” as fluid/inflammatory relaxation skills and intensity. relaxation skills
verbalized by patient. process, Reports and diversional  Assess and manage and diversional
of activities into chronic and acute pain. activities into
Objective pain/discomfort, the pain control Favorable in  Assessed and the pain control
vital signs: fatigue program: determining pain managed chronic program:
BP: 110/90 mmHg -reduced pain management needs and acute pain. -reduced pain
PR: 94 cpm sensation in and effectiveness of the sensation in
RR: 18 bpm joints program.  Assessed home joints
Temperature: 37.5 C -Able to Have environment for -Able to Have
O2 Sat: 97% minimal motility  Assess home factors that adequate
 Pale during motion environment for factors create barriers to motility during
 Active and of movement that create barriers to physical mobility. motion of
responsive -Reduce the physical mobility. To movement
 Unable to bend pain scale from know if client needs  Maintained bed -Reduce the pain
knee 7 out of 10, to 4 referral. rest or chair rest scale from 7 out
completely out of 10 when indicated. of 10, to 4 out of
 Swelling on left  Maintain bed rest or 10
and right chair rest when  Recommend or
patella indicated. Schedule provided a firm
 Limited ROM frequent rest periods mattress or
 Rheumatoid and uninterrupted bedboard, small
nodules on nighttime sleep. pillow. Elevate
small joints of Systemic rest is linens with bed

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fingers, wrist mandatory during cradle as

and toes. acute exacerbations needed.
 Gait changes and important
Pain scale of 7 out of 10 throughout all phases  Established
of disease to reduce frequent changes
fatigue, improve of position. Assist
strength. the patient to
move in bed,
 Recommend or provide supported
a firm mattress or affected joints
bedboard, small pillow. above and below,
Elevate linens with bed avoiding jerky
cradle as needed. movements.
Soft and sagging
mattress, large pillows  Established
prevent maintenance patient to
of proper body perform ADLs
alignment, placing such as
stress on affected practicing good
joints. Elevation of bed hygiene,
linens reduces pressure dressing, and
on inflamed or painful feeding himself
joints.
 Provided patient
 Encourage frequent to take a warm
changes of position. bath or shower
Assist the patient to upon arising or at
move in bed, bedtime. Applied
supporting affected warm, moist
joints above and below, compresses to
avoiding jerky affected joints
movements. Prevents several times a
general fatigue and day. Monitored
joint stiffness. Stabilizes water

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NCM-114J

joint, decreasing joint temperature of

movement and compress, baths,
associated pain. and so on.
 Urge patient to perform
ADLs such as practicing  Encouraged
good hygiene, dressing, activity/exercise
and feeding himself to as tolerated.
promote self-care ADLs Patients feel
that can be done fatigue easily, but
should be encouraged daily exercise can
to maximize and help loosen
function. joints.

 Recommend that
patient take a warm  Administered
bath or shower upon medication
arising or at bedtime. appropriately
Apply warm, moist
compresses to affected
joints several times a  Established
day. Monitor water positive self-
temperature of image.
compress, baths, and
so on. Heat
promotes muscle relax  Discussed and
ation and mobility, provided safety
decreases pain, and needs such as
relieves morning raised chairs
stiffness. Sensitivity to and toilet seat,
heat may be use of handrails
in shower and
diminished and dermal
toilet, proper
injury may occur.
use of mobility
 Encourage aids.
activity/exercise as

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NCM-114J

tolerated. Patients feel

fatigue easily, but daily
exercise can help  Nutrition and
loosen joints. Promotes lifestyle
joint stability to reduce education.
risk of injury, maintain Educated
proper body position. patients make
healthy diet
choices by
 Administer medication
following an
appropriately To reduce anti-
inflammation and slow inflammatory
joint damage. diet..

 Promote positive self-

image. Patients with
joint deformities may
experience a negative
body image

 Discuss and provide

safety needs such as
raised chairs and toilet
seat, use of handrails in
shower and toilet,
proper use of mobility
aids. Relieves pressure
on tissues and
promotes circulation.
Facilitates self-care and
patient’s

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NCM-114J

independence.

 Nutrition and lifestyle

education. Educate
patients make healthy
diet choices by
following an anti-
inflammatory diet.
Encourage hydration.

Learning objectives Content outline Method(s) of Time allotted Resources Method of

teaching(teaching (instruction evaluation
strategies) materials)
After 15-45mins of Interactive
health teaching on food 1. (definition) lecture with visual
poisoning, client will be Rheumatoid arthritis images and
able to: (RA), is a type of demonstration

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NCM-114J

arthritis that results in 3mins Flyers infographic

1. Defined what is joint pain, swelling,
rheumatoid stiffness, and loss of 1. By
arthritis is function (mediline, sharing
2. Differentiate 2012). An autoimmune facts and
rheumatoid disease that causes the informati
arthritis body to attack its own on about
3. Enumerate the soft tissue and joints on how
available a systemic level. rheumato
treatment and Rheumatoid arthritis id
management in affects the hands and arthritis
bouts related to feet the most, although because a
pain due to it can also affect the burdens
rheumatoid elbows, shoulders, and to one’s
arthritis neck. life Standardized test,
4. State the 2. Rheumatoid arthritis 10mins Inforgraphic and Q and A
importance of versus other types of
compliance to arthritis 2. By citing
treatment and -osteoarthritis(While it example
management to is commonly referred that
lessen to as "wear-and-tear" trigger
complication arthritis, this ailment is the
5. Display a caused by more than occurrenc
positive just the surface of the e of the Demonstration of
behaviour in the joints wearing away. disease video, and live
course of health The most prevalent and its
teaching type of arthritis is complica Active recall of
osteoarthritis. It is most tion if it the educatiosn
commonly caused by worsen
pain and limited
motion in the knee and 3. By
hip joints.) showing
-gouty arthritis (is a picture
condition that is caused what it

