Understanding Rheumatoid Arthritis: Key Symptoms and Care

School

Forsyth Technical Community College**We aren't endorsed by this school

Course

NUR 211

Subject

Nursing

Date

Dec 11, 2024

Pages

Uploaded by ChiefPorcupine4057

Case Study: Rheumatoid ArthritisThe nurse is caring for Robin Jones, a 37-year-old female during an outpatient clinic appointment. Robin reports joint pain and swelling for the past two months and is concerned about her health.During the assessment, the following data are obtained:•Reports of extremity joint pain (6/10) and morning stiffness, especially in hands, for past two months.•Reports tenderness when hand joints palpated and moved passively.•Reports of episodic swelling of hands and feet that interferes with mobility.•Reports difficulty with hand movement throughout day and states hands “look deformed.”•No skin rashes or lesions noted.•Concave curvature in thumbs and slight ulnar deviation of fingers noted bilaterally.•Works in day care for preschoolers and states “job is stressful” due to staffing limitations and illnesses of children.•Denies alcohol intake but states smoking 1.5 packs cigarettes every two days.•Reports poor nutritional intake and lack of sleep.Discussion Questions:Recognize Cues:oWhat are the relevant factors contributing to the client’s condition?Joints: Robin reports significant joint pain, morning stiffness, tenderness, and swelling in her extremities, particularly in her hands and feet. These symptoms are characteristics of RA. Physical Findings: The concave curvature of her thumbs and slight ulnar deviation of her fingers indicates joint deformities often associated with chronic inflammation in rheumatoid arthritis. Occupational Stress: Working in a daycare setting can be physically demanding and stressful, especially with staffing limitations and frequent illnesses among children. This stress may exacerbate her symptoms and impact her overall health. Smoking:

Robin’s smoking habit (1.5 packs every two days) is a significantrisk factor, as smoking is associated with an increased risk of developing RA and can worsen the diseases progression. Poor Nutrition:A poor nutritional intake can negatively affect her immune system and overall health, potentially contributing to her symptoms and making it harder for her to cope with the disease.Lack of Sleep: Insufficient sleep can lead to fatigue and may affect her body’s ability to manage inflammation and recovery, further worsening her condition. Psychosocial Factors: Robin’s emotional state, including her feelings of concern indicates potential anxiety and stress related to her diagnosis and its implications for her job and life. Analyze Cues:oWhat potential complications is the client at risk for in this situation?Joint pain and potential for joint damage. Functional Mobility Chronic fatigue.Emotional distress and stress management. Prioritize Hypotheses:oList the client’s problems in priority order. oWhat prioritizing framework supports this ranking?Joint pain and mobility issues Fatigue and lack of sleep Poor nutritional intake Smoking Job related stress. Maslow’s Hierarchy of Needs:oThis framework supports this ranking. Physical safety and physiological needs (pain management, fatigue) are prioritized over (emotional distress) in the context of her health. Generate Solutions:oWhat evidence-based approaches to client care should the nurse implement?Findings include the patients reports of pain, swelling, emotional distress, and lifestyle factors.

Medication Management: Education on MedicationsoProvide education on prescribed medications regarding their purpose, dosage, potential side effects, and importance of adherence to regimen. Monitoring for Side Effects: oRegularly monitor for side effects of medications: signs of infection, liver function, and gastrointestinal issues. Pain Management: oPain AssessmentoNon-pharmacological pain relief: Heat or cold therapy application, gentle ROM exercises to help manage joint pain and stiffness. Lifestyle Modifications: oSmoking Cessation Support oNutritional Counseling oSleep Hygiene Education Physical Activity: oExercise program oOccupational therapy referralMental Health Support: oAssess emotional well-being. oCounselling services Regular Follow Up: oMonitor disease progression.Take Actions:oWhat other members of the interdisciplinary health care team need to be involved in her care?RheumatologistManage her RA, adjust medication regimen, and monitor diseaseprogression and response to treatment. Nurse Educator Provide education on disease management, medication adherence, lifestyle modifications, and self-care strategies. Physical TherapistImprove joint mobility, strength, and function while also addressing pain management. Occupational Therapist Assist with ADLs, recommend adaptive devices, and teach techniques to minimize strain on her joints. Dietitian/Nutritionist Assess nutritional intake and develop a balanced diet plan that may help manage symptoms and improve her energy levels.

