- Chronic Pain related to Joint damage and Inflammation as evidenced by Stiffness, Erythema and swelling of the joints
- Disturbed Body Image related to Inability to perform usual tasks and Impaired mobility as evidenced by Joint deformities and change in lifestyle and ability to perform roles
- Impaired Physical Mobility related to Skeletal deformity and Intolerance to activity as evidenced by reluctance to attempt movement and limited ROM
| Assessment | Nursing Diagnosis | Planning/Outcomes | Intervention | Evaluation |
| Subjective Data: Verbalization of pain Objective Data: -Stiffness -Fatigue -Guarding behavior -Erythema and swelling of the joints -Decreased range of motion | Chronic Pain related to Joint damage and Inflammation as evidenced by Stiffness, Erythema and swelling of the joints | Patient will verbalize relief or control of pain. Patient will be able to participate in activities and perform self-care. Patient will verbalize two strategies to control pain. | 1. Recommend firm mattresses and supportive pillows. Soft sagging mattresses and soft pillows prevent the maintenance of proper body alignment, placing further stress on the affected joints and preventing restful sleep. 2. Consider alternative therapies. Massage, acupuncture, meditation, and more can help reduce cortisol levels, the stress hormone, which in turn reduces inflammation. 3. Recommend warm, moist heat. Heat promotes muscle relaxation and mobility, decreases pain, and relieves morning stiffness. Methods such as using paraffin gloves and whirlpool baths will provide sustained heat to reduce pain and improve the range of motion (ROM) of affected joints. 4. Administer medications appropriately. NSAIDs are given to reduce inflammation and ease pain. Diclofenac, a common topical NSAID, can be applied directly to the joints. Steroids may be prescribed during flares to reduce inflammation and to slow joint damage. 5. Ensure adherence to a DMARD. Disease-modifying antirheumatic drugs (DMARDs) are used to treat RA and slow disease progression. These drugs reduce systemic inflammation and the incidence of flares. | Patient verbalized relief or control of pain. Patient participated in activities and performed self-care. Patient verbalized two strategies to control pain. |
| Subjective Data: verbalize a realistic self-image Objective Data: -Joint deformities -RA nodules -Negative self-talk -Change in lifestyle and ability to perform roles -Withdrawal from social involvement -Attempt to hide body parts -Sense of isolation | Disturbed Body Image related to Inability to perform usual tasks and Impaired mobility as evidenced by Joint deformities and change in lifestyle and ability to perform roles | Patient will verbalize a realistic self-image. Patient will demonstrate an acceptance of their self instead of an idealized image. Patient will be able to recognize health-destructive behaviors and demonstrate a willingness to follow a treatment plan that will promote overall health. Patient will be able to describe, touch, and/or observe the affected body part. Patient will be able to demonstrate social involvement. | 1. Encourage open communication with patient. Providing open communication and an environment that is free from judgement will allow the patient to feel more comfortable and will increase the patient’s sense of control and willingness to engage in activities with the nurse. 2. Educate the patient on healthy coping patterns. Patients with disturbed body image may have unhealthy coping patterns. Educating the patient on healthy coping patterns will allow the patient more control and independence in their daily life. 3. If weight loss or gain is needed create a weight graph. This will allow the patient a visual in how s/he is progressing towards her/his goal. 4. Identify and encourage the patient to participate in community support groups. Community support groups can help motivate patients and decrease their loneliness and isolation. 5. Encourage a regular exercise routine for patient. Regular exercise can improve the patient’s ability to function and improve mood and mental state. 6. Provide appropriate assistive devices. If assistive devices are needed for patient ensure these are available to guide the patient towards becoming more independent. | Patient verbalized a realistic self-image. Patient demonstrated an acceptance of their self instead of an idealized image. Patient recognized health-destructive behaviors and demonstrate a willingness to follow a treatment plan that will promote overall health. Patient described, touch, and/or observe the affected body part. Patient demonstrated social involvement. |
| Subjective data: -Expression of pain and discomfort with movement -Refusal to move Objective data: -Limited range of motion -Uncoordinated movements -Poor balance -Inability to turn in bed, transfer, or ambulate -Postural instability -Gait disturbances -Reliance on assistive devices Contractures -Decreased muscle strength | Impaired Physical Mobility related to Skeletal deformity and Intolerance to activity as evidenced by reluctance to attempt movement and limited ROM | Patient will participate in their activities of daily life (ADLs) and prescribed therapies. Patient will display improvement in physical mobility by transferring from bed to wheelchair independently (if this is a realistic goal). Patient will remain free of contractures and decubitus ulcers from impaired mobility. Patient will demonstrate exercises to improve physical mobility. | 1. Encourage the patient to do as much as they can. Once the nurse has assessed the degree of immobility, they should encourage independence aligned with the patient’s capabilities. This decreases dependence on others and increases the patient’s self-esteem. 2. Medicate for pain. If pain and discomfort are a barrier, the nurse can provide analgesics prior to performing exercises or planned ADLs. Even simple interventions such as a heating pad or ice packs may alleviate muscle and joint pain and increase movement. 3. Schedule activities around rest periods. Allow the patient to determine the best times for exercise or movement related to their energy levels. Do not overwhelm or exhaust and allow periods of rest between activities. 4. Provide adaptive equipment. Provide equipment that allows for maximum movement related to the patient’s capabilities. For example, if bed-bound but able to use upper extremities, a trapeze bar can help the patient pull themselves up. 5. Provide passive ROM. If the patient is unable to perform exercises independently, the nurse should provide passive range of motion (ROM) several times per day to prevent contractures and muscle weakness. 6. Promote proper nutrition and hydration. Malnourishment prevents recovery and contributes to a higher risk of functional disability. Adequate caloric intake is required for energy with high-protein foods supporting muscle mass and strength. Hydration will prevent dehydration, promote circulation, and keep skin, tissues, and muscles hydrated. Depending on the patient’s nutrition status, it may also be useful to consult with a registered dietician. 7. Incorporate family and caregivers. Patients who feel supported by their families and spouses will feel committed to increasing their mobility. Families may need education on how to best support their loved ones, how to keep them safe, and how to use equipment. 8. Consult with the multidisciplinary team. Impaired mobility may require the support of a physiotherapist or occupational therapist to instruct on exercises and perform activities that stimulate muscle control and fine motor movement. 9. Coordinate ongoing support at discharge. Patients may require ongoing support either at home through home health services or at a rehab center. Coordinating with the case manager to ensure the patient receives the appropriate care at discharge is vital to preserving their progress. 10. Set goals. Patients may feel overwhelmed or hopeless if their barriers seem impossible. Helping them choose small goals, such as brushing their hair or sitting up in bed, gives them the motivation to keep going. 11. Provide positive reinforcement. A patient who is making an effort, no matter how small, will be more inclined to continue when their accomplishments are noticed and praised. | Patient participated in activities of daily life (ADLs) and prescribed therapies. Patient displayed improvement in physical mobility by transferring from bed to wheelchair independently (if this is a realistic goal). Patient remained free of contractures and decubitus ulcers from impaired mobility. Patient demonstrated exercises to improve physical mobility. |