Tugas Muscullo Rozi 25m1i

MUSCULOSKELETAL SYSTEM “NURSING PROCESS OF RHEUMATOID ARTHRITIS”

LECTURER: Ns.Leni Merdawati,M.Kep

NAME ROZI ARDI TAMALA 1511314002

NURSING FACULTY ANDALAS UNIVERSITY PADANG 2016/2017

CHAPTER I INTRODUCTION 1.1.BACKGROUND Disease of rheumatoid arthritis (RA) is one of the autoimmune disease in the form of inflammatory arthritis in adult patients (Singh et al., 2015). Pain in people with RA Synovial ts, on the part of the tendon sheaths, and exchanges will experience a thickening due to an inflammation followed by erosion and destruction of bone of the bone around the t (Syamsuhidajat, 2010) to be able to cause the disability (Yazici & Simsek, 2010). However, most of the ongoing chronic rheumatic diseases, namely, recovery and relapse repeatedly causing damage to the ts permanently in people with RA (Muchid, 2006). According to the Arthritis Foundation (2015), as much as 22% or more than 50 million adults in the United States aged 18 years or more was diagnosed with arthritis. From these data, about 3% or 1.5 million adults experience the RA (Arthritis Foundation, 2015). RA occurs in 0.5-1% of the adult population in developed countries (Choy, 2012). The prevalence of RA in Indonesia according to the results of research conducted by Nainggolan (2010), the number of sufferers of RA in Indonesia year 2009 was 31.3% to 23.6%.

1.2. Purpose

1.2.1. Definition of Rheumatoid Arthritis 1.2.2. Risk Factors Rheumatoid Arthritis 1.2.3. Pathophysiology of Rheumatoid Arthritis 1.2.4. Signs and Symptoms of Rheumatoid Arthritis 1.2.5. Diagnostic test of Rheumatoid Arthritis 1.2.6. Treatment of Rheumatoid Arthritis 1.2.7. Nursing Process

CHAPTER II RHEUMATOID ARTHRITIS 2.1. Definition of Rheumatoid Arthritis The word arthritis means inflammation of the t (“artho” meaning t and “itis” meaning inflammation). Inflammation is a medical term describing pain, stiffness, redness and swelling. Arthritis is a disease that can involve any of the ts in the body, often occurring in the hip, knee, spine or other weight bearing ts, but can also affect the fingers and other non-weight-bearing ts. Symptoms of arthritis include t pain, swelling, stiffness and fatigue. Untreated inflammation can eventually lead to t damage, destruction and disability. Some forms of arthritis can also affect the body’s internal organs. Rheumatoid athritis (RA) is one of the common conective tissue diseases and the most destructive to the ts. It is a chronic,progressive,systemic inflammatory autoimmune diseases process that affects primarily the synovial ts. Systemic means this disease affect the body system, affecting many ts and other tissues. RA affect over 2 million people, and European Americans have the disease more often than other groups. In RA , autoantibodies ( rheumatoid factors [RFs]) are formed that attack healthy tissue, especially syynovium causing inflammation. RFs consist mainly of immunoglobulins M and G , and they bind with antigens forming immune complexe. Phatocytes attemp to engulf these complexes and , as a results, release powerful enzymes, such as cytokines. The B and T-lymphocytes of the immune system are also stimulates and increase the imflammatory respone. Rheumatoid arthritis is a systemic diseases, area of the body beside the synovial t can be affected. Inflammatory responses similar to those occuring in synovial tissue may be seen in any organ or body system in which connective tissue prevalent. If blood vessel involvement occurs, the organ suplied by that vessel can be affected. The result is malfunction and eventual failure of the organ or system. Theses pathologic changes may occurs late in the disease process and cause life theartening problems.

