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K.R., a 42-yr-old married white woman, comes to the rheumatology clinic with tenderness and pain in the small joints of her hands.

 

Subjective Data

    • Reports tenderness, joint pain, and stiffness in her hands for the last 3 mo

    • Having fatigue, anorexia, and morning stiffness

    • Mother diagnosed with ankylosing spondylitis 8 yr ago

    • Expresses doubt about her ability to manage the disease

 

Objective Data

Physical Examination

    • Swelling, warmth, and tenderness of third and fourth metacarpophalangeal joints of both hands

    • Mild pain with neck motion

    • Tenosynovitis

 

Diagnostic Studies

    • Positive ESR, RF, and anti-CCP

    • Mild bone demineralization present bilaterally in hand x-rays

 

Interprofessional Care

    • Diagnosed with RA

    • Started on methotrexate 7.5 mg PO once per week, etanercept (Enbrel) 50 mg subcutaneously once per week, prednisone 10 mg/day

 

Discussion Questions

How will you explain the pathophysiology of RA to K.R.?
K.R. asks you if genetic factors are related to a diagnosis of RA. How will you respond?
Based on the assessment data presented, what are the priority nursing diagnoses?
Why is an exercise program important in the treatment plan for K.R.?
SCIENCE
HEALTH SCIENCE
NURSING
MED SURG 223