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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/protective behavior Restlessness facial grimacing pain scale of 7 out of 10 V/S taken as follows T: 37.5˚C P: 100 R: 20 BP: 120/ 80 acute pain distension of tissues by accumulation of fluid/inflammatory process
Investigate reports of pain, noting location and intensity(scale of >Report pain is 0–10). 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 Soft/sagging appropriately. 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.
Student Nurses’ Community
. Assist with physical therapies, e.g., paraffin glove, whirlpool baths. Provides sustained heat to reduce pain and improve ROM of affected joints
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);