PAMANTASAN NG CABUYAO

COLLEGE OF HEALTH AND ALLIED SCIENCES - BACHELOR OF SCIENCE IN NURSING

Rheumatoid Arthritis
LEVEL III SECTION A - GROUP NO. 2

Nursing Students: Clinical Instructor

Dela Calzada, Shaina Mae A. Professor. Herman F. Zoleta, RN,.MAN
Delan, Juliana Sophia V.
Dimayuga, Josemari Christian I.
What is Rheumatoid Arthritis?
Rheumatoid Arthritis is an autoimmune disease that attacks tissues within the joints. It
is a systematic disease that affects organs such as the heart, kidneys or other tissues like
muscles, cartilage, and ligaments. It is also often results in bone erosion and joint
deformity, depending on its severity. According to an article written by Jennifer
Freeman, MD. In 2018, Rheumatoid Arthritis is a Chronic Disease affecting at least 1%
of the Population worldwide. RA can be treated through altering lifestyles and taking
medications. Nevertheless, there’s still no known cure for the disease. It often affects
individuals ages around 30 to 60 years old, chiefly women rather than men.
Objectives of the Study
General Objectives:

Specified Objectives

Significance of the Study

Patient and Family
Nurses
Other Health Professionals
Nursing Research

Scope and Limitation

II. History Taking
A. Patient Profile
B. Socio-Demographic Characteristics
C. Concept of Health, Illness, and Hospitalization
D. Common Health Practices at Home
E. Comprehensive History
F. Physical Assessment
 Family Genogram

Family and Social History

Nursing History
1. Health Perception | Health Management Pattern
2. Nutritional | Metabolic Pattern
3. Elimination Pattern
4. Activity | Exercise Pattern
5. Sleep-Rest Pattern
6. Cognitive | Perceptual Pattern
7. Self-Perception | Self-Concept Pattern
8. Role | Relationship Pattern
9. Sexuality and Reproductive Pattern
10. Coping | Stress Tolerance Pattern
11. Value | Belief Pattern
Physical Assessment

GENERAL SURVEY
1. Appearance
2. Head to Toe Assessment
3. Neurological Examination
a. Cranial Nerve
b. Muscle Strength
c. Sensory
d. Reflexes
III. Clinical Discussion
Anatomy and Physiology
III. Clinical Discussion
Comorbidity: Hypertension
Pathophysiology
COMMUNITY VISIT

SEPTEMBER 3, 2022|DAY NO. 1

SEPTEMBER 5, 2022|DAY NO. 2

SEPTEMBER 8, 2022|DAY NO. 3

DOCUMENTATION:
Day 1 Day 2

Day 3
 DRUG STUDY/
MAINTENANCE MEDS
Drug Details Mechanisms of Action
Rosuvastatin is a Statin Agent|Medication and a
Brand Name:
competitive inhibitor of the enzyme HMG-CoA
Crestor
reductase, which catalyzes the conversion of HMG-
Generic Name: CoA to Mevalonate; an early rate-limiting step in
Rosuvastatin Calcium 10mg
Cholesterol Biosynthesis.

Classification:
HMG-CoA Reductase Inhibitors
Lipid-Lowering Agents|Statins
It acts in the Liver, where decreased Hepatic
Cholesterol concentrations stimulate the upregulation
of the Hepatic Low Density Lipoprotein (LDL)
receptors which increases Hepatic uptake of LDL.
Indications & Contraindications with Common Side Effects

Indications:
It is indicated to Patients with Cardiovascular Disease or for Patients with
Moderate to High Risk of developing Chronic Heart Disease, including the
following: Adjunctive Management in the Treatment of Trigyceridemia; Primary
Dysbetalipoproteinemia; and Hypercholesterolemia.

Contraindications:
Rosuvastatin is contraindicated for Patients with Hypersensitivity Reactions
including the following:
Skin Rashes
Pruritus &Urticaria
Angioedema
Active Liver Disease
Pregnant or Lactating Women
Indications & Contraindications with Common Side Effects

Side Effects: Adverse Reactions:

Confusion
Headache
Nausea Memory Problems
Myalgia
Dark Colored Urine
Asthenia
Constipation Jaundice
Nursing Responsibilities

Assess Patient’s History of Allergies, Pregnancy or Lactation.

Strictly Assess and Monitor the Vital Signs of the Patients; Heart Rate,
Respiratory Rate, Systolic and Diastolic Pressure.
Assess and Observe for Rashes and other Skin Reactions as results of
Hypersensitivity.
Assess the Patient for Joint Pain or Muscle Pain, Tenderness, and
Weakness; especially if it is associated with Fever, Severe Malaise, and
Confusion.
Encourage the Patient to take the right dose or medication as prescribed by
her Physician; to control Hyperlipidemia even though they’re
asymptomatic.
Counsel the Patient together with their families or relatives.
Drug Details Mechanisms of Action

