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Rheumatoid Arthritis ((Helper t cells stimulate monocytes, macrophages and…
Rheumatoid Arthritis
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Autoantibodies “RF (rheumatic factor) combine with IgG forms immune complexes, deposit in synovial membrane
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Helper t cells stimulate monocytes, macrophages and synovial fibroblasts to secrete interleukin -1 and interleukin 6 and tumor necrosis factor (TNF)
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If unarrested, disease progresses through the 4 stages
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X- ray evidence of cartilage and bone destruction in addition to osteoporosis, joint deformity (subluxation, ulnar deviation, or hyperextension) extensive muscles atrophy
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Neutrophils are attracted to site of inflammation (release proteolytic enzymes that damage articular cartilage)
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Destruction of articular cartilage, erosion, subluxation, and deformity are seen.
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Acute pain related to distension of tissues by inflammation process as evidenced by patient report of pain.
Impaired physical mobility related to skeletal deformity as evidenced by limited ROM, decreased muscle strength/mass.
Disturbed body image related to changes in ability to perform usual tasks as evidenced by negative self-talk, focus on past strength/function.
Nursing interventions: :Lizbeth
- consider reports of pain, noting location and intensity (scale of 0–10). Note precipitating factors and nonverbal pain cues.
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Suggest patient assume position of comfort while in bed or sitting in chair. Promote bedrest as indicated.
Place and monitor use of pillows, sandbags, trochanter rolls, splints, braces.
Rationale: Rests painful joints and maintains neutral position. Note: Use of splints can decrease pain and may reduce damage to joint; however, prolonged inactivity can result in loss of joint mobility and function.
Rationale: In severe disease or acute exacerbation, total bedrest may be necessary (until objective and subjective improvements are noted) to limit pain or injury to joint.
Recommend that patient take warm bath or shower upon arising or at bedtime. Apply warm, moist compresses to affected joints several times a day. Monitor water temperature of compress, baths, and so on.
Rationale: Heat promotes muscle relaxation and mobility, decreases pain, and relieves morning stiffness. Sensitivity to heat may be diminished and dermal injury may occur.
Medicate before planned activities and exercises as indicated.
Rationale: Promotes relaxation, reduces muscle tension and spasms, facilitating participation in therapy.
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