2.2. Risk Factors The exact causes of RA are unknown, but research has shown that several factors may contribute to its development: 1. Family history Some people who develop RA have genetic risk factors. However, having genetic risk factors for RA does not necessarily mean you will develop the disease. 2. Gender RA affects women two to three times more often than men. 3. Hormones There seems to be an increased risk of RA related to hormonal changes. For instance, RA symptoms often improve during pregnancy, however, these women may experience a flare up after delivery. RA is less common among women who breastfeed. Also, some studies have even found that women who’ve used oral contraceptives had a modest decrease in the risk of RA. 4. Age Anyone can get RA at any age, but the risk does increase with age (commonly developing between ages 40 and 60). 2.3. Pathophysiology Environment–gene interactions described in the text promote loss of tolerance to selfproteins that contain a citrulline residue, which is generated by post-translational modification. This anticitrulline response can be detected in T-cell and B-cell compartments and is probably initiated in secondary lymphoid tissues or bone marrow. Thereafter, localization of the inflammatory response occurs in the t by virtue of poorly understood mechanisms that probably involve microvascular, neurologic, biomechanical, or other tissuespecific path ways. Synovitis is initiated and perpetuated by positive loops and in turn promotes systemic disorders that make up the syndrome of rheumatoid arthritis. AA denotes anti–citrullinated protein antibody, and RF rheumatoid factor.

2.4. Signs and Symptom Rheumatoid athritis affects different people in different ways. Symptoms may slowly develop over several years, or the disease may progress quickly. Symptoms may be mild or very severe. You may go through phases called “flares” or “flare-ups” when symptoms are severe. At other times, it may seem as if the disease and its symptoms have gone away. This is called “remission.”t pain and swelling may happen slowly and may occur over weeks or months. The small ts in the wrists and hands are often inflamed first. Over time, other ts may be painful and swollen due to Rheumatoid athritis. Common sign and symptoms of rheumatoid athritis include:  t pain and swelling  Stiffness  Fatigue, depression and irritability  Anemia  Flu- like symtoms, such as feeling generally ill, feeling hot and sweating. Less common symtoms include:  Weight loss  Inflammation in the eye  Rheumatoid nudules

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Inflamation of other body parts, for example, the lungs and blood vessels and the membrane around the heart, but this is rare.

2.5. Diagnostic test Getting a firm RA diagnosis is not always easy. In its early stages, RA may resemble other forms of inflammatory arthritis. No single test can confirm RA. An experienced arthritis specialist (rheumatologist) will consider many factors, such as the following 1. Medical history Your doctor will ask about your personal and family medical history; recent and current symptoms (pain, tenderness, stiffness, difficulty moving) when they started, if they come and go, how severe they are and if anything makes them better or worse. The number and pattern of ts involved can also indicate RA; the disease tends to affect the same t on both sides of the body. However, it is possible for the disease to develop in a single t. RA involves large and small ts, but typically starts in small ts, such as those in the hands and feet. 2. Physical exam Your doctor will examine each t, looking for tenderness, swelling, warmth and painful or limited movement. An overall physical exam may reveal other signs, such as rheumatoid nodules or a low-grade fever. 3. Blood tests Blood will be drawn for two types of tests. One measures inflammation levels. The other looks for biomarkers such as antibodies (blood proteins) linked with RA. 4. Imaging tests An X-ray, ultrasound or magnetic resonance imaging (MRI) scan may be done to look for t damage, such as erosions, a loss of bone within the t and narrowing of t space. Their absence doesn’t rule out RA, however. It may mean that RA is in an early stage and hasn’t yet damaged the ts. Early images can be compared to ones taken later to help monitor how well treatment is work

2.6. Treatmens The general approach to treating RA is to reduce inflammation and prevent long-term damage to the ts. Pain management is also important. The cornerstone of medication

therapy for RA is diseasemodifying anti-rheumatic drugs (DMARDs) and a newer class of medications called biologics 1. Corticosteroids Cortisol is a hormone produced naturally by the body’s adrenal glands that has many functions in our bodies. One of cortisol’s important actions is its antiinflammatory function. Cortisol can be considered the “brake” for the immune system, preventing it from overreacting to infections, injuries and trauma. However, steroids have many potential long term side effects. Therefore, they are often used as an interim measure to help control inflammation while waiting for the slower-acting DMARDs to take effect or in the case of someone experiencing a flare of inflammatory arthritis. Ideally, steroids should be used at the lowest dosage that provides benefit for the shortest period of time. 2. Disease-Modifying Anti-Rheumatic Drugs (DMARDs) DMARDs are a class of medications used to treat many different types of inflammatory arthritis, such as RA, and work well for most people. The earlier a DMARD is started the more effective it can be to suppress inflammation and prevent t damage. It is important to slow or even stop the progression of t damage, but keep in mind that DMARDs cannot fix t damage that has already occurred. 3. Biologics Biologics are drugs made from living cells (human, animal, bacteria, etc.). They are a class of medications specially designed to treat inflammatory types of arthritis, such as RA. Biologic medications work by modifying the body’s inflammatory response. Like DMARDs, biologics can reduce pain, t inflammation and damage to bones and cartilage.

