Rheumatoid Arthritis Nursing Interventions Quiz

Rheumatoid Arthritis Treatment Options and Considerations

• Biologic DMARDs are engineered to target prominent proinflammatory mediators in RA, such as TNF-α, B cells, T cells, IL-1, and IL-6.
• Biologic DMARDs work more quickly than nonbiologic DMARDs and show greater delay in radiologic disease progression.
• They are more expensive and have fewer years of usage with the RA population, thus reserved for patients with persistent moderate to severe RA who have not responded adequately to synthetic DMARDs.
• After initiating treatment with a DMARD, patients generally report a beneficial effect within 6 weeks and tolerate the medication relatively well.
• Corticosteroids are recommended as a "bridge" in early treatment but not for long-term therapy due to side effects.
• JAK inhibitors, a newer class of drugs, inhibit cytokine production and decrease the immune response, and are used in combination with methotrexate or other nonbiologic DMARDs.
• NSAIDs and COX-2 enzyme blockers are used for pain and inflammation relief, with caution due to the possibility of gastric ulcers.
• NSAIDs do not prevent erosions or alter disease progression and are useful only for symptom relief.
• Opioid analgesic agents are avoided due to the potential for continuing need for pain relief.
• Nonpharmacologic pain management techniques are taught, and a formal program with occupational and physical therapy is prescribed for patients with established RA.
• The prevalence of obesity is increasing in patients with RA, adversely affecting disease progression, function, and quality of life.
• Certain medications used in RA treatment, such as oral corticosteroids, stimulate the appetite and may lead to weight gain when combined with decreased activity.

Nursing Interventions for Rheumatoid Arthritis Patients

• Nursing interventions for patients with rheumatoid arthritis (RA) include allowing ample time for activity, providing rest periods, and reinforcing principles of pacing and work simplification.
• The goal is for patients to perform self-care activities independently or with the use of resources.
• Nursing interventions to achieve this goal include assisting the patient to identify self-care deficits and factors that interfere with self-care activities, providing appropriate assistive devices, and allowing the patient to control the timing of self-care activities.
• Another nursing diagnosis for RA patients is disturbed body image associated with physical and psychological changes and dependency imposed by chronic illness.
• Nursing interventions for this diagnosis involve identifying areas of life affected by the disease, assisting in identifying past coping mechanisms, and developing a plan for managing symptoms and enlisting support.
• Difficulty coping associated with actual or perceived lifestyle or role changes is another nursing diagnosis for RA patients.
• Nursing interventions for this diagnosis include identifying areas of life affected by the disease, assisting in identifying past and effective coping mechanisms, and developing a plan for managing symptoms and enlisting support.
• Collaboration with healthcare agencies is important when individuals have attained a maximum level of self-care yet still have deficits, especially regarding safety.
• Complications secondary to effects of medications are a collaborative problem for RA patients, and the goal is the absence or resolution of complications.
• Nursing interventions for this problem involve performing periodic clinical assessment and laboratory evaluation, providing education about correct self-administration and potential side effects, counseling regarding methods to reduce side effects, and administering medications in modified doses as prescribed if complications occur.
• RA patients commonly have comorbid conditions such as cardiovascular disease, which can lead to complications. Up to 40% of patients diagnosed with RA may have cardiovascular disease as the primary cause of death.
• Patient education is essential in nursing care of RA patients to enable them to maintain independence, take medications accurately and safely, and use adaptive devices correctly.