Nursing Care Plan for Rheumatoid Arthritis (RA)

Pathophysiology

RA is an autoimmune disease where the immune system mistakenly targets and attacks the joint linings causing uncontrolled inflammation of the synovium.  Joints on both sides of the body (bilateral) are affected, primarily the hands, wrists and knees. RA is characterized by bone erosion and joint deformity. As the disease progresses other joints may be affected symmetrically.  Chronic inflammation and degenerative changes are the hallmark aspects of RA.

Etiology

Doctors are still unsure as to what triggers RA, but it appears to be at least partially genetic in nature. This genetic predisposition makes the patient more susceptible to environmental factors like viruses and bacteria that may trigger the initial inflammation. Once the inflammation begins, the synovial fluid thickens and the tendons and ligaments weaken and stretch, resulting in the joint losing its shape and alignment.

Desired Outcome

While there is no cure, the goal of treatment is to manage the symptoms and slow disease progression. Medication, physical or occupational therapy and possibly surgery may be necessary.

Rheumatoid Arthritis (RA) Nursing Care Plan

Nursing Interventions and Rationales

• Assess and manage chronic and acute pain
  • Pillow supports
  • Warm compresses to loosen stiff joints/relax muscles
  • Cold compresses to numb pain and reduce swelling
  • Administer PRN pain meds

• Administer medications appropriately

• Promote self care

• Cluster care, promote rest

• Promote positive self-image

• Encourage activity / exercise

• Nutrition and lifestyle education
  • Healthy diet
  • Avoid alcohol
  • Quit smoking

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References

• https://www.webmd.com/rheumatoid-arthritis/guide/coping-with-pain
• https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/diagnosis-treatment/drc-20353653