NCM 114 Geriatric Assessment

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NCM-114J

by the accumulation of looks like

crystals made of urate to be a
within the joints. The person
urate crystals are with
formed by an unusual rheumato
breakdown of normal id
body surface. arthritis
Accumulation of urate
within joints causes 4. By briefly
gouty arthritis, thse explain
most commonly affced the topic
joints are the big toe, by using
and the knee. ) images
-juvenile rheumatoid and
arthritis, or JRA(is portraits
another auto-immune
condition, but it tends 5. By
to affects children and encouragi
adolescent, there is a ) ng
cooperati
3. Etiology and clinical on and
manifestation active
-Although the specific participati
etiology of RA is on during
unknown, it appears the
that the disease is discussion
caused by a
combination of genetic
predisposition,
environmental triggers,
and chance. 9 The
genetic contribution to
the variance in RA
liability, which is

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equivalent to RA
heritability, was
investigated in a study
of monozygotic and
dizygotic twins.

-Clinical manifestations
of RA vary, usually Lecture discussion
reflecting the stage and
severity of tge disease:

*Joint pain. One of the

classic signs, joints that
are painful are not
easily moved.
*Swelling. Limitation in
function occurs as a Demonstration
result of swollen joints.
*Warmth. There is Inquiry-based
warmth in the affected instruction
joint and upon
palpation, the joints are
spongy or boggy.
*Erythema. Redness of
the affected area is a
sign of inflammation.
*Lack of function.
Because of the pain,
mobilizing the affected
area has limitations.
*Deformities.
Deformities of the
hands and feet may be
caused by

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misalignment resulting
in swelling.
*Rheumatoid nodules.
Rheumatoid nodules
may be noted in
patients with more
advanced RA, and they
are nontender and
movable in the
subcutaneous tissue.

4. Complication
-Rheumatoid arthritis
medications can have
dangerous and perhaps
fatal side effects.

Suppression of the
bone marrow.
Immunosuppressants
used incorrectly can
cause bone marrow
suppression.

Anemia.
Immunosuppressive
drugs like
methotrexate and
cyclophosphamide are
extremely dangerous
and can cause anemia.

Disturbances in the

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NCM-114J

gastrointestinal tract.
Gastric inflammation
and ulceration are
possible side effects of
several NSAIDs.

5. Available treatment
-The drugs used in
each phase of
rheumatoid arthritis
include:

Early Rheumatoid
Arthritis

*NSAIDs. COX-2
medications block the
enzyme involved in
inflammation while
leaving intact the
enzyme involved in
protecting the stomach
lining.
*Methotrexate.
Methotrexate is
currently the standard
treatment of RA
because of its success
in preventing both joint
destruction and long-
term disability.
*Analgesics. Additional
analgesia may be
prescribed for periods

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NCM-114J

of extreme pain.

Moderate, Erosive
Rheumatoid Arthritis

*Cyclosporine. Neoral,
an immunosuppressant
is added to enhance
the disease modifying
effect of methotrexate.
Persistent, Erosive
Rheumatoid Arthritis

*Corticosteroids.
Systemic
corticosteroids are
used when the patient
has unremitting
inflammation and pain
or needs a “bridging”
medication while
waiting for slower
DMARDs to begin
taking effect.
Advanced, Unremitting
Rheumatoid Arthritis

*Immunosuppressants
. Immunosuppressive
agents are prescribed
because of their ability
to affect the production
of antibodies at the
cellular level.

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NCM-114J

*Antidepressants. For
most patients with RA,
depression and sleep
deprivation may
require the short-term
use of low-dose
antidepressants such as
amitriptyline,
paroxetine, or
sertraline, to
reestablish an
adequate sleep pattern
and to manage chronic
pain.

6. Therapy
For persistent, erosive RA,
reconstructive surgery is
often used.

*Reconstructive surgery.
Reconstructive surgery is
indicated when pain cannot
be relieved by conservative
measures and the threat of
loss of independence is
eminent.

*Synovectomy.
Synovectomy is the
excision of the synovial
membrane.

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*Tenorrhaphy.
Tenorrhaphy is the suturing
of a tendon.

*Arthrodesis. Arthrodesis
is the surgical fusion of the
joint.

*Arthroplasty. Arthroplasty
is the surgical repair and
replacement of the joint.

7. Mom-pharmacological
management

*Rest enough to avoid

fatigue

*Exercises for
conditioning and
maintaining strength
and flexibility

*Local therapy
including moist hot
packs or cold following
trauma

*Physical supports for

wrists for pain control,
although does not
prevent deformity

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NCM-114J

*Patient education and

psychosocial support

*Orthopedic surgery to
repair structural
damage that may lead
to disability over the
long term

NCM 114 Geriatric Assessment