Nursing Interventions for Pain (Acute / Chronic) related to Rheumatoid Arthritis

Nursing Diagnosis for Rheumatoid Arthritis: Pain (Acute / Chronic)

related to:

• Tissue distension by accumulation of fluid / inflammatory process
• Joint destruction.

Characterized by:

• Complaints of pain, discomfort, fatigue.
• Focusing on self / narrowing of focus
• Distraction behavior / response of autonomic
• Behavior is deliberate / protect

Expected results:

• Showed pain relief / control
• Looks relaxed, sleep / rest and participate in activities according to ability.
• Follow the program prescribed pharmacological
• Combining the skills of relaxation and entertainment activities in a pain control program.

Nursing Interventions - Pain (Acute / Chronic) for Rheumatoid Arthritis

1. Investigate complaints of pain, record the location and intensity (scale 0-10). Write down the factors that speed up, and signs of non-verbal pain.
Rational: To assist in determining the need for pain management and program effectiveness

2. Give the mat, small pillow. Elevate the bed linen as needed
Rational: a soft mattress, pillow that would prevent maintenance of proper body alignment, placing stress on the joints that hurt. Elevation of the bed linen reduce pressure on the inflamed joint / pain.

3. Place / monitor the use of pillows
Rational: Resting sore joints and maintain a neutral position. Use of the brace can reduce pain and can reduce damage to the joints

4. Encourage to frequently change positions. Helps to move in bed, prop joint pain above and below, avoid jerky movements.
Rational: To prevent the occurrence of general fatigue and joint stiffness. Stabilize joints, reduce the movement / joint pain.

5. Instruct the patient to a warm bath or shower at the time of waking and / or at bedtime. Provide a warm washcloth to compress the joints are sore several times a day. Monitor the temperature of the water compresses, baths, and so forth.
Rational: The heat increases muscle relaxation, and mobility, reduce pain and stiffness in the morning release. Sensitivity to heat can be removed and dermal wounds can be healed.

6. Give a gentle massage
Rationale: Increase relaxation / reducing pain.

7. Encourage the use of stress management techniques, such as progressive relaxation, therapeutic touch, biofeed back, visualization, imagination guidelines, self hypnosis, and breath control.
Rationale: Increase relaxation, gives a sense of control and may increase the coping abilities

8. Engage in entertainment activities appropriate to individual situations.
Rational: To focus attention again, provide stimulation, and increased self-confidence and feeling healthy.

9. Give the drug before the activity / planned exercise as directed.
Rationale: Increase relaxation, reduce muscle tension / spasm, making it easy to participate in therapy.

10. Collaboration: Give medicines as directed.
Rational: As an anti-inflammatory and mild analgesic effect in reducing stiffness and improve mobility.

11. Give ice-cold compress if needed
Rational: The cold can relieve pain and swelling during the acute period.

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Clinical Manifestations of Rheumatoid Arthritis

There are several clinical manifestations are commonly found in patients with Rheumatoid Arthritis. Clinical manifestations do not have to appear simultaneously at the same time because this disease has Clinical manifestations are highly variable.

1. Constitutional symptoms such as fatigue, poor appetite, weight loss and fever. Sometimes fatigue can be so great.

2. Symmetrical polyarthritis (inflammation of the joints on the left and right), especially in peripheral joints, including joints in the hand, but usually does not involve the joints between the fingers and toes. Almost all diarthrodial joints (joints that can be moved freely) can be attacked.

3. Stiffness in the morning for more than 1 hour, can be general, but especially to attack the joints. Stiffness is different from the joint stiffness in osteoarthritis (inflammation of bone and joints), which usually only lasts for a few minutes and for less than 1 hour.

4. Erosive arthritis is the hallmark of this disease on radiological picture. Chronic joint inflammation that lead to the erosion of the bone edge.

5. Deformity: destruction of the supporting structure of the joint with the course of the disease. Ulnar deviation of fingers or shift, the shift in the bone joints in the palm of the hand and finger, boutonniere deformity, swan neck and hands are some of the deformities that are often encountered in patients. There is a knob on the head of the metatarsal foot, arising from the secondary metatarsal subluxation. Large joints can also be attacked and suffered a reduction in the ability to move, especially in the extension movement.

6. Rheumatoid nodules subcutaneous mass was found in about one third of adult patients with rheumatoid arthritis. The most frequent location of this deformity is the exchange olekranon (elbow joint) or along the extensor surfaces of arms, however bulge) may also occur in other places. The existence of these nodules are usually an indication of an active disease and more severe.

7. Extra-articular manifestations (excluding joints) rheumatism can also invade other organs outside the joint. As the eye: keratoconjunctivitis sicca which is Sjögren's syndrome, cardiovascular system may resemble a severe constrictive pericarditis, inflamatif lesions resembling rheumatoid nodules can be found on the myocardium and cardiac valves, these lesions can lead to valve dysfunction, a phenomenon embolissasi, conduction disturbances and cardiomyopathy.

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