Nursing 213

N213: Health Differences Across the Lifespan 3 Study Guide 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 • Teach stretching and range-of-motion exercises; swimming is also helpful • Refer to physical therapy • Provide a firmmattress and teach patient to sleep in the prone position; use pillows and splints for positioning • Encourage child to participate in usual activities when stable to avoid image or self-esteem issues • Teach family to treat the child as normal as possible; encourage school attendance and extra- curricular activities • Refer to JRA support groups and community based activitygroups Expected outcomes for juvenile rheumatoid arthritis: • Verbalizes or demonstrates relief of pain and increased comfort • Demonstrates use of diversionary techniques for pain and discomfort • Patient tolerates activity • Maintains positive body image • Patient maintains adequate organ functions • Patient remains free of skin lesions and skin breakdown • Patient and parents verbalize understanding of disease, medications, and treatment plan o

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