rematiod arthritis

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease of unknown cause that primarily affects the peripheral joints in a symmetric pattern : 

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease of unknown cause that primarily affects the peripheral joints in a symmetric pattern

Pathophysiology : 

Pathophysiology Primary occur in the synovial tissue Phagocytosis produce enzyme within the joinit-------enzyme breakdowen collegen---- Edema----synovial membrane proliferation---and ultimately paunus formation ------destroyed the cartilage and the bone -----and muscle fiber under go generative changes tendone and ligementes elasticity lost

Clinical manifestation : 

Clinical manifestation Vary Usually reflacting the stage and severity of the disease Joint pain Swelling Warmth Erythema Lack of function Palpatiaon of the joint reveals spongy As the diseas progress the main joint involved

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The symptoms are usually bilateral and symmetric There is aclassic sign of RA specially in the morning for more 30m Early stage of disease before bone change occur limitation of function can occur ----- hot,warm, swollen .painfull joint not easy to move lead to protect this joint by immobilization Deformities of the hand and feet are common in RA caused by partial dislocation of joint and destruction of bone

Assessment and diagnosis : 

Assessment and diagnosis Several factor contribute to diagnosis of RA Joint inflammation detect on palpation Certain laboratory finding History and physical examintion (tenderness, swollen, warmth, fatique, stiffness,lymph node enlargment)

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Ra factor present in 80% of pt of ra Labratory studies ESR (ERTHOCYT SEDMINTION RTE) is elevated C reative protine positive Arthocentesis show synovial fluid that cloudy, mailky and dark yellow

Radiology studies : 

Radiology studies X ray performed to help in In diagnoses Monitor progressive of ra Show characteristics bony erosion and narrowed joint space

Medical management : 

Medical management Early stage 1- balance rest and exercise 2- NSAID 3- methotrexate is drug of choice in the early stage 4- cyclosporine

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Moderate stage For moderate stage formal program with Occupational and physical therapy (educational pt about principle of joint protection , range of motion, muscle strengthen exercise ) Advance stage Reconstructive surgary and cortcostriod are used is indicated when the pain can not be relived by conservative measure **synovectomy excision of the synovial membrane ** arthoplasty surgical repair and replacment of the joint

Nutrition management : 

Nutrition management Pt with RA frequently experience anoroxia , wt loss , anemia , Food selection should include the daily requirement of the basic food group high in protine , vit , iron for tissue building and repair

Nsg management : 

Nsg management 1-Teaching the pt about RA (cause , s+s, medication , how to deal with disease ) 2- provide comfort measure A- application of heat or cold B- massage .poistion change , rest 3- administer anti inflammatory ,analgesic

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4- provide instruction about fatigue A- describe relationship of RA and activity B- describe comfort measure while providing them C- encourage sleep routine D- explain importance of rest for reliving stress