Case
Ms. Thompson is a 52-year-old woman diagnosed with rheumatoid arthritis for five years now. She has been on treatment with Ibuprofen for pain relief and methotrexate for symptom relief of Rheumatoid arthritis (RA). Ms. Thompson presented with morning stiffness for over an hour and swelling associated with tenderness, particularly in the wrist and knee joints. She had a normal blood pressure reading of 130/80.
Previous goals and solutions
The previous goal of care was to reduce morning stiffness and improve joint function in Ms. Thompson within three months of nursing care. This goal can be achieved by implementing a personalized exercise plan, administering analgesics, and treatment with disease-modifying anti-rheumatic drugs.
New Smart goal
Within the next three months, the nurse aims to reduce Ms. Sarah Thompson’s dependence on pain medication and enhance self-management skills through the use of lifestyle modifications and an exercise plan. This can be measured by documenting Ms. Sarah Thompson’s frequency of ibuprofen use for pain relief in the next three months.
Long-term use of Ibuprofen and other non-steroidal anti-inflammatory drugs has been associated with gastrointestinal and cardiovascular side effects (Tjenggal et al., 2021). Important side effects include ulcers and increased risk of gastrointestinal bleeding, increased risk of hypertension and myocardial infarction, and reduced platelet function leading to bleeding disorders (Watheq et al., 2020). It is important to reduce dependence on Ibuprofen, a non-steroidal anti-inflammatory drug (NSAID), to avoid long-term use and the potential for the above-named side effects.
Interventions
The following nursing interventions can be implemented to reduce dependence on Ibuprofen and enhance self-management for Ms. Thompson. The nurse should start with comprehensive health education for Ms. Thompson. Ms. Thompson needs to understand rheumatoid arthritis as the cause of her symptoms and the reason she needs analgesics. The next step would be for the nurse to educate Ms Thompson on factors that may exacerbate her symptoms. She needs to be informed that overexertion and lack of physical activity can both exacerbate her pain, hence the need to maintain a delicate balance in exercising. Other factors that may increase pain in rheumatoid arthritis are trauma, emotional stress, cold weather, and infections, as reported by (Biddle et al., 2020). Knowing the contraindications is the first step towards self-management of rheumatoid arthritis (Shao et al., 2020). The nurse needs to educate Ms Thompson on why continuous use of Ibuprofen for pain relief is unhealthy and not sustainable. Knowing the side effects may improve Ms. Sarah Thompson’s compliance with the care plan.
The nurse should then introduce alternative pain management strategies for Ms Thompson gradually during treatment. (Sánchez-Flórez et al., 2021) Notes that heat and cold therapy, use of protective joint equipment. Gentle exercise, occupational therapy, and weight management are effective alternatives to analgesics in managing pain associated with rheumatoid arthritis. The nurse also has a role in discussing more invasive options like acupuncture.
The nurse should provide health promotion education to Ms. Thompson’s family on the intricate aspects of rheumatoid arthritis. They need to understand the chronic nature of the disease, hence the need for Ms. Thompson to have good family support going forward. Having a family that understands her care plan may improve compliance for Ms. Sarah Thompson (Direskeneli, et al., 2022). Higher treatment compliance rates are associated with higher quality of life for patients with rheumatoid arthritis (Direskeneli et al., 2022).
According to (Kirkpatrick et al., 2018), dealing with the diagnosis of a chronic illness can be challenging, especially in extremes of age. As such, the nurse must encourage Ms. Thompson to build a support system using her family and healthcare team. Encouraging Ms. Thompson to communicate openly with her family and her healthcare team could improve the holistic nature of care and provide important outlets for raising new concerns. Moreover, the nurse must encourage Ms. Thompson to seek the services of a psychiatrist or a mental health nurse of her choice. The presence of a chronic disease has been listed as a risk factor for the development of depressive disorders and suicide attempts (Ernst et al., 2020). By allowing Ms. Thompson to choose a mental health professional she is comfortable with, her right to autonomy is being respected (Lbugami et al., 2020).
In line with the use of a multidisciplinary approach in the provision of nursing care, the nurse should collaborate with the doctor and Ms. Thompson to draw updates for review by the doctor. The nurse should educate Ms. Thompson on the benefits she can gain from attending these clinics. During clinics, the nurse will monitor Ms. Sarah Thompson’s weight to ensure it does not exceed the recommended by her doctor to reduce strain on her joints. Compared to individuals with healthy weight, people who are obese have a 24% increased risk of developing rheumatoid arthritis (Ye et al., 2021). This suggests that weight-bearing plays a significant role in rheumatoid arthritis. Liaising with the dietitian to recommend the best nutrition practices for Ms. Thompson may be relevant. (Vadell, et al., 2020) Notes that diet has an important role in recovery for patients with rheumatoid arthritis.