Social WorkerAssist with resource navigation, financial concerns, and provide support with stressors related to her job and personal life. Case Study (Continued):After Robin is examined by the provider, a diagnosis of suspected rheumatoid arthritis is made. The following laboratory studies are ordered and obtained.oRheumatoid factoroErythrocyte sedimentation rateoC-reactive proteinoAntinuclear antibodyoCBCoLiver Enzymes (ALP/ALT/AST)oBUNoCreatinineThe client returns to the outpatient clinic one week later. Based on her laboratory results and physical findings, the provider confirms the diagnosis of rheumatoid arthritis and discusses the need for immunosuppressive medication regimens with her.Robin is prescribed dexamethasone, hydroxychloroquine, and methotrexate.Robin returns for a three-month follow-up appointment, and during the session, she beginsto cry. She states that she is concerned about working in the children’s day care setting with the medications she is taking. She states she has had several upper respiratory infections and “can’t seem to get well.” She states she is constantly tired, and her smoking has increased to one pack daily.Discussion Questions:Evaluate Outcomes:oDescribe your concerns with this client. Physical Health: Robin’s symptoms of RA are indicative of a chronic, progressive condition that may lead to further joint damage and disability if not managed properly. Her complaints of constant tiredness and recurrent upper respiratory infections suggest that her immune system may be compromised due to the immunosuppressive medications she is taking. Mental Health:

Robin’s emotional distress, as evidence by her crying during the appointment. Raises concerns regarding her mental health. The stress from her job, coupled with her health concerns and the impact of RA on her daily life, may lead to anxiety or depression.Lifestyle Factors:Robin’s smoking habit and poor nutritional intake are additional concerns. Smoking can exacerbate RA symptoms and increase the risk of infections, while inadequate nutrition can impair her overall health and recovery. Occupational Stress: Working in a stressful environment, particularly one involving young children who may frequently be ill, raises her risk for exposure to infections, which is concerning given her current health status. oHow would you document this situation?Subjective: Robin Jones, a 37-year-old female, reports joint pain (6/10) and morning stiffness for the past two months. She expresses concern about her health and states that her hands “look deformed.” She reports increasing fatigue and recurrent upper respiratory infections since beginning immunosuppressive therapy.Objective: Assessment reveals tenderness in hand joints, concave curvature of thumbs, and slight ulnar deviation bilaterally. Patient smokes 1 pack daily and reports a poor nutritional intake. No skin rashes or lesions. Assessment: Confirm diagnosis of RA. Concerns include potential complications from immunosuppressive therapy, emotional distress, and lifestyle factors contributing to health decline. Plan: Assess need for mental health support. Evaluate smoking cessation programs. Discuss nutritional counseling. Review the impact of job stress on health and provide resources for stress management. oWhat resources and referrals could you provide?Mental Health Support: Refer Robin to a mental health professional for counseling to help her cope with the emotional aspects of her diagnosis and jobs stress. Nutritionist/Dietitian:

Provide a referral to a registered dietitian who can help develop a balanced diet plan to support her immune system and overall health. Smoking Cessation Programs: Recommend local or online smoking cessation programs to help Robin quit smoking. Support Groups: Encourage her to join a support group for individuals with RA to share experiences and coping strategies. Occupational Health Services: Suggest engaging with occupational health services to address workplace stress and explore potential accommodations in her job. oHow should the plan of care be revised to help this client?Holistic Care Approach: Integrate a holistic approach that addresses physical, emotional,and lifestyle factors. Regular follow-ups should include assessments of her mental health and stress levels. Medication Management: Monitor for side effects of RA medications, especially regarding her recurrent infections. Consider discussing alternatives or adjunct therapies if recurrent infections persist. Lifestyle Modifications: Create a plan that includes smoking cessation strategies, nutritional counseling, and stress management techniques. Education: Provide education on the importance of regular follow-ups and adherence to the treatment regimen, as well as the potential side effects of medications and preventive measures against infections. Regular Monitoring: Schedule more frequent follow-up appointments to monitor her physical symptoms, mental health status, and adherence to lifestyle modifications, adjusting the care plan as necessary based on her progress and challenges.