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NURSING CARE PLAN Rheumatoid Arthritis ASSESSMENT SUBJECTIVE: Napakasakit ng mga kasukasuhan ko (I'm having severe joint pain) as verbalized by the patient. DIAGNOSIS Acute pain r/t distension of tissues by accumulation of fluid. INFERENCE destruction and proliferation of the synovial membrane joint destruction, ankylosis, and deformity PLANNING After 8 hours of nursing intervention the patient will: INTERVENTION Independent RATIONALE EVALUATION Goal met, patient has Verbalize relief of pain.

OBJECTIVE: Guarding/protectiv e behavior Restlessness facial grimacing pain scale of 7 out of 10 V/S taken as follows T: 37.5C P: 100 R: 20 BP: 120/ 80 distension of tissues by accumulation of fluid/inflammatory process acute pain

Investigate reports of pain, noting location and intensity(scale of >Report pain is 010). Note relieved/controlled. precipitating factors and nonverbal pain >Appear relaxed, cues. able to sleep/rest and participate in Recommend/provide activities firm mattress or appropriately bedboard, small pillow. Elevate linens with bed >Follow cradle as needed. prescribed pharmacological regimen. >Incorporate relaxation skills and diversional activities into pain control program

Helpful in determining pain management needs and effectiveness of >Demonstrated program relaxed body posture and be able to sleep/rest appropriately. Soft/sagging mattress, large pillows prevent maintenance of proper body alignment, placing stress on affected joints. Elevation of bed linens reduces pressure on inflamed/painful joints. In severe disease/acute exacerbation, total bedrest may be necessary (until objective and subjective improvements are noted) to limit pain/injury to joint.

Suggest patient assume position of comfort while in bed or sitting in chair. Promote bedrest as indicated.

Collaborative Apply ice or cold packs when indicated Cold may relieve pain and swelling during acute episodes.

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Provides sustained heat to reduce pain and improve ROM of affected joints

. Assist with physical therapies, e.g., paraffin glove, whirlpool baths.

Administer medications as indicated Salicylates, e.g., aspirin (ASA) (Acuprin, Ecotrin, ZORprin);

ASA exerts an anti-inflammatory and mild analgesic effect, decreasing stiffness and increasing mobility. ASA must be taken regularly to sustain a therapeutic blood level. Research indicates that ASA has the lowest toxicity index of commonly prescribed NSAIDs. Characteristics of anti-inflammatory and immune modifier effects coupled with ability to block metalloproteinases

Tetracyclines, e.g., minocycline (Minocin);

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Nursing Interventions and Rational - Nursing Care Plan for Rheumatoid Arthritis 1. Record complaints of pain, record the location and intensity (scale 0-10). Write down the factors that accelerate and signs of pain - non-verbal. Rational: To assist in determining the need for pain management and program effectiveness. 2. Give a hard mattress, a small pillow. Elevate the bed linen as needed. Rational: a soft mattress, pillow that would prevent maintenance of proper body alignment, placing stress on the joints that hurt. Elevation of the bed linen lowering the pressure in the inflamed joints / pain. 3. Place / monitor the use of pillows, sandbags, splint, brace. Rational: Resting sore joints and maintain a neutral position. The use of the brace can reduce pain and can reduce damage to the joints. 4. Advise to change position frequently. Help to move in bed, prop joint pain above and below, avoid jerky movements. Rationale: Prevent the occurrence of general fatigue and joint stiffness. Stabilize joints, reduce the movement / pain in the joints. 5. Instruct the patient to a warm bath or shower at the time awake and / or at bedtime. Provide a warm washcloth compress for sore joints several times a day. Monitor the temperature of the water compresses, baths, and so on. Rational: The heat increases muscle relaxation, and mobility, reduce pain and stiffness in the morning release. Sensitivity to heat can be removed and dermal wound can be healed. 6. Give a gentle massage Rationale: Increase relaxation / reducing pain. 7. Encourage the use of stress management techniques, such as progressive relaxation, therapeutic touch, biofeed back, visualization, guidelines imagination, self hypnosis, and breath control. Rationale: Increase relaxation, provide a sense of control and may enhance coping abilities. 8. Engage in activities appropriate entertainment for individual situations. Rationale: Focusing attention back, providing stimulation, and increased self-confidence and feeling healthy. 9. Give drug before the activity / planned exercise as directed. Rationale: Increasing realaksasi, reduce muscle tension / spasm, making it easier to participate in therapy.

Student Nurses Community 10. Collaboration: Give medications as directed. Rational: As an anti-inflammatory and mild analgesic effect in reducing stiffness and increasing mobility. 11. Give ice-cold compress if needed Rational: The cold can relieve pain and swelling during the acute period

ered.] Provide emotional support and reassurance to help the patient cope with limited mobility. Encourage the patient to perform as much self-care as his immobility and pain allow. To help promote sleep, adjust pain medications to allow for maximum rest. Help the patient identify techniques and activities that promote rest and relaxation. For joints in hand, provide hot soaks and paraffin dips to relieve pain as ordered. Check crutches, cane, braces, or walker for proper fit. Assess the patients pain patterns. Watch for skin irritation caused by prolonged use of assistive devices. Instruct the patient to plan for adequate rest during the day. Instruct the patient to take medications exactly as prescribe