NURSING CARE PLAN

Patient’s initials: N.M Chief Complaint: Acute Pain Level/Block/Group: GROUP 1 (3BSN- 9)
Age & Gender: 66-year-old Female Admitting Diagnosis: Rheumatoid Arthritis Clinical instructor: Amelita Dumaguin
Birthdate: 2/9/1956 Date of Confinement: 10/18/2022 Date: 10/18/2022
Address: La Union, Pangasinan

NURSING NURSING
ASSESSMENT NURSING ANALYSIS PLANNING RATIONALE EVALUATION
DIAGNOSIS INTERVENTIONS

SUBJECTIVE: Acute pain related to Rheumatoid arthritis (RA) - is SHORT TERM  Assess patient’s knowledge  Patients who are temporarily SHORT TERM
distension of tissues by an autoimmune disease that of immobility and its immobile are at risk for effects of (GOAL MET)
 Reports an intermittent the accumulation of causes inflammatory arthritis In 4 hours, the patient will implications immobility such as skin breakdown,
low-grade fever fluid/inflammatory as well as extra-articular be able to decrease the muscle weakness, thrombophlebitis, After 4 hours, the
 Take naproxen (Aleve) process possibly involvement. It is a chronic level of pain. constipation, and pneumonia patient is being able to
220 mg twice daily evidenced by painful, inflammatory disorder with an decrease the level of
 Wears a copper stiff hands and feet. unknown cause that primarily LONG TERM  Assess the location and  Favorable in determining pain pain
bracelet on the advice affects synovial joints. It intensity (Scale of 0-10) of management needs and
on of a neighbor frequently affects multiple After 48–72 hours the the pain reposted by the effectiveness of the program. LONG TERM
 Has painful, stiff hands joints in both hands, resulting patient will be able patient. And note (GOAL MET)
and feet in morning stiffness that can maintain or increase the precipitating factors and
last for several hours. strength and function of nonverbal cues. After 48–72 hours the
 Feels tired all of the
the affected and/or patient is able to
time maintain or increase the
compensatory body part.  Advice or provide firm  Soft and sagging mattresses, as well
And demonstrate mattress or bed board and as large pillows, prevent proper strength and function of
techniques/behaviors that pillow. Elevate linens with body alignment, putting strain on the affected and/or
OBJECTIVE: compensatory body
enable bed cradle as needed affected joints. Bed linen elevation
resumption/continuation relieves pressure on inflamed or part. And demonstrate
of activities. painful joints. techniques/behaviors
 Temperature: 100 F that enable
(37.8C) resumption/continuatio
 Suggest patient assume a  Total bedrest may be necessary
 Hands show mild ulnar n of activities.
position of comfort while in (until objective and subjective
drift and puffiness
bed or sitting in a chair. improvements are noted) to limit
 Admitted to the Promote bedrest as pain or injury to joint.
hospital for indicated.
examination and
comprehensive
treatment plan
 Methotrexate
(Rheumatrex)
 Place and monitor use of
pillows, sandbags,
trochanter rolls, splints,
braces. And encourage
frequent change of position
and assist the patient to
move.
 Suggest that the patient
take a warm bath or shower
and apply warm, moist
compresses to the affected
joints. Also, offer a gentle
massage.
• If prescribed by a physician,
administer the following
medications: salicylates,
Nonsalicylates, glucocorticoids,
disease-modifying
antirheumatic drugs (DMARD),
COX-2 inhibitors.
 Splints can reduce pain and joint
damage by keeping painful joints in
a neutral position, but prolonged
inactivity can lead to loss of
mobility and function. Changing
positions frequently also helps to
prevent general fatigue and joint
stiffness.
 Heat promotes muscle relaxation
and mobility, as well as pain
reduction and morning stiffness
relief. A gentle massage promotes
relaxation, gives a sense of control,
and may improve coping abilities.
 Salicylates (NSAIDs) act as an anti-
inflammatory and mild analgesic,
reducing stiffness and increasing
mobility. Glucocorticoids are anti-
inflammatory drugs that modify
immune response. Disease-
modifying antirheumatic drugs
(DMARD) alleviate rather than
eliminate arthritic symptoms. COX-
2 inhibitors, like NSAIDs, inhibit
prostaglandin production but have a
lower risk of causing stomach or
kidney damage.