Please enable JavaScript.
Coggle requires JavaScript to display documents.
14.1 (RA) Rheumatoid Arthritis - Coggle Diagram
14.1 (RA) Rheumatoid Arthritis
Definition: a
chronic systemic autoimmune disease
that causes inflammation of connective tissue, primarily in the
joints
Pathophysiology
exposure to an unidentified antigen (virus) causes an aberrant immune response in a genetically susceptible host.
normal antibodies (immunoglobulins) become autoantibodies & attack host tissues -> transformed antibodies
the self-produced antibodies bind with their target antigens in blood.
leukocytes from the circulation are attracted to the synovial membrane of involved joints (neutrophils & macrophages ingest the immune complexes & release enzymes that degrade synovial tissue and articular cartilage) -> this increases the inflammatory process.
the inflammatory processes damage the synovial membrane. It swells and abnormally enlarge.
Causes
genetic factors
environmental factors
role of estrogens
infectious agent (e.g. mycoplasma, Epstein-Barr virus - may initiating the abnormal immune responses)
cigarette smoking - increase the risk
Manifestations
joint: inflammation cause inflammation (joint is destroyed -> weakened ligaments, tendons) -> weakened structure can cause deformity
red, hot, swollen, pain, stiffness in the morning (lasts more than 1 hour), inflammation, fatigue, anorexia, weight loss, aching
usually affect PIP and MCP
*PIP (proximal interphalangeal)
*MCP (metacarpophalangeal)
OA vs. RA
OA
caused by mechanical wear & tear on joints
affects the small finger joints, thumb and knees
only affect 1 particular joint/ area of the body
RA
an autoimmune disease in which the body's own immune system attacks the body's joints
affect joints all the over the body including hands, fingers, elbows, knees & hips
affects multiple joints on
both sides
of the body
STAGES
Stage 2: Presence of x-ray evidence of periarticular
osteoporosis
, subchondral
bone destruction
but
no
joint deformity
Stage 3: X-ray evidence of cartilage and bone destruction in addition to
joint deformity
and periarticular osteoporosis
Stage 1: No destructive changes on x-rays
Stage 4: Presence of
bony or fibrous ankylosis
(bone fused together) along with stage 3 features.
Patient Education
Address the disease process & treatments, including rest and exercise.
Inform pt and family management of stiffness and pain.
the need for energy conservation
Inform pt and family of assistive devices to maintain independence, including self-care aids such as handheld showers, long-handles brushes and shoehorns, and eating utensils with oversized/ special handles.
Teach pt and family on how to apply splints and take care of skin. Highlight the need for home and equipment modifications, such as a raised toilet seat and grab bars in the bathroom.
Treatment
Rest and exercise
regular rest periods reduce manifestations
splinting reduces unwanted motion
low-impact aerobic exercises (swimming, walking)
Heat and Cold therapy
used for analgesics and muscle-relaxing effects
Assistive Devices and splints
splints provide joint rest, prevent contractures
Surgery
for to has failed to prevent joint damage
Arthrodesis (joint fusion)
: used to stabilize joints
Arthroplasty (total joint replacement)
: for gross deformity and joint destruction
Diagnostic tests
Rheumatoid factor
: found in the blood of RA pts
(CRP) C-reactive Protein: elevated due to inflammation. (measures the amount of a certain protein that is produced by the body due to inflammation)
(ESR) Erythrocyte sedimentation rate: RBCs that settle faster than normal indicate inflammation in the body (measures how fast red blood cells settle in the test tube)
Anti-CCP antibody: a specific marker for RA (detects antibodies to CCP: cyclic citrullinated peptide)
(FBC) Full Blood Count: to identify anaemia
Synovial Fluid examination: demonstrate changes associated with inflammation (increased turbidity- cloudiness, decreased viscosity, increased protein and WBC levels)
X-ray of affected joints: space narrowing may be seen
Nursing diagnosis
PROMOTE SELF-HEALTH MANAGEMENT
Assess the pt's understanding of RA, its manifestations and effects, and the anticipated course of the disease. Reinforce and clarify information as needed.
(R) Newly diagnosed pts need understandable information that is readily available to develop an understanding of their disease and its treatment.
Initiate an interprofessional care conference with the pt and family.
(R) Pt and families need opportunities to discuss management strategies and their concerns and perceptions to develop a better understanding of interprofessional team member roles and services.
Refer the pt and family to community & social service agencies and local support groups.
(R) These groups and agencies are valuable resources for the pt and family.
Encourage the pt and family members to discuss the effect of the disease on their lives.
(R) Open discussion helps identify the need for practical skills manage RA.
DISTURBED BODY IMAGE
Demonstrating a caring, accepting attitude towards the patient. (R) Help pt accept the physical changes.
Encourage the pt to talk about the effects of the disease, both physical effects and effects on life roles.
(R) Verbalization helps identify the feelings and gives the nurse the opportunity to validate证实 the feelings.
Encourage pt to maintain self-care and usual roles to the extent possible.
(R) Independence enhances self-esteem.
Provide positive feedback for self-care activities and adaptive strategies.
(R) This can encourage pt to continue adaptive measures and maintain independence.
MANAGE CHRONIC PAIN
Monitor the level of pain and duration of morning stiffness.
(R) Increased pain may necessitate changes in treatment plan.
Teach the use of heat and cold applications to provide pain relief.
(R) Both heat and cold have analgesic effects and can help relieve associated muscle pain.
Teach about the use of prescribed anti-inflammatory medications and the relationship of pain and disease activity.
(R) Anti-inflammatory agents reduce chemical mediators of inflammation and edema, relieving pain.