Rheumatoid Arthritis

Rheumatoid Arthritis (RA)

This is thought to be an auto-immune disease in which the body attacks its own cartilage and joint linings, causing inflammation, swelling, pain and loss of function. The main symptom is inflammation of the synovial membrane. If left untreated the membrane thickens, the synovial fluid increases, and the resulting pressure causes pain and tenderness. The membrane then produces abnormal granulation tissue (pannus) which adheres to the surface of articular cartilage allowing fibrous tissue to adhere to the exposed bone ends. The tissue ossifies and fuses the joint so that it becomes fixed. The range of motion of the joint is greatly restricted. The growth of the membrane causes joint distortion. It is this which gives the clinical appearance of RA. Removal of the pannus reduces its growth, helps to prevent deformities, and improves joint function. Ligaments and tendons also become inflamed, leading to shortening, stiffening and scarring, resulting in contractures and subluxation (partial dislocation) of the joint.

OSTEOARTHRITIS
Osteoarthritis is the most common form of arthritis. It causes deterioration of the joint cartilage and formation of reactive new bone at the margins and subchondral areas of the joints. This chronic degeneration results from a breakdown of chondrocytes, most often in the hips and knees.
Osteoarthritis occurs equally in both sexes, after age 40, with the earliest symptoms occurring in middle age and progressing with advancing age.
Depending on the site and severity of joint involvement, disability can range from minor limitation of the fingers to near immobility in people with hip or knee disease. Progression rates vary; joints may remain stable for years in the early stage of deterioration.


Causes
Primary osteoarthritis, a normal part of aging, may result from metabolic, genetic, chemical, and mechanical factors.


Nursing diagnoses

• Acute pain
• Anxiety
• Disturbed body image
• Disturbed sleep pattern
• Dressing or grooming self-care deficit
• Impaired physical mobility
• Ineffective coping
• Chronic pain, related to joint inflammation
• Impaired home maintenance, related to fatigue
• Activity intolerance, related to the effects of inflammation
• Deficient knowledge: Therapeutic regimen

EXPECTED OUTCOMES
• Verbalize effective pain management strategies.
• Use assistive devices to minimize joint stress with ADLs.
• Verbalize a plan to reduce responsibilities for home maintenance.
• Express a willingness to plan rest breaks during the day.
• Demonstrate understanding of the prescribed therapeutic regimen and its importance for both short- and long-term benefit.


PLANNING AND IMPLEMENTATION
• Teach techniques for relieving pain and morning stiffness, including:
• Performing ROM exercises in shower or bathtub
• Applying local heat with paraffin dip or compress; using cold packs as needed
• Teach techniques to minimize joint stress while performing ADLs.
• Provide Arthritis Foundation literature and information.
• Discuss ways to delegate household tasks to other family members.
• Provide information about the disease process and its manifestations,
prescribed medications with desired and adverse effects,
and the importance of balancing rest and activity.