Nursing Care Plans

Nursing Diagnosis #1

Diagnosis	Deficient Knowledge
Related factors	·       New diagnosis ·       Unfamiliarity with treatment regimen ·       Lack of interest/denial
Defining Characteristics (signs/symptoms)	·       Asking lots of questions ·       Asking no questions ·       Verbalized misconceptions ·       Inaccurate follow through
Expected Outcome	Patient verbalizes understanding of RA and treatment
Assessment	Assess patients understanding of RA
Intervention	Ask what they understand of the disease. Discuss topics such as disease process, treatment options, chronicity, inflammation, remission, exacerbation, and control versus cure.

Nursing Diagnosis #2

Diagnosis	Joint Pain
Related factors	·       Inflammation associated with increased disease activity. ·       Degenerative changes secondary to longstanding inflammation.
Defining Characteristics (signs/symptoms)	·       Patient reports pain ·       Guarding or motion toward affected joints ·       Facial mask of pain ·       Moaning or other sounds associated with pain
Expected Outcome	Patient reports mild to moderate pain rather than severe Patient implements pain management plan that includes both pharmacological and non-pharmacological strategies
Assessment	·       Assess signs or symptoms of joint inflammation such as redness, warmth, swelling, and decreased motion. ·       Evaluate location and description of pain. ·       Assess interference with lifestyle.
Intervention	Discuss pharmacological strategies including anti-inflammatory medications, DMARD’s. Encourage patient to monitor position and to always maintain anatomically correct alignment of the body Encourage patient  to use knee pillow to prop knees, small pillow under head, and wear prescribed splints. Encourage use of hot or cold packs. Encourage use of ambulation aids when pain is related to ambulation.

Diagnosis	Joint Stiffness
Related factors	Inflammation associated with increased disease activity Degenerative changes secondary to longstanding inflammation
Defining Characteristics (signs/symptoms)	Complaints of joint stiffness Guarding Refusal to participate in usual self-care activities Decreased functional ability
Expected Outcome	Patient verbalizes decrease in stiffness Patient is able to participate in self-care activities
Assessment	Assess patients description of stiffness, including location, timing, and length of time stiffness persists How it affects activities How they alleviate stiffness How does stiffness interfere with lifestyle?
Intervention	Encourage patient to take 15 minutes warm shower or bath in the morning Provide sufficient time between tasks, and don’t schedule a lot of events when you are most stiff Encourage the patient to take anti-inflammatory medications in the morning, and to not take them on an empty stomach. Avoid prolonged periods of inactivity

Diagnosis #4

Diagnosis	Impaired Physical Mobility
Related factors	Pain, Stiffness, fatigue, psychosocial factors, altered joint function, and muscle weakness
Defining Characteristics (signs/symptoms)	Patient’s description of difficulty with purposeful movement Decreased ability to transfer and ambulate Reluctance to attempt movement Decreased muscle strength Decrease range of motion
Expected Outcome	Patient performs physical activity independently within liits of RA Patient demonstrates use of adaptive techniques that promote ambulation and transfer
Assessment	Assess patients description of what type of movement aggravates or alleviates the condition and to what degree they interfere with their lifestyle Observe patients ability to ambulate and to move all joints functionally Assess ability to perform ADL’s Assess need for assistive or adaptive devices
Intervention	Reinforce the need for adequate time to perform activities Reinforce proper use of ambulation devices as taught by a physical therapist Encourage patient o wear footwear when ambulating Reinforce exercise taught by the physical therapist Instruct patient to avoid excessive exercise during an inflammatory exacerbation

Nursing Diagnosis #5

Diagnosis	Chronic Pain
Related factors	Chronic physical or psychosocial disability
Defining Characteristics (signs/symptoms)	Pain over long periods of time Weight changes Irritability Fatigue Depression Reduced interaction with people Altered ability to continue previous activities
Expected Outcome	Patient reports pain less than 4 on a 0-10 scale Patient uses pharmacologic and non-pharmacologic pain interventions Patient engages in desired activities without an increase in pain level
Assessment	Assess pain characteristics Assess for signs/symptoms associated with pain Assess patients perception of the effectiveness of methods used for pain relief in the past Assess patients expectations about pain relief
Intervention	Encourage patient to keep a pain diary Acknowledge and convey acceptance of the patient pain experience Provide patient and family with information about chronic pain and options available for pain management Assist in making decisions about selecting a particular management strategy Refer to physical therapy

Gulanick, M. & Myers, J. L. (2011). Nursing Care Plans, 7^th Edition. Elsevier Mosby, St. Louis, MO.