Nursing Assessment, Management and Treatment of Autoimmune Diseases
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● Lung disease : People who have RA have an increased risk of inflammation and scarring of lung tissue. This can compromise respiratory status. ● Lymphoma : RA increases the risk of lymphoma. Assessment and diagnosis Assessment The primary characteristic of RA is per- sistent polyarthritis (synovitis) that affects any joint lined by a synovial membrane. In many patients, RA has an insidious on- set (Smith, 2020a). Initially, patients may complain of non-specific symptoms that are seen in multiple disorders. These symptoms include fatigue, malaise, an- orexia, low-grade fever, and weight loss. As the inflammatory process progresses, more specific symptoms develop (Rebar et al., 2019). | NURSING CONSIDERATION About 10% of patients with RA ex- perience an abrupt onset with acute development of synovitis as well as extra-articular manifestations (Smith, 2021a). During physical assessment patients are assessed for the following more specific signs and symptoms (Smith, 2020a): ● Stiffness. ● Tenderness. ● Pain with motion. ● Warmth of affected joints. ● Swelling. ● Deformity. ● Limitations of range-of-motion. ● Extra-articular manifestations. ● Rheumatoid nodules. ● Muscle atrophy. As joints and tendons are destroyed, deformities such as ulnar deviation, bou-
EVIDENCE-BASED PRACTICE Research shows that women who have breastfed their infants have a de- creased risk of developing RA (CDC, 2020a). Complications RA increases the risk of developing sev- eral complications. These include the fol- lowing (Mayo Clinic, 2021b): ● Osteoporosis : RA and medications used to treat RA can increase the risk of osteoporosis. ● Rheumatoid nodules : These firm tissue nodules are usually found around pressure points. However, these nodules can form anywhere in the body, even in the heart and lungs. ● Dry eyes and mouth : RA increases the risk of developing Sjogren’s syndrome, which is a disorder that decreases the amount of moisture in the eyes and mouth. ● Infections : RA and medications used in its treatment can impair the immune system, which leads to increased risk of infections. Patients are urged to get recommended vaccines such as influenza, pneumonia, shingles, and COVID-19. ● Body composition : The ratio of fat to lean body mass is often higher in people with RA. This is true even for persons who have a normal body mass index (BMI). ● Carpal tunnel syndrome : If RA affects the patient’s wrists, the resulting inflammation can compress the nerves that serve the hands and fingers. ● Cardiac issues : RA increases the risk of atherosclerosis and arteriosclerosis. RA can also cause inflammation of the pericardium.
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