Rheumatoid Arthritis Patient Profile: H.M. is a

Rheumatoid Arthritis Patient Profile: H.M. is a 32-year-old female who presents for her annual physical examination and mentions to the health care provider that she has been having pain in her toes when she gets up during the night and first thing in the morning. Subjective Data: Wife and mother of a seven-month-old son Works part-time as a registered nurse Her mother recently passed away and she has been experiencing tension headaches States has been having difficulty walking, sometimes needing to crawl, due to pain in toes when she gets up during the night to go to the bathroom and the first couple of hours in the morning Has noticed pain in her fingers in the morning when she tries to open baby food jars Objective Data Physical Examination: Temperature 98.6° F, pulse 76, respirations 16, blood pressure 114/68 Swelling and tenderness to palpation of the proximal interphalangeal (PIP) jointof the bilateral second and third digits of hands, metacarpophalangeal (MCP) joint of bilateral thumbs, and the metatarsophalangeal (MTP) joint of bilateral great toes Diagnostic Studies: -Rheumatoid factor (RF) positive -X-rays of bilateral hands and feet reveal soft tissue swelling; without any evidence of bone or cartilage destruction or joint deformities -Bone density T-score of +1 Discussion Questions: 1. The health care provider diagnoses H.M. with Stage I rheumatoid arthritis. Explain the pathophysiology of rheumatoid arthritis and the classification criteria that H.M. demonstrates that determined this diagnosis. 2. How could H.M.’s recent childbirth and death of her mother be related to her rheumatoid arthritis? 3. Describe some of the extraarticular manifestations of rheumatoid arthritis H.M. may develop. a) What are some priority nursing diagnoses for H.M. at this time? b) What are the overall goals of H.M.’s care? 5. 4. a) What treatment and inter professional care are involved in managing a patient with rheumatoid arthritis? b) M. is started on methotrexate. What instructions should you give H.M. regarding this medication?

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