PRIORITIZATION:

1. Chronic pain related to inflammatory process and destruction of the joints as evidenced by pain scale 8/10 in the joints of hands, shoulders and feet, inability to
lift arm, deformities of the hands, weakness, presence of swelling and tenderness on hands and lack of function on the affected areas. 

Justification: Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or represented in terms of such damage by the
International Association for the Study of Pain (IASP). Patients with rheumatoid arthritis may experience an uncomfortable sensation of pain that is highly subjective in nature.
With that being said, this is the prioritized nursing problem since pain became an evident clinical manifestation on our patient causing changes in her body’s homeostasis and
behavior which greatly affected her condition. Comfort, rest and sleep are included in the Physiological needs. Under Maslow’s Hierarchy of needs, it is emphasized that
physiological needs should be prioritized when tending to patients. Chronic pain can cause other complications of not treated immediately like impaired physical mobility due to
the intense pain felt by the patient. If the patient can’t alleviate pain, he will not be able to focus on the medical regimes ordered by the physician, thus it should be out top priority.

In addition, according to Abdellah’s Theory, people have physical, emotional and sociological needs. Therefore, it is important to give prompt interventions to alleviate pain and
promote comfort as it influences not only a person’s physical health, but also their mental health and quality of life by affecting an individual’s mood, exercise, sleep, grooming,
appetite, and the ability to focus and concentrate. To add, Comfort theory by Kolcaba, explains that comfort is a fundamental need of all human beings for relief or transcendence
arising from health care situations.

2. Activity intolerance related to joint inflammation and pain secondary to Rheumatoid Arthritis as evidenced by verbalization of “naninigas yung kamay ko, hindi ko na
maigalaw”, generalized weakness, presence of stiffness and tenderness

3. Risk for injury related to impaired mobility secondary to rheumatoid arthritis.

NURSING CARE PLAN

DATA EXPLANATION OF GOALS/OBJECTIVES INTERVENTIONS RATIONALE EVALUATION

THE PROBLEM
Subjective: Chronic pain is defined as STO: Diagnostic: STO:
 Patient verbalized an unpleasant sensory and
8/10 pain scale on emotional experience After 8 hours of nursing  Assess the patient’s vital  To create a baseline FULLY MET if the
 her joints associated with actual or interventions, the patient signs set of observations patient reported pain relief
 Verbalized “masakit potential tissue damage, or will: for the patient and/or controlled pain
yung mga kamay ko represented in terms of a. Report pain relief from pain rating of 8/10 to
tsaka balikat ko, such damage by the and/or controlled pain  Assess and monitor for  Aids in identifying 4/10; participated in the
hindi ko na International Association from pain rating of reports of pain and the degree of treatment regimen; and
maigalaw” for the Study of Pain 8/10 to 4/10 stiffness, noting location, discomfort and was able to demonstrate
 Verbalized pain (IASP). It is a sudden or b. Follow and comply duration, and intensity effectiveness of use of non-
when standing for slow onset of disagreeable with prescribed (0–10 scale). Note analgesia. pharmacological methods
too long as intensity from mild to pharmacologic regimen reports of numbness and to provide relief
aggravating factor severe; constant or with the nurse's swelling.
recurring without an assistance  To alleviate the PARTIALLY MET if the
anticipated or predictable c. Demonstrate use of  Administer symptoms and patient reported controlled
Objective: end and a duration of non-pharmacological analgesics/pain provide pain relief pain from pain rating of
 Patient appears weak longer than 6 months. methods that provide medications and other to the patient 8/10 to 6/10; participated
and anxious pain relief such as medications for in the treatment regimen
 Awake and oriented The patient verbalized that comfort measures: rheumatoid arthritis as but was not able to
 Presence of bone the pain in her joints in warm compress, use of prescribed. demonstrate use of non-
deformities and joint hands, shoulders and feet relaxation exercises pharmacological methods
stiffness on both started seven months ago. (visualization, guided to provide relief
hands Chronic pain can be mild imagery), and Therapeutic:
 V/S taken as or excruciating, episodic or diversional activities  Promotes relaxation, NOT MET if the patient
follows: T: 36.9C continuous, merely (watching TV and  Provide basic comfort helps refocus reported no pain relief
PR: 78bpm RR: 20 inconvenient or totally listening to music) measures (reposition on attention, and may and/or controlled pain
BP: 128/68mmHg incapacitating. Eventually, back or unaffected side, enhance coping from pain rating of 8/10;
spO2: 99% it becomes more difficult LTO: back rub) and diversional abilities. did not participate in the
 Positive rheumatoid for the patient to activities. treatment regimen; and
factor, CCP differentiate the exact After 72 hours of nursing  To limit pain or was not able to
antibodies location of the pain and interventions, the patient  Suggest patient assume a injury to joint demonstrate use of non-
 Elevated ESR and C- clearly identify the will: position of comfort while pharmacological methods
reactive protein intensity of the pain. a. Achieve optimal in bed or sitting in a to provide relief
comfort as evidenced chair. Promote bedrest as
by being able to indicated.
Chronic pain can cause ambulate, move joints

