ra by meilan

8/13/2019 RA by Meilan

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SITI MEILAN SIMBOLON

MEDICAL SURGICAL NURSING DEPARTMENTSTIKES ST ELISABETH MEDAN


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Definition

RA is a chronic, system diseasecharacterized by recurrent inflamationof the diarthrodial joints and relatedstructures.


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Etiology

Unknown

Several etiologies are posible :

1. Infection Epstein-Barr virus, parvovirus,mycobacteria

2. Autoimunity

3. Genetic factorsmetabolic and

biochemical abnormalities, nutritional andenvironmental factors, occupational andpsychological.


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Pathogenesis

1. First stage the unknown etiology factor initiatesjoint inflamation, or sinovitis

2. Second stage inflamatory granulation tissue

Pannus3. Third stage Tough fibrous connective tissue

replaces pannus,Fibrous ankylosis decreaseof joint motion, malalignment, and deformity

4. Fourth stageAs fibrous tissue calcifiesbonyankylosis total joint immobilization.


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Clinical manifestation

Specific articular :

Pain

Stiffness Limitation of motion

Signs of inflamation (heat, swelling, tenderness)

Extraarticular see picture


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Diagnostic finding

Laboratory anemia, LED,

leukositosisSerum rheumatoid factor 80%

Synovial fluid analysis

X-Ray erosive

MRI


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Management o RA

Non-farmakologik Edukasi pasien

Rehabilitasi medik

Diet dan kontrol obesitas

rest Farmakologik

OAINS

Disease Modifying Drugs (DMARDs)

Steroid oral Injeksi steroid intrasynovial

Orthopedic surgery reconstructive joint replacment


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PASIEN RA

Rematologist

Nutritionist

Dokter Keluarga

NersFisioterapist

Ortopedist


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Complications : Infection

Osteoporosis

Amyloidosis Spinal cord compression instability of articulations

in the servical spine


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NURSING PROCESS : Thepatient with A Rheumatic

diseases


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Assestment

Subjective data :

- Importanthealthinformation

- Functionalhealth pattern

Ojective data :-General

-Integumentary-Cardiovascular-Neurologic

-Musculosceletal-Possible finding


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Nursing diagnosis, NOC, NIC (NNN)Chronic pain related to joint inflamation,over use of joint, and innefective pain or

comfort measures manifested by complaintsof pain and limited joint function : hot,swollen, paintful joints of more than 6months duration.

NOC : - decrease pain, swelling, anderythema of joint

NIC : IS


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Impared physical mobility related to jointpain, stiffness, and deformity as manifestedby limitation of joint pain, strenght,endurance, inability to perform routine

activities of daily living.NOC : - increased ROM and function

- Decreased stiffness

-Ability to perform activities ofdaily living

- Minimal deformity

NIC : IS


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Fatique related to exacerbation of diseaseactivity, anemia, drug side effects, ordepression as manifested by verbalization ofoverwhelming lack of energy and decrease

activity tolerance

NOC : - Improved stamina and endurance

- Better quality of sleep

- Good eating habits

NIC : IS


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Body image disturbance related to chronich

disease activity, long term treatment,deformities, stiffness, inability to performusual activities as manifested by social

withdrawal, flat affect, altered self-concept,

reduced sexual interest.NOC : - Acceptance of body changes

- Maintanance of interest in life

NIC : IS


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Innefective management of theraupeticregimen related to complexity of chronic

health problem, pain, and fatiquemanifested by questioning managementplan, self-doubt about ability to managedisease, ability to perform activities for only

shorth periods.NOC : - Expression of increased confidencein ability to manage disease.

- Ability to describe treatment plan- Expression of satisfaction with pain

and fatique management

NIC : IS


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Altered family process related to patients

inability to function secondary to chronichillness and complexity of treatment regimenas manifested by changes in family, social,and occupational roles, dysfunctional family

dynamics.NOC : - successful adjusment to diseaseactivity by patient and family

-Vocational rehabilitation ormodification

NIC : IS


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Self care deficits related to disease

progression, weakness, and contracture asmanifested by inefective to perform abilityto perform activities of daily activity (ADLs).

NOC : - Completion of ADLs independentlyor with assistance

- Expression of satisfaction with howselft care needs are met

NIC : IS


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EvaluationReferr to the expected outcome (NOC)


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References Bulecheck G.M, Butcher H.K and Dochterman J.M., 2008.

Nursing Intervention Classification (NIC), fifth edition.USA : Mosby

Brunner and Suddarths, 2000. Medical Surgical Nursing,9th Edition, Unit 2. Philadelphia : Lippincott

Lippincott., J.B., 1987. Medical Surgical Nursing, SixthEdition. Philadelphia : Mosby

Herdman, T.H, 2012. NANDA INTERNATIONAL NursingDiagnosis : Defenition & Classification 2012-2014. Oxford :Wiley-Blackwell

Lewis, Heitkemper and Dirksen, 2000. MEDICALSURGICAL NURSING, Assesment and Management ofclinical problems, Fifth edition, Volume 2. USA : Mosby

Moorhead dkk., 2008. Nursing Outcomes Classification

(NOC), Fourth Edition. USA : Mosby


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THANK YOU

ra by meilan

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