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RHEUMATOID ARTHRITIS Rheumatoid arthritis ( RA ) is a chronic, systemic inflammatory disease involving connective tissue and characterized by destruction and proliferation of the synovial membrane, resulting in joint destruction, ankylosis, and deformity. Although the cause is unknown, researchers speculate that a virus may initially trigger the body’s immune response, which then becomes chronically activated and turns on itself (autoimmune response). Immunologic mechanisms appear to play an important role in the initiation and perpetuation of the disease in which spontaneous remissions and unpredictable exacerbations occur. RA is a disorder of the immune system and, as such, is a whole-body disease that can extend beyond the joints, affecting other organ systems, such as the skin and eyes. CARE SETTING Community level unless surgical procedure is required. RELATED CONCERNS Psychosocial aspects of care Total joint replacement Patient Assessment Database Data depend on severity and involvement of other organs (e.g., eyes, heart, lungs, kidneys), stage (i.e., acute exacerbation or remission), and coexistence of other forms of arthritis/autoimmune diseases. ACTIVITY/REST May report: Joint pain and tenderness worsened by movement and stress placed on joint; morning stiffness (duration often l hr or more), usually occurs symmetrically Functional limitations affecting ADLs, desired lifestyle, leisure time, and occupation Fatigue; sleep disturbances May exhibit: Malaise Impaired ROM of joints; particularly hand (fingers and wrist), hips, knees, ankles, elbows, and shoulders Muscle atrophy; joint and muscle contractures/deformities Decreased muscle strength, altered gait/posture CARDIOVASCULAR May report: Intermittent pallor, cyanosis, then redness of fingers/toes before color returns to normal (Raynaud’s phenomenon) EGO INTEGRITY May report: Acute/chronic stress factors (e.g., financial, employment, disability, relationship factors) Hopelessness and powerlessness (incapacitating situation) Threat to self-concept, body image, personal identity (e.g., dependence on others) FOOD/FLUID May report: Inability to obtain/consume adequate food/fluids (temporomandibular joint [TMJ] involvement) Anorexia, nausea May exhibit: Weight loss Dryness of oral mucous membranes, decreased oral secretions; dental caries (Sjögren’s syndrome) HYGIENE May report: Varying difficulty performing self-care activities; dependence on others NEUROSENSORY
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May report: Numbness/tingling of hands and feet, loss of sensation in fingers May exhibit: Symmetrical joint swelling PAIN/DISCOMFORT May report: Acute episodes of pain (may/may not be accompanied by soft-tissue swelling in joints) Chronic aching pain and stiffness (mornings are most difficult) May exhibit: Red, swollen, hot joints (during acute exacerbations) SAFETY May report: Difficulty managing homemaker/maintenance tasks Persistent low-grade fever Dryness of eyes and mucous membranes May exhibit:
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