N213: Health Differences Across the Life Span 3

N213: Health Differences Across the Lifespan 3 Study Guide Nursing assessment for rheumatoid arthritis: • Take vital signs: temperature will be slightly elevated 98.9 to 99.9 and patient will complain of chronic fevers, usually towards evening time • Chart fatigue and pain; have patient keep a diary of symptoms over 30days • Family history of auto-immune disease/arthritis • Assess joints for fluid, crepitus, and boggy feeling • Assess for range of motion • Review laboratory reports: o ESR (erythrocyte sedimentation rate): Will be elevated; 20-40 is mild inflammation; 40-70 is moderate inflammation; 70-150 is severe inflammation o CRP (C - reactive protein) o RF (rheumatoid factor): Not always positive, 20% of RA patients show negative o ANA: Antinuclear antibodies; almost always 95% positive but not in everyone o CBC: Red blood cells will be decreased in RA o Synovial fluid analysis: Fluid will show RF antibodies and WBCs o X-ray: Can show joint inflammation Nursing diagnosis for rheumatoid arthritis: • Pain related to inflammation, tissue damage, and joint immobility • Impaired mobility related to inflammation, secondary to pain and inflammation • Impaired skin integrity due to skin lesions • Body image disturbance related to changes in appearance • Fatigue related to immune system factors • Knowledge deficit related to disease process, medication, and self-management Nursing interventions for rheumatoid arthritis: • Patient teaching on disease management, medications, and lifestyle adjustments; patients need to be taught this is a lifelong disease that can be verymanageable • Give medications per MD order: o Salicylates and other anti-inflammatories: Helps decrease inflammation in the body and affected areas o Analgesics: Used for moderate to severe pain until anti-inflammatories are effective, which is about two weeks o Corticosteroids: Helps to reduce inflammation and slow the body’s immune response; primary drug used in the treatment of systemic lupus erythematosus o Biologic response modifiers: Decreases immune system response; warn patient risks of infection while on these medications ©2017 Achieve Test Prep Page 119 of 204