other complications if not
treated immediately like
impaired physical mobility
due to the intense pain felt
by the patient. If the
patient can’t alleviate pain,
she will not be able to
focus on the medical
regimes ordered by the
physician, thus it should be
the top priority nursing
diagnosis.
and lift arms without  Assist the patient to  Stabilizes joint, LTO:
complaints of severe move in bed, supporting decreasing joint
pain (0-3/10) and affected joints above and movement and FULLY MET if the
discomfort. below, avoiding jerky associated pain. patient was able to achieve
b. Patient will appear movements. optimal comfort as
relaxed and be able to evidenced by being able to
sleep/rest  Recommend that patient ambulate, move joints and
appropriately. take a warm bath or  Heat promotes lift arms without
c. Patient displays shower upon arising or at muscle relaxation complaints of severe pain
improvement in mood; bedtime. Apply warm, and mobility, (0-3/10) and discomfort;
coping. moist compresses to decreases pain, and patient is relaxed and was
affected joints several relieves morning able to sleep/rest properly
times a day. stiffness. and manifests mood
improvement and coping
Educative:
PARTIALLY MET if the
 Educate to patient was able to achieve
nonpharmacological pain  Enables patient to comfort as evidenced by
management activities participate actively being able to ambulate,
(relaxation techniques, in nondrug move joints and lift arms
visualization, guided treatment of pain with complaints of mild
imagery, biofeedback, and enhances sense pain (4-5/10) and minimal
laughter, music, of control. discomfort; patient is
aromatherapy, relaxed but was not able to
and therapeutic touch). sleep/rest properly and
manifests minimal mood
 Discuss with SO/ improvement and coping
watcher with ways in
which they can assist the  Active participation NOT MET if the patient
patient with pain from caregivers was not able to achieve
management, such as gives a great sense optimal comfort as
providing gentle of support and is evidenced by inability to
massage, assisting in associated with ambulate, move joints and
 ADLs, etc.
 Inform patient and SO of
the expected therapeutic
effects and discuss
management of side
effects.
References:
Doenges, M., Moorhouse, M. and Murr, A. (2012). Nurse's Pocket Guide Diagnoses, Prioritized, Interventions, and Rationales, (14th Edition). Philadelpia. F.A. Davis Company
Nursestudy.net (n.d). Rheumatoid Arthritis Nursing Diagnosis Interventions and Care Plans. Retrieved from https://nursestudy.net/rheumatoid-arthritis-nursing-review/?
fbclid=IwAR0jfD5bmjdRXfNMIp86zPl54skg0hJOzyHDtoLUGGz5EEOBhTYcvHBPgw0
Belleza, M. (2021). Rheumatoid Arthritis. Retrieved from https://nurseslabs.com/rheumatoid-arthritis/
greater patient lift arms without
satisfaction and complaints of severe pain
treatment adherence (6-8/10) and discomfort;
of patients in patient appears restless and
general medical was not able to sleep
Care properly and manifest no
mood improvement and
coping
 This information
helps establish
realistic
expectations and
confidence in own
ability to handle
what happens.