Brand Name: Losartan and its Principal Active Metabolite

Cozaar
blocks the Vasoconstrictor and Aldosterone
Generic Name: secreting effects of Angiostensin II by
Losartan Potassium 50mg
selectively blocking the binding Angiostensin
Classification: II to the ATI Receptor found in the Tissues
Angiotensin II Receptor Blockers
Antagonist (ARBs) e.g Vascular Smooth Muscle, and Adrenal
Glands.
Indications & Contraindications with Common Side Effects

Indications:

It is indicated for Patients with Hypertension. Lowering Blood

Pressure decreases the Risk of both Fatal and Non-Fatal
Cardiovascular events, such as Stroke and Myocardial Infarction;
including the Treatments for the following conditions:

Left Ventricular Hypertrophy

Diabetic Nephropathy in Patients with Type II Diabetes.
 Indications & Contraindications with Common Side Effects
Contraindications:
Losartan is contraindicated for Patients with High Levels of Potassium in the
Blood, including the following condition:

Renal Artery Stenosis

Liver Problems
Hypotension
Pregnancy|Lactating Mothers
Decreased Blood Volume of Patient who undergo Mild to Moderate Kidney
Transplant.

Side Effects: Adverse Reactions:

Fatigue & Asthenia
Oliguria|Hypotension
Malaise|Cough & Colds
Diarrhea|Insomnia Acute Renal Failure|Anaphylaxis
 Nursing Responsibilities

Assess Patient’s Health History and Allergies, including if the Patient is

Pregnant or Lactating.
Assess and Monitor Patient’s Vital Signs; Heart Rate, Respiratory Rate, Systolic
and Diastolic Pressure.
Assess and Observe for Rashes and other Skin Reactions as results of
Hypersensitivity.
Observe signs of Angioedema, including Raised Patches or Red or White Skin
(Welts); Sensation such Burning and Itchiness; Face Inflammation with
Difficulty of Breathing.
First Dose of Losartan shouldn’t be given at Night due to increase Risk of
Hypotension.
Monitor Urine Input & Output, including the Sodium and Potassium Level;
Uric Acid.
Drug Details Mechanisms of Action

Brand Name: Ascorbic Acid is required for collagen

Vitamin C
formation and tissue repair by acting as a
Generic Name: cofactor in the Post-transitional formation of
Ascorbic Acid with Zinc 500mg
4-Hydroproline in -Xaa-Pro-Gly sequence in
Classification: collagens. It is a water-soluble vitamins that
Water-Soluble Vitamins
also acts as antioxidants and aids in Iron
absorption and distribution.
Indications & Contraindications with Common Side Effects

Indications:

Ascorbic Acid or Vitamin C is indicated and recommended for the

Prevention including the Treatment of Scurvy. Its Parenteral
Administration id desirable for Patients with Acute Deficiency, including
the following conditions:

Febrile State
Chronic Infection e.g Pneumonia, Whooping Cough, Tuberculosis,
Diphtheria, Sinusitis, Rheumatic Fever etc. that requires increased
Ascorbic Acid and Immune System.
Indications & Contraindications with Common Side Effects

Contraindications:
Ascorbic Acid is contraindicated for Patients with Hypersensitivity.

Side Effects:
Fatigue and Headache
Flushing or Fainting Sensation

Adverse Reactions:
Hyperoxaluria
Nausea & Vomiting
Heartburn|Diarrhea
 Nursing Responsibilities

Assess Patients History regarding Hypersensitivity or Allergic Reaction

to the Ascorbic or Zinc. High Dosage of Ascorbic Acid is not
recommended for Pregnant and Lactating Women.
Assess and Monitor Patient’s Vital Signs; Heart Rate, Respiratory Rate,
Systolic and Diastolic Pressure.
Assess and Observe for Rashes and other Skin Reactions as results of
Hypersensitivity.
Educate the Patient to consume higher dosage Vitamin C in dived
amounts; our bodies needed it at specific time and excretes the rest in
Urine; Mega-Dose can interfere with the absorption of Vitamin B12.
IV. NURSING MANAGEMENT
A. PROBLEM LIST
Approximate Date Nursing Date
Active Inactive
Date of Onset Identified Problem Resolved

March 20, 2019 September 03, 2022 Acute Pain    

Activity

August 10, 2021 September 05, 2022 Intolerance; Impaired    

Physical Mobility

October 14, 2021 September 08, 2022 Disturbed Body Image

   
B. LONG TERM OBJECTIVES:

After the series of Nursing Intervention together with Healthcare Teaching

and the comfort and assistance of PDC’s families and relatives; she would be
able to obtain a Vital Sign and Health Status at least at an average or normal
range; reduce Acute Pain and Activity Intolerance; changed perception
regarding her body, and felt the care and acceptance of the society in favor of
the older adult community.
V. NURSING CARE PLAN
ASSESSMENT

Subjective Data:
Patient PDC verbalized “Sumasakit ang tuhod ko kapag natayo at
minsan rin kapag ako ay naglalakad; natitiis ko naman ang sakit
minsan.”

