Question

Case study:

Miranda Miles is a 35-year-old white female. She has a 10-year history of cigarette smoking and refuses to quit after several educational teachings from health care providers and family members. There is no history of alcohol consumption. She has been married for five years and lives with her husband and son. Miranda works at a factory and her husband is a truck driver. She was admitted on August 7th, 2020 at 1700 with complaints of joint and back pain, difficulty performing ADL’s especially in the mornings, difficulty falling asleep due to chest pain, and a fever. Upon admission, the patient’s vitals were taken and blood was drawn. Diagnostic and laboratory testing resulted in a medical diagnosis of rheumatoid arthritis exacerbation.

Lab/Diagnostic Testing

Upon admission, the patient's joints were inspected and palpated to find any swelling. Findings in this patient’s case, spongy swelling has been found in knees and ankles and deformities in both hands and feet. Also, a complete blood count (CBC) was taken and white blood cells were found to be mildly elevated in response to inflammation. A synovial fluid culture will be taken as well. The synovial fluid was cloudy with elevated white blood cells. A rheumatoid factor test was also taken and results were positive. An MRI on her knee was ordered and findings include erosion of bone and destruction of cartilage which results in the patient's problem with limited range of motion and pain in knee.

Medication:

Medications
Drug	Drug Classification	Patient Use
Methotrexate	Disease Modifying Antirheumatic Drug	decrease risk of joint deformity and
Aspirin 200 mg PO	Anti-inflammatory	Reduce Pain and Inflammation
Minocylcine	Tetracycline	Treat bacterial infection
Prednisone	Corticosteroid	reduce severe pain and inflammation

QUESTION: Come up with a......

-psychosocial Nursing diagnosis,

-Short term goal,

-Long term goal

-5 nursing interventions,

-5 Evaluated statement

-Patient education teaching

please add references.

Answer 1

1) Psychosocial Nursing Diagnosis :

• Disturbed body image related to physical psychological impairments & dependency imposed by disease condition as evidenced by feeling of hopelessness & sense of isolation.
• Self care deficit related to musculoskeletal impairment & pain on movement as evidenced by difficulty in ADLs.

2) Short Term Goals include :

• Reduce joint & back pain.
• Improve performing abilities of ADLs.
• Reduce chest pain.
• Reduce body temperature to normal range.
• Eliminate infection in body.

3) Long Term Goals include:

• Slowing the disease process.
• Stopping the erosion of bone & destruction of cartilage.
• Improve Range of Motion.

4) Nursing Interventions :

• Provide comfort measures ( eg, hot & cold applications, changes in position, rest, foam mattress, splints, extra supportive pillows, diversional activities).
• Encourage expression of feelings about pain & chronicity of disease.

Evaluation : By implementing this intervention the pain in joint and back will be relieved.

• Encourage independence in mobility & assist if needed, provide rest before & after activities.

Evaluation : This intervention will help in increasing the mobility of patient.

• Identify the factors that impedes in the performance of self care activities & develop plan for how to establish & achieve goals to meet self care needs.

Evaluation : By implementing, this intervention will facilitate the self care activities.

• Identify the areas of life that are affected by disease condition, answer queries of patent & dispel myths.

Evaluation : This will help in improving the body image.

5) Health Education :

• Educate regarding the basic disease management & necessary adaptations in life style.
• Make sure that patient has no pain, fatigue, or depression before starting teaching programme.
• Educate patient regarding signs & symptoms of disease, complications of disease & explaine the need & use of medication & procedures carried out.
• Provide knowledge about prescribed therapeutic regimen, side effects of prescription.
• Provide counseling to the patient in case to cope up with depression related to disease condition.
• Inform patient regarding the lifestyles that may contribute to worsening of disease.