2.7. Nursing Process A. Assessment 1. Identity Including name, gender, age, address, religion, marital status, education, occupation, number, hospital ission date. 2. Main complain 3. History of the disease now Data collection is done since complaints arise. In rheumatoid arthritis clients, the early stages are usually characterized by generalized disorders such as malaise, weight loss,

4.

5. 6. 7.

fatigue, slight heat, and anemia. Local symptoms that occur in the form of swelling, tenderness, and motion disorders in the metacarpophalangeal t. Past medical history • Is there a history of previous t or bone disorders? • Has the patient undergone surgery such as t replacement? Family health history Assess whether there is a family of previous generations who have the same complaint with clients. Physical examination After anamnesis, physical examination is very useful to data history. Diagnostic test Physicians rely on diagnostic tests to help them provide quality care to people with RA. Diagnostic tests can take the form of blood analyses, t fluid analyses, urine analyses, and x-rays.

B. Nursing management NANDA ACUTE PAIN Related factor • Biological injury agent • Chemical injury agent • Physical injury agent CHRONIC PAIN Related factor • Age > 50 years • Chronic musculoskeletal condition • Fatigue • Famale gender • Genetic disorder • Post trauma related condition

IMPAIRED PHYSICAL MOBILITY Related factor:

NOC Outcomes to assess and measure actual occurrence of the diagnosa: Pain control: • Recognize pain onset describe causal factors • Uses diary to monitor over time • Uses preventive measure Pain level: • Report pain • Length of the episode • Rubbing affected area • Moaning and crying • Facial expressions of pain Activity intolerance • walking phase • walking distance • stair climbing

NIC Analagesic istration • Determine pain location,characteristic, quality, and severuty before medicating patient • Check medical order • Check history for allergy • Determine analgesic selesction Pain management • Performs comprehensive assessment of pain include location, characteristic,frequenct,quality,inten sity, or severity of pain and precipitating factor • Observe for non verbal cues of discomforts, especially in those unable to communicate effectively

Activity therapy • determine patien ability to parcipante • determine patient commitment to

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Activity intolerance Alteration in bone structure integrity Anxiety Decrease in muscle control , mass, and strength Musculoskeltal impaired pain

tolerance • upper and lower strength Endurance • performance of usual routine • physical activity • muscle endurance

increasing frequncy and activity • assist patient to focus in abilities rather than of deficit Exercise promotion • exercise promotion: strength , training, streching, balance, and mobility • explored barries to exercise • encourage individual to begin or continue exercise

CHAPTER III CONCLUSION 3.1.CONCLUSION Rheumatoid athritis (RA) is one of the common conective tissue diseases and the most destructive to the ts. It is a chronic,progressive,systemic inflammatory autoimmune diseases process that affects primarily the synovial ts. . Inflammatory responses similar to those occuring in synovial tissue may be seen in any organ or body system in which connective tissue prevalent. If blood vessel involvement occurs, the organ suplied by that vessel can be affected. The result is malfunction and eventual failure of the organ or system. Theses pathologic changes may occurs late in the disease process and cause life theartening problems.

REFERENCE Donna D. Ignatavicius, M. Linda Workman.2009. Medical-Srgical Nursing: 6th Edition The Community Athritis Society.Rheumatoid Athritis-Causes, Symptoms and Treatments Iain B. Mcinnes, F.R.C.P., Ph.D., And Georg Schett, M.D. 2011.The Pathogenesis Of Rheumatoid Arthritis. United Kingdom Athritis Foundation. Understanding Symptoms,Diagnosis and Treatments Gloria M. Bulechek, Howard K.Butcher, Dkk. 2013. Nursing Interventions Classification (Nic) :6 Edition . Elseiver : United States Of America Sue Moorhead, Marion Johnson, Dkk. 2013. Nursing Outcomes Classification (Noc) 5 Edition. Elseiver : United States Of America