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Acute Pain / Chronic Pain - NCP for Rheumatoid Arthritis

Nursing Care Plan for Rheumatoid Arthritis

The changes will occur in the human body in line with the increasing age. Body changes occur early in life until old age in all organs and tissues of the body. Such circumstances also appears on all of the musculoskeletal system and other tissues related to the possibility of some classes of rheumatism. Such circumstances it appears also in all other tissues of the musculoskeletal system and that has to do with the possibility of some classes of Rheumatoid Arthritis. Rheumatoid Arthritis can lead to changes in the muscle, until the function can be decreased when the muscles in the suffering does not trained to activate muscle function. With increasing age old muscle function can be properly trained. But old age is not always experienced or suffered from rheumatism. How the onset of rheumatic this incident, until now has not been fully understood.

According to the consensus of the experts in the field of rheumatology, rheumatism can be expressed as a complaint and / or markings. Of the agreement, otherwise there are three main complaints of the musculoskeletal system are: pain, stiffness and weakness, as well as the three main signs are: swelling of the joints, Muscle weakness, and movement disorders. (Soenarto, 1982).

Rheumatoid arthritis is a long case very often tested. Usually there are many physical signs. Diagnosis of the disease is easily enforced. Management is often a major problem. The incidence of rheumatoid arthritis peaks occur in the fourth decade of age, and the disease is found in women 3 times more often than men. Rheumatoid arthritis is believed to be an immune response to an unknown antigen. Stimulus can be viral or bacterial. There may also predispose to the disease.


Rheumatoid arthritis is a chronic multisystem disease of unknown cause, is a characteristic feature of rheumatoid arthritis; persistent synovial inflammation, usually of the peripheral joints in a symmetric distribution (Harrison, 2000: 1840).

Rheumatoid arthritis is a chronic disorder that attacks a variety of organ systems, this disease is one of a group of diffuse connective tissue diseases mediated by immune and unknown cause (Sylvia A.Price, 2005: 1385).


According to Harrison (2000 : 1841), the cause of rheumatoid arthritis is unknown, it is likely a manifestation of rheumatoid arthritis in response to an infectious agent. One of the possible presence of persistent infection in the joint structure or retention of microbial products in the synovial tissue that trigger chronic inflammatory response. Another potential causative mechanism in rheumatoid arthritis is a disruption of the normal self tolerance which cause reactivity against self antigens in the joints.

But the biggest factor precipitating factors of rheumatoid arthritis is an infection such as bacteria, mycoplasma and viruses (Lemone & Burke, 2001). The main cause of this disorder is unknown. There are several theories put forward as to the cause of rheumatoid arthritis, namely:
  1. Haemolytic streptococcal infection and non-haemolytic streptococci.
  2. Endocrine
  3. Autoimmune
  4. Metabolic
  5. Genetic factors as well as other trigger factors.

At this time, suspected rheumatoid arthritis is caused by autoimmune and infectious factors. This autoimmune reaction against collagen type II; factor for infection may be caused by a virus and mycoplasma organism or group of diphtheroids which produce collagen type II antigens of joint cartilage patients.

Clinical Manifestations

Criteria of the American Rheumatism Association (ARA) 1987 revised are:
  1. Stiff in the morning. Patients feel stiff in the joints and surrounding from waking up at least one hour before maximal improvement.
  2. Arthritis in the three regions. Swelling of soft tissue or bone enlargement joints instead, occurs in at least three joints simultaneously. There are 14 joints that meet the criteria: proximal interphalangeal, metacarpophalang, wrist, elbow, ankle, and metatarsophalangeal left and right.
  3. Artrtis on hand joints. At least there is swelling of the joints of the hands as shown above.
  4. Symmetrical arthritis. That is the involvement of the same joint (not absolutely symmetrical) on both sides simultaneously.
  5. Rheumatoid nodule is a local swelling or tissue lump, usually rather firm to the touch, like an unripe fruit, the which Occurs almost exclusively in association with rheumatoid arthritis.
  6. Serum rheumatoid factor positive. There abnormal titers of serum rheumatoid factor were examined in a way that gives a positive result is less than 5% of the control group.
  7. There is a typical radiological changes on chest X-ray examination postero-anterior hand or wrist, which should indicate the presence of erosions or decalcification of bones located at joints or areas adjacent to joints.
The diagnosis of rheumatoid arthritis is made if at least four of the seven criteria are met above. Criteria 1 till 4 there must be at least 6 weeks.

Nursing Diagnosis for Rheumatoid Arthritis : Pain Acute / Chronic Pain

Acute Pain / Chronic related to the agent of injury, tissue distension by the accumulation of fluid / inflammation, joint destruction.

Shows the pain is relieved / controlled,
Looks relaxed, sleep / rest and participate in activities according to ability.
Following the prescribed pharmacological programs,
Combining the skills of relaxation and entertainment activities in a pain control program.

Intervention and Rational:
1. Assess pain, note the location and intensity (scale of 0-10). Note the factors that accelerate and signs of non-verbal pain.
R / : Assist in determining the need for pain management and program effectiveness.

2. Provide mat / hard mattress, small pillows. Elevate the patient's bed linens as needed.
R / : Mattress soft / soft, big pillows will prevent the maintenance of proper body alignment, putting stress on diseased joints. Elevation of the bed linens pressure on inflamed joints / pain.

3. Place / monitor the use of pillows, sandbags, rolls trokhanter, splint, brace.
R / :Resting sore joints and maintain a neutral position. The use of the brace can reduce pain and can reduce damage to the joints.

4. Pushes to frequently change positions, help to move in bed, prop joints above and below sick, avoid jerky movements.
R /: Prevent the occurrence of general fatigue and joint stiffness. Stabilize the joint, reducing movement / joint pain

5. Instruct the patient to a warm bath or shower to wake-up time and / or at bedtime. Provide a warm washcloth to compress the affected joints several times a day. Monitor the temperature of the water compresses, bath water, and so on.
R /: Heat improves muscle relaxation, and mobility, decrease pain and stiffness in the morning release. Sensitivity to heat can be removed and dermal wounds can be healed.

6. Provide gentle massage.
R /: Increase relaxation / reduce pain.

7. Encourage use of stress management techniques, such as progressive relaxation, therapeutic touch, biofeedback, visualization, imagination guidance, self hypnosis, and breath control.
R /: Increase relaxation, gives a sense of control and may improve coping skills

8. Involve in entertainment activities appropriate to the individual situation.
R /: Refocus attention, stimulate, and improve self-confidence and feeling healthy.

9. Give medication before activity / exercise planned as directed.
R /: Increase realaksasi, reduce muscle tension / spasm, making it easy to participate in therapy.

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