RHEUMATOID ARTHRITIS NURSING INTERVENTIONS

rheumatoid arthritis involves inflammation of the joints. A membrane called the synovium lines each of your movable joints. When you have rheumatoid arthritis, white blood cells — whose usual job is to attack unwanted invaders, such as bacteria and viruses — move from your bloodstream into your synovium. Here, these blood cells appear to play an important role in causing the synovial membrane to become inflamed (synovitis).
This inflammation results in the release of proteins that, over months or years, cause thickening of the synovium. These proteins can also damage cartilage, bone, tendons and ligaments. Gradually, the joint loses its shape and alignment. Eventually, it may be destroyed.
Some researchers suspect that rheumatoid arthritis is triggered by an infection — possibly a virus or bacterium — in people with an inherited susceptibility. Although the disease itself is not inherited, certain genes that create an increased susceptibility are. People who have inherited these genes won't necessarily develop rheumatoid arthritis. But they may have more of a tendency to do so than others. The severity of their disease may also depend on the genes inherited. Some researchers also believe that hormones may be involved in the development of rheumatoid arthritis.

Risk factors
The exact causes of rheumatoid arthritis are unclear, but these factors may increase your risk:
§ Getting older, because incidence of rheumatoid arthritis increases with age. However, incidence begins to decline in women over the age of 80.
§ Being female.
§ Being exposed to an infection, possibly a virus or bacterium, that may trigger rheumatoid arthritis in those with an inherited susceptibility.
§ Inheriting specific genes that may make you more susceptible to rheumatoid arthritis.
§ Smoking cigarettes over a long period of time.


Signs and symptoms
The signs and symptoms of rheumatoid arthritis may come and go over time. They include:
§ Pain and swelling in your joints, especially in the smaller joints of your hands and feet
§ Generalized aching or stiffness of the joints and muscles, especially after sleep or after periods of rest
§ Loss of motion of the affected joints
§ Loss of strength in muscles attached to the affected joints
§ Fatigue, which can be severe during a flare-up
§ Low-grade fever
§ Deformity of your joints over time
§ General sense of not feeling well (malaise)

Rheumatoid arthritis usually causes problems in several joints at the same time. Early in rheumatoid arthritis, the joints in your wrists, hands, feet and knees are the ones most often affected. As the disease progresses, your shoulders, elbows, hips, jaw and neck can become involved. It generally affects both sides of your body at the same time. The knuckles of both hands are one example.
Small lumps, called rheumatoid nodules, may form under your skin at pressure points and can occur at your elbows, hands, feet and Achilles tendons. Rheumatoid nodules may also occur elsewhere, including the back of your scalp, over your knee or even in your lungs. These nodules can range in size — from as small as a pea to as large as a walnut. Usually these lumps aren't painful.
In contrast to osteoarthritis, which affects only your bones and joints, rheumatoid arthritis can cause inflammation of tear glands, salivary glands, the linings of your heart and lungs, your lungs themselves and, in rare cases, your blood vessels.
Although rheumatoid arthritis is often a chronic disease, it tends to vary in severity and may even come and go. Periods of increased disease activity — called flare-ups or flares — alternate with periods of relative remission, during which the swelling, pain, difficulty sleeping, and weakness fade or disappear.
Swelling or deformity may limit the flexibility of your joints. But even if you have a severe form of rheumatoid arthritis, you'll probably retain flexibility in many joints.


RHEUMATOID ARTHRITIS NURSING INTERVENTIONS

Assess joints carefully.
Look for deformities, contractures, inability to perform ADL, and immobility.
Monitor vital signs.
Monitor changes of weight.
Assess sensory disturbances.
Assess level of pain.
Monitor duration of stiffness and not the intensity to determine when to perform ROM.
Observe for pressure ulcers – with traction and wearing splints.
Encourage patient to perform ADL at the level of activity.
Provide emotional support.
Teach patient how to stand, walk, or sit correctly upright and erect.
collaborative:
a) Bed rest during acute pain
b) Passive ROM exercises of joints
c) Splint painful joints
d) Heat and cold application – cold application during acute pain; 20 minutes at a time.
e) Warm bath in the morning. To relieve morning sickness.
f) Protect from infection
g) Well-balanced diet
h) Physical therapy
i) Surgery:
· Osteotomy –surgical removal of a wedge from the joint
· Synovectomy – removal of synovia
· Arthroplasty – replacement of joints with prostheses.
· Pharmacotherapy
v Aspirin – mainstay of treatment, has both analgesic and anti inflammatory effects.
v NSAIDS:
§ Indomethacin (Indocin)
§ Phenylbutazone (Butazolidin)
§ Ibuprofen (Motrin)
§ Fonoprofen (Nalfon)
§ Naproxen (Naprosyn)
§ Sulindac (Clinoril)
v Gold compounds (chrysotherapy)
§ Injectable form: sodium thiomalate (Myochrysine)
Aurothioglucose (Sulganal); given IM once a week; takes 3-6 months to become effective.
§ Oral form: auranofin (Ridaura); smaller doses are effective; diarrhea is a common side effect.
v Corticosteroids (intra-articular injections)