1. The client/caregiver can define rheumatoid arthritis (RA).
   1. It is a systemic inflammatory disorder of connective tissue and joints.
   2. It is a chronic disease characterized by remissions and exacerbations.
   3. The cause of this disease is unknown, but it is considered an autoimmune disease.
   4. RA affects small joints early and progresses to involve large joints.
   5. RA strikes most often between the ages of 20 and 40 years of age, but it can also be found in children and older adults.
2. The client/caregiver can recognize signs and symptoms of rheumatoid arthritis.
   1. Localized symptoms are joint pain, swelling, warmth, redness (erythema), stiffness, limited mobility of affected joints, and fluid on joints.
   2. The swelling and pain can come and go.
   3. Stiffness can occur, particularly in the morning and when sitting for long periods of time.
   4. Joints are usually affected bilaterally and symmetrically.
   5. Fatigue, weakness, loss of appetite, depression, and weight loss can occur.
   6. Flu-like symptoms are possible, including a low-grade fever.
   7. Anemia is possible.
   8. Decreased tolerance to stress can occur.
3. The client/caregiver can list measures to manage rheumatoid arthritis.
   1. Adequate Exercise
      1. Always get the physician’s approval for the level of exercise.
      2. Regular exercise includes
         • Flexibility (stretching, range of motion)
         • Strengthening (resistance)
         • Cardiovascular (aerobic)
      3. Exercise at a slow, steady pace.
      4. Perform active or passive range of motion exercises.
      5. Never exercise a hot, inflamed joint.
      6. Balance exercise with rest.
      7. Set realistic goals.
      8. Stop exercise or activity if pain occurs.
   2. Proper Diet
      1. Maintain a healthy weight to decrease pressure on joints.
      2. Eat well-balanced meals that are high in protein, vitamins, zinc, and iron to promote tissue building and repair.
   3. Stress Management Skills
   4. Pain Control
      1. Apply heat or cold as ordered.
      2. Apply splints as ordered.
      3. Use transcutaneous electrical nerve stimulation as ordered.
      4. Take pain medications as ordered.
      5. Consider other alternatives, such as biofeedback, relaxation techniques, Tai Chi exercise, and pain clinics.
      6. Avoid extremes in temperature and damp, moist environments.
   5. Physical or occupational therapy referrals
   6. Assistive, adaptive, or protective devices (braces, splints, etc.)
   7. Joint Protection Principles
   8. Medications as ordered (report any side effects to physician)
   9. Reporting of exacerbation of symptoms to physician
   10. Surgery as recommended
   11. Keep follow-up appointments with physician, laboratory tests, or therapies
4. The client/caregiver is aware of possible complications.
   1. Deformity and disability
   2. Infections
   3. Neuropathy
   4. Chronic renal failure
   5. Cardiac complications
   6. Sjogren’s syndrome (dry eyes and mucous membranes)

Resources

Arthritis Foundation
www.arthritis.org

National Institute of Arthritis and Musculoskeletal and Skin Diseases
www.niams.nih.gov

American College of Rheumatology
www.rheumatology.org

Exercise program (i.e., YMCA and health clubs) Support Groups

References

Ackley, B. J., & Ladwig, G. B. (2006). Nursing diagnosis handbook: A guide to planning care. St. Louis: Mosby Inc.
Cohen, B. J., & Taylor, J. J. (2005). Memmler’s the human body in health and disease (10th ed.). Philadelphia: Lippincott Williams & Wilkins.
Diet and your arthritis. (2007). Arthritis Foundation. ww2.arthritis.org/default.asp.
Hitchcock, J. E., Schubert, P. E., & Thomas, S. A. (2003). Community health nursing: Caring in action. Clifton Park, NY: Thomson Delmar Learning.
Timby, B. K., & Smith, N. C. (2003). Introductory medical-surgical nursing (8th ed.). Philadelphia: J. B. Lippincott Williams & Wilkins.

Credits

Client Teaching Guides for Home Health Care, 2nd ed.
© 2008 Jones and Bartlett Publishers, Inc.
www.jbpub.com