Evaluation
Ms Thompson received comprehensive health education on rheumatoid arthritis, its causes, and the need for analgesic use. Understanding her condition is crucial to self-management (Shao et al., 2020). The nurse also educated Ms. Thompson on factors that could worsen her symptoms, especially pain, and this provided a basis for self-awareness for Ms. Thompson. Moreover, Ms. Thompson was informed of the risks associated with long-term ibuprofen use, and this was manifested by very good compliance with her alternative plan of care. Ms Thompson’s family received health promotion education regarding her condition and needs. As per subjective reports by Ms. Thompson, her family has been very supportive throughout her treatment. The nurse collaborated successfully with Ms Thompson’s doctor to set clinic dates. As evidenced by records of her clinic attendance, Ms. Thompson attended all her scheduled clinics on time.
Despite the need for dietary modifications, Sarah Thompson reports she has yet to change her diet as recommended. Moreover, Ms. Thompson has yet to consult a mental health professional and states she has all the support she needs from her family and her healthcare team.
Overall, nursing interventions for Ms. Thompson have been well implemented. However, a mental health professional needs dietary modifications and support to ensure holistic care and improve the overall effectiveness of nursing interventions.
References
Biddle, K., & Sofat, N. (2020). Understanding the Mechanisms of Pain in Rheumatoid Arthritis. Rheumatoid Arthritis – Other Perspectives towards a Better Practice. https://doi.org/10.5772/intechopen.93829.
Direskeneli, H., Karadag, O., Ateş, A., Tufan, A., Inanç, N., Koca, S., Cetin, G., Akar, S., Çınar, M., Yılmaz, S., Yılmaz, N., Dalkılıç, E., Beş, C., Yılmazer, B., Şahin, A., Ersözlü, D., Tezcan, M., Şen, N., Keser, G., Kalyoncu, U., Armağan, B., Hacıbedel, B., Helvacioglu, K., Cesur, T., Basibuyuk, C., Alkan, S., & Gunay, L. (2022). Quality of life, disease activity and preferences for administration routes in rheumatoid arthritis: a multicentre, prospective, observational study. Rheumatology Advances in Practice, 6. https://doi.org/10.1093/rap/rkac071.
Ernst, M., Kallenbach-Kaminski, L., Kaufhold, J., Negele, A., Bahrke, U., Hautzinger, M., Beutel, M., & Leuzinger‐Bohleber, M. (2020). Suicide attempts in chronically depressed individuals: What are the risk factors?. Psychiatry Research, 287. https://doi.org/10.1016/j.psychres.2019.112481.
Kirkpatrick, S., Locock, L., Farre, A., Ryan, S., Salisbury, H., & McDonagh, J. (2018). Untimely illness: When diagnosis does not match age‐related expectations. Health Expectations : An International Journal of Public Participation in Health Care and Health Policy, 21, 730 – 740. https://doi.org/10.1111/hex.12669.
Lbugami, M., & Alem, U. (2021). Patient autonomy. International Journal of Medicine. https://doi.org/10.14419/ijm.v9i1.31526.
Sánchez-Flórez, J., Seija-Butnaru, D., Valero, E., Acosta, C., & Amaya, S. (2021). Pain Management Strategies in Rheumatoid Arthritis: A Narrative Review. Journal of Pain & Palliative Care Pharmacotherapy, 35, 291 – 299. https://doi.org/10.1080/15360288.2021.1973647.
Shao, J., Yu, K., & Chen, S. (2020). Effectiveness of a self-management program for joint protection and physical activity in patients with rheumatoid arthritis: A randomized controlled trial.. International journal of nursing studies, 103752 . https://doi.org/10.1016/j.ijnurstu.2020.103752.
Tjenggal, K., Sinuraya, R., Rahayu, C., & Abdulah, R. (2021). NSAID-Induced Adverse Drug Reaction: Mechanism and Management. Indian Journal of Forensic Medicine & Toxicology. https://doi.org/10.37506/ijfmt.v15i2.14308.
Vadell, A., Bärebring, L., Hulander, E., Gjertsson, I., Lindqvist, H., & Winkvist, A. (2020). Anti-inflammatory Diet In Rheumatoid Arthritis (ADIRA)—a randomized, controlled crossover trial indicating effects on disease activity. The American Journal of Clinical Nutrition, 111, 1203 – 1213. https://doi.org/10.1093/ajcn/nqaa019.
Watheq, B., Mohammed, A., Al-Mashhadani, M., & Yousif, E. (2020). Improve the Role of Ibuprofen in the Biological Field: Short Review. International Journal of Advanced Research in Chemical Science. https://doi.org/10.20431/2349-0403.0706001.
Ye, D., Mao, Y., Xu, Y., Xu, X., Xie, Z., & Wen, C. (2021). Lifestyle factors associated with incidence of rheumatoid arthritis in US adults: analysis of National Health and Nutrition Examination Survey database and meta-analysis. BMJ Open, 11. https://doi.org/10.1136/bmjopen-2020-038137.
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