Nursing Care Plan for Rheumatoid Arthritis

Nursing diagnosis: acute/chronic Pain related to injuring agents—distention of tissues by accumulation of fluid/inflammatory process, destruction of joint

Possibly evidenced by
Reports of pain, discomfort; fatigue
Self-narrowed focus
Distraction behaviors; autonomic responses
Guarding, protective behavior

Desired Outcomes/Evaluation Criteria—Client Will
Pain Level
Report pain is relieved or controlled.
Appear relaxed and able to sleep, rest, and participate in activities appropriately.
Pain Control
Follow prescribed pharmacological regimen.
Incorporate relaxation skills and diversional activities into pain control program.

Nursing intervention with rationale:
1. Investigate reports of pain, noting location, and intensity using a scale of 0 to 10 or similar. Note precipitating factors and nonverbal pain cues.
Rationale: Self-report should be the primary source of pain assessment in determining pain management needs and effectiveness of program.

2. Recommend or provide firm mattress or bedboard and small pillow. Elevate linens with bed cradle as needed.
Rationale: Soft or sagging mattress and large pillows prevent maintenance of proper body alignment, placing stress on affected joints. Elevation of bed linens reduces pressure on inflamed, painful joints.

3. Suggest client assume position of comfort while in bed or sitting in chair. Promote bedrest when indicated, but resume movement as soon as possible.
Rationale: In severe disease or acute exacerbation, total bedrest may be necessary until objective and subjective improvements are noted to limit pain and injury to joint. Note: Immobility is known to worsen arthritis pain and stiffness.

4. Place and monitor use of pillows, sandbags, trochanter rolls, and splints.
Rationale: Rests painful joints and maintains neutral position. Note: Use of splints can decrease pain and may reduce damage to joint; however, prolonged inactivity can result in loss of joint mobility and function.

5. Encourage frequent changes of position. Assist client to move in bed, supporting affected joints above and below, avoiding jerky movements.
Rationale: Prevents general fatigue and joint stiffness. Stabilizes joint, decreasing joint movement and associated pain.

6. Recommend that client take warm bath or shower on arising and/or at bedtime. Apply warm, moist compresses to affected joints several times a day. Monitor water temperature of compresses, baths, and so on.
Rationale: Heat promotes muscle relaxation and mobility, decreases pain, and relieves morning stiffness. Sensitivity to heat may be diminished and dermal injury may occur.

7. Encourage use of stress management techniques, such as progressive relaxation, biofeedback, visualization, guided imagery, self-hypnosis, and controlled breathing. Provide Therapeutic Touch.
Rationale: Promotes relaxation, provides sense of control, and may enhance coping abilities.

8. Involve client in diversional activities appropriate for individual situation.
Rationale: Refocuses attention, provides stimulation, and enhances selfesteem and feelings of general well-being.

9. Medicate before planned activities and exercises, as indicated.
Rationale: Promotes relaxation, reduces muscle tension and spasms, facilitating participation in therapy.

10. Monitor for development of skin rash in clients usingcyclo-oxgenase-2 (COX-2) inhibitors, especially those allergic to sulfur.
Rationale: Severe, life-threatening skin reactions, such as toxic epidermal necrolysis, Stevens-Johnson syndrome, and erythema multiforme, may develop within the first 2 weeks of treatment or later on, indicating need for prompt discontinuation of medication.