Nursing care plan Rheumatoid Arthritis RA

I. Pathophysiology
a. Systemic inflammatory process originating in the synovium
or synovial fluid involving connective tissue and characterized
by destruction and proliferation of the synovial membrane
b. Phagocytosis produces enzymes within the joint, causing
inflammation
c. Collagen is destroyed over time and pannus formations
occur, narrowing the joint space
d. May result in joint destruction, ankylosis, and deformity,
with loss of articulation and joint motion
e. Inflammatory process can also affect the spine, blood vessels,
the pleural membrane of the lungs, or the pericardial
sac.
f. Condition may be short lived and limited or progressive and
severe.
g. Spontaneous remissions and unpredictable exacerbations can
occur.

II. Classification (New York Times, 2007)
a. Type 1: benign, less common, milder form lasting a few
months at most and leaving no permanent disability
b. Type 2: aggressive, more severe, progressive form lasting
for years, often for life

III. Etiology (King & Worthington, 2006)
a. Specific cause unknown
b. Associated factors: infectious triggers, genetic predisposition,
autoimmune response
c. Other possible factors: more common in females, with ratio
to males approximately 3:1; hormone interaction; psychological
stress; heavy, long-term smoking; history of blood
transfusions

IV. Statistics
a. Morbidity: Prevalence in United States is approximately
1% or 2.1 million adults (King & Worthington, 2006;
NIAMS, 2004); peak incidence occurs at ages 40 to
60 years (Gupta & Bhagia, 2006).
b. Mortality: Dependent on overall deterioration in health and
secondary organ dysfunction (King & Worthington, 2006);
shortens lifespan by 3 to 10 years.
c. Cost: Annual medical costs are approximately $14 billion
(Arthritis Foundation and National Pharmaceutical
Council, 2002).

Care Settings
Client is treated at community level unless surgical procedure
is required.

Related Concerns
Psychosocial aspects of care
Total joint replacement

Nursing Priorities
1. Alleviate pain.
2. Increase mobility.
3. Promote positive self-concept.
4. Support independence.
5. Provide information about disease process, prognosis,
and treatment needs.

Discharge Goals
1. Pain relieved or controlled.
2. Dealing realistically with current situation.
3. Managing activities of daily living (ADLs) by self or with
assistance, as appropriate.
4. Disease process, prognosis, and therapeutic regimen
understood.
5. Plan in place to meet needs after discharge.

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