Rheumatoid Arthritis Patient Education Activity A 48-year old female presents stiffness in both hands in the morning for last 7 months. Stiffness now lasted more than 1 hour every morning and includes hands, wrists and ankles. She also had increasing difficulty standing for long periods at work or at home due to foot and ankle pain. She began taking ibuprofen 800mg 3 times daily and found it helped her get through her day with less pain and stiffness. Three months ago, Joy noticed pain in her right and left shoulders when she would cut or blow dry her client’s hair. She also began feeling extremely tired and short tempered. She had no energy to do her usual activities. Ibuprofen was no longer very effective for her pain or stiffness. One morning, Joy could not lift her arms at all without extreme shoulder pain. She knew it was time to get help. Pt is married with 3 teenagers, and works part time as a hairdresser. Dx: Rheumatoid Arthritis (RA) Rx: methotrexate, Physical Therapy You are providing the patient with education on her new diagnosis. Create a patient teaching plan that covers the following questions. 1. What is rheumatoid arthritis? It is an autoimmune disease where the immune system mistakenly targets and attacks the join lining causing uncontrolled inflammation of the synovium. Joints of both sites of the body are affected; primarily the hands, wrists, and knees. It is characterized by bone erosion and joint deformity. 2. What are the important teaching points for her medication? - Encourage activity as tolerated - Tell her to have healthy diet and avoid alcohol - Instruct patients to quit smoking - Instruct the patient to increase his fluid intake - Instruct patient pain medication such as NSAIDS, CORTICOSTEROID - Instruct the client to observe for changes in vision, blood glucose, and impaired healing when taking corticosteroid. - Place cold pack for 20 min every 2 hours to help with swelling - Stay away from large crowds - You should not get pregnant when taking methotrexate because of an increase risk of birth defects. 3. What are the recommendations to manage her joint pain during remission? During exacerbation? To manage her joint pain during remission, I would recommend her to talk to her physical therapist about the best activity she can do. I would recommend her to use warm shower to help with morning stiffness. Furthermore, when she is experiencing swelling, she should use cold pack for 20 min every 2 hours. She can also use some muscle relaxation technique. During exacerbation, I would recommend her to rest her joints or splinting her joints when she is working. She should not strained her joins when her symptoms get worse.
