Evaluation (Goals met/unmet)-5 pts (long term)
Medical Treatment/Collaborative Care (interdisciplinary)
 NSAIDs, Analgesics for pain and inflammation
 Methotrexate
 Corticosteroids
 Immunosuppressant
 Anti-depressant
 Synovectomy/Arthroplasty
 Physical therapy
Nursing Interventions (Planning)-25 pts
 Encourage verbalization regarding limitations in
mobility.
 Assess need for occupational or physical therapy
consultation: Emphasize range of motion of affected
joints; promote use of assistive ambulatory devices;
explain use of safe footwear; use individual
appropriate positioning/posture.
 Assist to identify environmental barriers.
 Encourage independence in mobility and assist as
needed: Allow ample time for activity; provide rest
period after activity; reinforce principles of joint
protection and work simplification.
 Initiate referral to community health agency.
Nursing Diagnosis (Analysis) - 10 pts
Impaired physical mobility related to decreased range of motion,
muscle weakness, pain on movement and limited endurance as
manifested by difficulty performing activities of daily living.
Signs/Symptoms (Assessment)-10 pts
After 3 shifts of nursing intervention, patient attained and
maintained optimal functional mobility as evidenced by performance of
daily activities without discomfort and unrestricted range of motion
activities.
Problem & Patho
RHEUMATOID ARTHRITIS
An autoimmune reaction (triggered by an
unknown source) leads to hypertrophy of
the cells in the synovial fluid, which then
leads to uncontrolled inflammation
↓ 
Cartilage damage resulting from
inflammation triggers further immune
responses, including complement activation
↓
Complement, in turn, attracts polymorph
nuclear leukocytes and stimulates the
release of inflammatory mediators, which
exacerbates joint destruction.
Interrelated Concepts (&Rationale)-15 pts
1. Mobility- Due to diffuse inflammation and
degeneration in the connective tissues, Range of
Motion in patients with RA is greatly affected.
2. Circulation- RA increases a patient’s chance to
develop anemia and hardened arteries which may
eventually affect the body’s oxygen transport to
tissues and organs.
3. Skin integrity- Rheumatoid nodules are hard lumps
caused by inflammation that appear under the skin,
usually near joints and may appear bothersome to
look at.
 Insidious onset of nonspecific signs and
symptoms, including fatigue,
malaise, anorexia, persistent low-
grade fever, weight loss, and vague
articular symptoms; later, more specific
localized articular signs and symptoms
occur, such as swelling, commonly in the
fingers
 Bilateral and symmetrical signs and
symptoms may extend to the hands,
wrists, elbows, knees, feet and ankles
 Difficulty performing activities of daily
living
Stiff joints (morning stiffness lasting
longer than 1 hour)
 Stiff, weak, or painful muscles
 Numbness or tingling in the feet or
weakness or loss of sensation in the
fingers
 Pain on inspiration
 Shortness of breath
Medical History (or Risk Factors)-5 pts
 Female gender
 Family history
 Age between 40 and 60
 Smoking
 Environmental exposure to toxins
Diagnostic Studies (labs, XR, etc.)-5 pts
 Anti-Nuclear Antibody (ANA) Titer
 Rheumatoid Factor tests
 CBC, IG & IM Assay
 X-ray
 Synovial membrane aspiration/ biopsy
 Radionuclide scan