Nursing Care Plan for Rheumatoid Arthritis (RA)

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Pathophysiology

RA is an autoimmune disease where the immune system mistakenly targets and attacks the joint linings causing uncontrolled inflammation of the synovium.  Joints on both sides of the body (bilateral) are affected, primarily the hands, wrists and knees. RA is characterized by bone erosion and joint deformity. As the disease progresses other joints may be affected symmetrically.  Chronic inflammation and degenerative changes are the hallmark aspects of RA.

Etiology

Doctors are still unsure as to what triggers RA, but it appears to be at least partially genetic in nature. This genetic predisposition makes the patient more susceptible to environmental factors like viruses and bacteria that may trigger the initial inflammation. Once the inflammation begins, the synovial fluid thickens and the tendons and ligaments weaken and stretch, resulting in the joint losing its shape and alignment.

Desired Outcome

While there is no cure, the goal of treatment is to manage the symptoms and slow disease progression. Medication, physical or occupational therapy and possibly surgery may be necessary.

Rheumatoid Arthritis (RA) Nursing Care Plan

Subjective Data:

  • Fatigue
  • Joint stiffness, symmetrical
  • Joint pain

Objective Data:

  • Warmth of joints
  • Joint edema
  • Dislocations
  • Deformity of joints
    • Ulnar deviation of hands
  • Fever
  • Weight loss

Nursing Interventions and Rationales

  • Assess and manage chronic and acute pain
    • Pillow supports
    • Warm compresses to loosen stiff joints/relax muscles
    • Cold compresses to numb pain and reduce swelling
    • Administer PRN pain meds

 

The primary complaint of patients with RA is the intense pain and stiffness of the joints. Manage chronic pain and breakthrough pain as necessary.

 

  • Administer medications appropriately

 

  • NSAIDs are given to reduce inflammation and ease pain
  • Steroids (prednisone) is often given to reduce inflammation and slow joint damage
  • DMARDs (methotrexate, hydroxychloroquine) are disease-modifying antirheumatic drugs that are given to slow the progression of RA and save the joints and tissues from permanent damage
  • Biologic agents (rituximab, adalimumab) are biologic response modifiers and work by targeting parts of the immune system that trigger inflammation.

 

  • Promote self care

 

As the disease progresses, it may be difficult for patients to perform ADLs such as feeding themselves or combing their hair; provide tools such as eating utensils or toothbrushes with larger grips to encourage patients to remain independent.

 

  • Cluster care, promote rest

 

Fatigue is a common symptom of RA. Cluster care and promote rest as necessary

 

  • Promote positive self-image

 

Patients with joint deformities may experience a negative body image

 

  • Encourage activity / exercise

 

Patients fatigue easily, but daily exercise can help loosen joints. Encourage activity as tolerated.

 

  • Nutrition and lifestyle education
    • Healthy diet
    • Avoid alcohol
    • Quit smoking

 

When patients are in pain, they often want to turn to comfort foods. Help patients make healthy diet choices, avoiding alcohol and smoking.

Encourage hydration.

Patients can also consult with a nutritionist regarding an anti-inflammatory diet.

 


References

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