Objective Data:
Facial Grimace
Pain Scale of 5/10
Unstable Gait
DIAGNOSIS

Acute Pain

PLANNING
EXPECTED GOALS|OUTCOMES

After series of 4 Hours of Nursing Interventions together with

Healthcare Teaching the Patient would be able to:

Patient describes increase in comfort and manageable gait with a Pain

Scale of ≤ 4/10.
NURSING INTERVENTIONS

1. Provide Methods to Relieve Pain before it becomes Severe.

Administering Analgesics at a required Dose.

2. Acknowledge and be Empathetic towards the Patient experiencing

Pain.

3. Provide Non-Pharmacological Pain Management e.g Physical

Cognitive-Behavioral Strategies and Lifestyle Pain Management.

4. Provide Pharmacologic Pain Management as ordered by the Physician;

Utilizing Opioids (Narcotics); Non-Opioids (NSAIDs), including the Co-
Analgesic Drugs.
 EVALUATION

GOAL MET:

After series of 4 Hours of Nursing Interventions together with

Healthcare Teaching the Patient was able to:

Patient describes increased in comfort and manageable gait with a

Pain Scale of 3/10.

Absence of Facial Grimace and Discomfort.

ASSESSMENT

Subjective Data:
Patient PDC verbalized
“Kapag kumikilos ako ng matagal at nagawa ng gawaing bahay
nasakit ang kasukasuan ko lalo na ang tuhod ko; naapektuhan ang
pagkilos ko sa araw-araw.”

Objective Data:
Facial Grimace
Unstable Gait
↓ Muscle Strength
Increased Blood Pressure during|after activities.
DIAGNOSIS
Activity Intolerance|Impaired Physical Mobility

PLANNING
EXPECTED GOALS|OUTCOMES

After series of 5 Hours of Nursing Interventions together with Healthcare

Teaching the Patient would be able to:

Patient would be able to independently complete activities of daily living.

Patient would be able to verbalize understanding and the need of

increasing Muscle Strength and Gait.
 Nursing Intervention

1. Establishing Guidelines and Goals of Activity with the Patient and their Significant
Others. It renders Cooperation and Rapport as the Patient participates in goal setting.

2. Evaluate the need for additional help at home; efforts that are coordinated and
effective in assisting the Patient in conserving energy.

3. Assist the Patient to do activities slowly, in a greater time but with frequent rest or
with the help if needed.

4. Foster Emotional Support and Positive Attitudes regarding abilities;

Complementing the Patient on their accomplishments.

5. Educate the Patient and Significant Other to recognize the signs of Physical
Overexertion.
 EVALUATION
GOAL MET:

After series of 5 Hours of Nursing Interventions together with

Healthcare Teaching the Patient was able to:

Patient was able to independently complete activities of daily living.

Patient would be able to verbalize understanding and the need of

increasing Muscle Strength and Gait.

Absence of Facial Grimace and Discomfort.

ASSESSMENT

Subjective Data:
Patient PDC verbalized
“Nalulungkot ako kasi ang kulubot na ng balat ko at mahina na
rin ako hindi na kagaya nung kabataan ko.”

Objective Data:
Negative Self-Talk
↓ Self-Confidence
Hopelessness
DIAGNOSIS
Disturbed Body Image

PLANNING
EXPECTED GOALS|OUTCOMES

After series of 2 Hours of Nursing Interventions together with Healthcare

Teaching the Patient would be able to:

Patient would be able to verbalize and demonstrate an acceptance of

their self and appearance instead of an idealized image.
 Nursing Intervention

1. Encourage an Open Communication with the Patient; Providing an Environment

that is Comfortable and Free from Judgement.

2. Assist and Encourage the Patient on Healthy Coping Mechanisms.

3. Identify and Encouraging the Patient to Participate in Community Support

Groups, including the Care and Support of their families: It aids in motivating the
Patient and in decreasing their Self-Isolation and Loneliness.

4. Encouraging and Assisting the Patient with grooming needs; trying out new sets
of clothes, etc. that would make them feel comfortable at their own age and skin.
 EVALUATION

GOAL MET:

After series of 2 Hours of Nursing Interventions together with

Healthcare Teaching the Patient was able to:

Patient was able to verbalize and demonstrate an acceptance of

their self and appearance instead of an idealized image.
 HOME CARE PLAN

Exercise: stretching, walking, and other activities that would

increase flexibility and enhanced joint stiffness or health.

Health Teaching

Engaging on Strenuous Exercises or Work and Lifting Heavy

Objects.
Having Vises such as Drinking and Smoking.
Consuming High Preservatives and Carbonated Drinks
 HOME CARE PLAN
Nutritional Diet
- advise PDC to eat fruits and vegetables that contains Vitamin A,
Vitamin C, and Vitamin D, for Calcium absorption and in
strengthening the Immune System. Fish that are rich in Omega 3 and
meals that contains Fiber, Protein, including using Organic Olive Oil
that contains Oleocanthal that is similar to Non-steroidal and Anti-
inflammatory Drugs (NSAIDs).

Spiritual
- encourage the Patient to engage in religious activities: attending
mass or listening to virtual homilies.
Thank you for listening