Rheumatoid Arthritis

timer Asked: Jan 19th, 2021

Question Description

I'm working on a health & medical case study and need support to help me understand better.

Hello, my paper is on Rheumatoid Arthritis. There is a template attatched for it with everything that should be written. The exampler written there is on Lupus. Use in text citation and peer reviewed references please

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Systems Disorder Template #1 Systemic Lupus Erythematosus Heidi Milicic Topic Descriptor Description of disorder/disease process Assessment Diagnostic procedures Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that affects a number of body systems. It is characterized by the presence of large numbers of circulating autoantibodies against DNA, platelets, erythrocytes, leukocytes, various nucleic acids, and antinuclear antibodies (“ANAs”). Because of the presence of ANAs, immune complexes are deposited in connective tissues anywhere in the body, activating complement and causing inflammation and necrosis. Because various autoantibodies are present throughout the body, numerous organs and tissues may experience inflammation and the destruction of healthy tissues. Also, the presence of the various autoantibodies causes inflammation of blood vessels (vasculitis) in many organs or tissues, impairing blood supply to the tissues. The ischemia (inadequate oxygen to the cells), that results from the vasculitis leads to further inflammation and destruction of the tissues in which the vasculitis occurs. This process of inflammation and destruction of tissues typically occurs in the kidneys, lungs, heart, brain, skin, joints, and digestive tract. Matters to be assessed and/or monitored in the patient will largely depend on which organs or body systems are affected by SLE. For example, if the kidneys are affected, it will be critical to monitor urine to ensure the kidneys are properly processing the body’s waste. Blood count should also be monitored to detect the presence of anemia, thrombocytopenia, and abnormalities in the white blood cell count. There is no definitive test to diagnose SLE. Diagnosis is based on the presence of multiple system involvement (a minimum of four areas) and laboratory data showing the presence of autoantibodies. The presence of ANAs shown in an ANA test, as well as other antibodies in the serum is indicative of SLE. Lupus erythematosus (LE) cells, mature neutrophils containing nuclear material in the blood are a positive sign. Erythrocyte sedimentation rate (ESR or “sed” rate) is a test for inflammation. It measures the amount of protein that makes the red blood cells clump together. The sed rate is usually high for people with active SLE, but can also be high due to other reasons such as infection. Low levels of erythrocytes, leukocytes, and lymphocytes is also indicative of SLE, and therefore, a CBC should be ordered. Risk Factors Objective and subjective Laboratory tests Management of client care Client education Additional immunologic tests for various antibodies may be required to confirm diagnosis. Also, all organs and systems should be examined for inflammation and damage if SLE is suspected. SLE affects primarily women and manifests between the ages of 20 and 40. The incidence is higher in African Americans, Asians, Hispanics, and Native Americans. The specific cause of SLE has not been established, but it appears to be multifactorial and includes genetic, hormonal (estrogen levels) and environmental (ultraviolet light exposure) factors. No lupus gene has been identified, although genes that generally increase susceptibility to autoimmune disorders have been identified. Research projects are underway to determine possible genetic defects that may cause SLE. Of the risk factors discussed above, only exposure to sunlight is modifiable. The remaining risk factors are not. Because SLE affects so many organs and body systems, a wide range of objective and subjective manifestations can occur. Depending on the body system affected by the SLE, some or all of the following objective manifestations may be anticipated: inflamed or swollen joints, “butterfly” rash with erythema on cheeks and all over nose and body, ulcerations in the oral mucosa, proteinuria (if the kidneys are affected), inflammation of pleural membranes of the lungs, inflammation of any layer of the heart, vasospasms of fingers and toes and/fingers turning white or blue (caused by Raynaud’s phenomenon), fever, edema, and low counts of red blood cells, white blood cells, and platelets. Subjective manifestations may include pain in the joints and other parts of the body, reports of hair loss, chest pain upon deep breathing, headaches, fatigue, sensitivity to the sun, mood changes, and feeling of depression and/or stress. A CBC is likely to show low counts of red blood cells, white blood cells, and low platelet levels which is indicative of SLE. A urinalysis may show proteinuria, which is a sign of inflammation of the kidneys. Other laboratory tests should be ordered depending on the specific symptoms. The focus of client care is the prompt treatment of acute episodes, the avoidance of exacerbations, and helping the client to achieve the highest level of comfort and function attainable. The client will be provided with understandable information about SLE, the types of treatment that may be received, and what to expect. The client will also be educated on strategies to reduce inflammation and other symptoms of Collaborative care Nursing care Surgical interventions Client outcomes Care after discharge Interdisciplinary care SLE and to prevent exacerbations. Specifically, the client will be educated on the importance of avoiding sun exposure, excessive fatigue, and stress. Given that the management of SLE requires a great deal of self-care, the patient should be encouraged to involve members of his or her family as partners in care. Communication techniques should convey a desire to elicit the patient and designated family members’ preferences, values, and needs and a willingness to act in accordance therewith. The communication should be sensitive and respectful and also involve active listening. Nursing interventions will be focused on reducing inflammation caused by SLE, with the priority on controlling inflammation in vital organs such as the lungs, heart, kidneys; suppression of the overactive immune system; treating acute episodes as they arise; controlling symptoms such as joint pain and fatigue; and preventing and treating flare-ups. N/A The goal for this patient will be to manage symptoms such as pain, fatigue, and depression and to avoid exacerbations so that he or she can achieve the best possible quality of life with the highest level of comfort and function attainable. The patient will need to continue to take medicines that have likely been prescribed for inflammation, suppression of the immune response, and the management of other symptoms. The patient also will likely need short-term as well as ongoing treatment by various healthcare specialists. The treatment needed will depend on which of the patient’s body systems have been affected by the SLE. For example, the patient may need to see a rheumatologist for joint and muscle issues, a dermatologist for skin and hair issues, and a nephrologist for kidney issues. Since SLE symptoms vary from one person to another, the best treatment approach requires a health care team that will tailor treatment to the patient’s specific condition. A wide variety of specialties may be involved in the care of this patient depending on which of the patient’s body systems have been affected by the SLE, including rheumatology (for joint and muscle issues), dermatology (for skin and hair issues), cardiology (for heart disease), nephrology (for kidney disease), and neurology (for brain and nervous system disease). Depending on the symptoms, allied health care professionals such as OT or PT may be appropriate. If the patient is experiencing psychological or spiritual distress, the involvement of mental health professionals and/or clergy is advisable. Medication Potential complications The choice of medications must be tailored to address the specific conditions that the patient is experiencing since SLE symptoms vary greatly from one patient to another. A patient with SLE usually needs medication to control inflammation and to suppress the immune response. He or she will also likely need medication to control pain, as well as other medications to control the effects on various organs and body systems caused by the SLE. If the SLE is not successfully managed, the patient could experience diseases of the major organs, such as progressive renal damage, pleurisy, and pericarditis. He or she may also become anemic. ...
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