Rheumatoid Arthritis PowerPoint - NC-NET

heehawultraMechanics

Feb 22, 2014 (3 years and 3 months ago)

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I
MMUNITY
:

R
HEUMATOID

A
RTHRITIS

A C
ASE

S
TUDY

Beth Downing, MSN, RN
-
BC, ONC

O
BJECTIVES


Demonstrate understanding of the
progression and treatment of
rheumatoid arthritis (RA).



Utilize the nursing process to plan
care for a client diagnosed with
rheumatoid arthritis.

Gail Stevens is a 47 yr old Caucasian
female who has been having pain in
both hands, with stiffness and
tenderness that is worse in the
morning. She also reports having a
poor appetite and being fatigued
easily.



What
is significant about this
report that leads you to RA
?




What additional nursing
assessment data would be
significant?





H
ISTORY



M
EDICATIONS


Mild
osteoarthritis
(bilateral knees)


Laparoscopic
cholecystectomy


T&A as a child


Ibuprofen 2 tabs
prn

pain


MVI daily






Mrs. Stevens has
mild OA
and is now being
diagnosed with
RA;
explain the differences to
her.


O
THER

P
ERTINENT

I
NFO


Married with 2 children; ages 16 & 20



Currently a loan officer at a bank



Active at the local community center



Denies ETOH or tobacco use



No significant family history



NKDA



D
IAGNOSTICS
??


Complete blood count (CBC)


C
-
reactive protein (CRP)


Erythrocyte sedimentation rate (ESR)


Rheumatoid factor (RF)


Anti
-
citrullinated

protein antibody (ACPA)


Synovial fluid analysis


Xray




How will these laboratory
values be affected or how
will they assist in the
diagnosis of RA?


T
REATMENT

OPTIONS


Diagnosed with early RA



PT/OT consult



Pharmacological treatment


NSAID &DMARD




According to the American College of
Rheumatology what are the 4 sets of data to
classify RA?



Explain
what these 2 classes of medications
are (NSAIDS & DMARDS)
& how they work?



Why
is PT/OT involved so early on when
there isn’t a current mobility problem?



What
additional teaching should be
completed at this time
?



What
are examples of NSAIDS & DMARDS
that could be used at this
time?

NSAID & DMARD T
REATMENT


Celebrex 100 mg
po

bid



Methotrexate 7.5 mg
po

each
week for the first 3 months, then
increase to 10 mg
po

each week




Prior to starting this treatment plan
what should be evaluated?




What
patient teaching is indicated
for these medications
?
Have
student
role play patient teaching




When
would
these medications
be
contraindicated?


N
URSING

D
IAGNOSES
???

2
YEARS

LATER


Mrs. Stevens RA has been well controlled
for the past few years. She continues to
take the
Methotrexate

& Celebrex; is in a
water aerobics class 4 days a week and
walks daily. However, Mrs. Stevens is
complaining of increased pain and
swelling of both hands and feet. Her
fatigue is worsening and she has lost 10
lbs in the past few months.

T
REATMENT

PLAN



Increase:


Methotrexate 15 mg
po

q week


Celebrex to 200 mg
po

bid



Add:


Humira

40 mg
subcut

every other week



What
new patient teaching
should be
included?


T
REATMENT

PLAN



Mrs. Stevens is not compliant with the
Humira

because she is having a difficult time giving
herself injections. Her physician would like to
start her on
infliximab

(
Remicade
) now to see if
she has better success. She is scheduled to begin
her first treatment tomorrow.



What
information
should be taught
to
Mrs
. Stevens
a
bout
the
use/administration of
Remicade
?


R
EMICADE

INFUSION


Mrs. Stevens is preparing to receive
her first dose of
Remicade

in the
outpatient infusion care center. She
has been talking to a friend who
knows someone who had a reaction
to
Remicade

and is concerned that
she will have a reaction as well.



What
should the nurse monitor for during
the initial infusion in regards to a reaction?






If
she were to have a reaction what should
the nurse do?


D
ISEASE

PROGRESSION


Remicade

is effective and she is not having any
reactions. Mrs. Stevens has been continuing on
the same treatment plan. The disease process is
slowly progressing. She is beginning to see
additional signs of RA.


What are some common signs of
disease
progression and
extra
articular signs of RA
? (To
view
photos of these deformities please
visit
http://
images.rheumatology.org




R
EFERENCES


North Carolina Concept
-
Based Learning

Editorial Board. (2011).
Nursing: A Concept
-


Based Approach to Learning.
Volume 1 & 2.

Pearson Publishing.



Smeltzer
, S., Bare, B., Hinkle, J., Cheever, K.

(2010).
Brunner and
Suddarth’s

Medical

Surgical Nursing.

12
th

ed. Lippincott,

Williams & Wilkins.