N213: Health Differences Across the Life Span 3

N213: Health Differences Across the Lifespan 3 Study Guide

Fatigue Morning stiffness Joint warmth Crepitus in joints

Positive ANA/RF Immobility Palpitations

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©2017 Achieve Test Prep Page 121 of 204 Nursing assessment for juvenile rheumatoid arthritis: • Thorough patient and family medical history: recent infections, medications, and family history of autoimmune disease • Inquire about pain using faces scale, location, duration, andseverity • Check vital signs: temperature may be elevated to 98.9 to 99.9during flares • Visualize joints for deformity, swelling, crepitus, and range ofmotion • Review laboratory and radiology reports: o Erythrocyte sedimentation rate (ESR): Will be elevated over 20 o CBC: Increased neutrophils and platelets o C-Reactive protein: Positive or increased o Anti-nuclear antibodies (ANA) and rheumatoid Ffactor (RF): Not always positive o Serum protein: Will be increased o X-rays: May show inflammatory related changes to joints/bones Note: Diagnosis of JRA cannot always be made by laboratory values. These tests are not always positive for JRA in some patients. Diagnosis is therefore mostly criteria based on symptoms. Nursing diagnosis for juvenile rheumatoid arthritis: • Pain related to inflammation and joint stiffness • Altered body temperature related to fever, secondary to inflammatory process • Activity intolerance related to chronic pain • Body image disturbance related to appearance and impaired mobility • Knowledge deficit related to disease process, medications, and treatment plan Nursing interventions for juvenile rheumatoid arthritis: • Encourage rest during active flares and teach patient to pace activities • Give anti-inflammatory and analgesic medications per MD order: non-steroidal anti- inflammatory medications, analgesics, disease modifying anti-rheumatic drugs, and slower acting anti-rheumatic drugs • Teach patient and family that NSAIDs take up to two weeks to become effective for pain; teach the importance of compliance with medications even if patient is feelingbetter • Teach pain diversion methods: drawing, TV, music, or conversation