Chapter 39: Nursing Management: Patients With Rheumatic Disorders

*The following is a sample care plan meant for adaptation. Always revise to meet your facility’s

protocols and the latest research and nursing diagnoses.

PLAN OF NURSING CARE

Care of the Patient with a Rheumatic Disease
NURSING DIAGNOSIS: Fatigue related to inflammatory process and increased

disease activity, pain, inadequate sleep/rest, impaired physical and psychosocial

functioning (including emotional stress/depression), and inadequate nutrition

GOAL: Incorporates as part of daily activities strategies necessary to modify

fatigue and improve quality of life

Nursing Interventions Rationale Expected Outcomes
1. Assess for defining 1. Recognition of fatigue • Self-evaluates and

characteristics of and its manifestations monitors fatigue

fatigue. is key. a. Description pattern

a. Obtain description of fatigue provides • Verbalizes the

of fatigue: onset, reliable evidence to relationship of fatigue

duration, intensity, base a plan of action to disease activity

aggravating and to manage the • Uses comfort

alleviating factors. symptom. measures as

b. Describe effects of b. The impact of fatigue appropriate

fatigue on: activities has significant effects • Practices effective

of daily living (ADL), on the patient’s sleep hygiene and

mood, libido, leisure physical and routine

activities, psychosocial • Makes use of various

 concentration, functioning, can be assistive devices

motivation, appetite / under-recognized and (splints, canes) and

nutrition intake, and under-treated, thereby strategies (bed rest,

sleep &/or rest influencing the relaxation techniques)

patterns. c. Monitor patient’s quality of life. to ease different kinds

daily fatigue levels c. The use of a fatigue of fatigue

using a simple scale assessment scale may • Incorporates energy

measuring severity help to identify the conservation

e.g., on a 0 to 10 patient’s perception of techniques in daily

scale, where “0” where they are within activities

equals no fatigue a continuum of • Uses appropriate

and “10” equals the progressive fatigue measures to prevent

worst fatigue and contribute to the physical and

imaginable. use of tailored emotional fatigue

2. Provide instruction interventions. • Has an established

about fatigue to 2. Patient’s plan to ensure well-

promote behavioral understanding of paced, therapeutic

changes. fatigue will affect his or activity schedule

a. Describe her actions. • Adheres to therapeutic

relationship of a. The amount of program

patient’s disease fatigue is directly • Follows a planned

activity to fatigue. related to the conditioning program

activity of the • Consumes a nutritious

b. Describe comfort disease. diet consisting of

measures while b. Pain is a contributor appropriate food

providing them. to fatigue; relief of groups and

discomfort can recommended daily

c. Develop and relieve fatigue. allowance of vitamins

encourage a sleep c. Effective bedtime and minerals

routine (warm bath routine promotes

and relaxation restorative sleep.

techniques that

promote sleep).

d. Explain importance

of rest for relieving d. Different kinds of

systematic, rest are needed to

articular, and relieve fatigue and

emotional stress. are based on patient

need and response.

e. Explain how to use

time management e. Planning can

strategies and provide for

energy conservation adequate rest and

techniques (pacing, reduce unnecessary

delegating, setting energy expenditure;

priorities, modifying such strategies can

 environment). enable continuation

of most desired

f. Identify physical activities.

and emotional f. Awareness of the

factors that can various causes of

cause fatigue. fatigue provides the

basis for measures

to modify the

3. Collaborate with fatigue.

patient to develop plan 3. The partnership

for activity and enhances patient’s

exercise within sense of control and

individual ability. commitment to

4. Motivate patient to attaining goals.

adhere to the 4. Overall control of

treatment program. health-related activities

has been associated

with a decrease in the

5. Refer to and amount of fatigue.

encourage a 5. Deconditioning

conditioning program. resulting from lack of

mobility,

understanding, and
 disease activity

6. Promote contributes to fatigue.

communication among 6. Presence of social

patients, family support is one of the

members, and most powerful

caregivers to predictors of self-care

encourage discussions behavior. An

of fatigue and its interactive

effects on daily life. environment

influences a patient’s

7. Encourage adequate thoughts and acts.

nutrition, including 7. Nutritionally balanced

source of iron from diet with proteins,

food and supplements, complex

and adequate fluid carbohydrates,

intake. vitamins, and minerals

may boost energy and

help counteract

fatigue. Iron may

improve anemia

induced fatigue.