Case Study
Rheumatoid Arthritis
Patient Profile Grace Kim, a 42-year-old married woman, is seen at the rheumatology clinic because she is experiencing swelling and stiffness in the small joints of her hands.
Subjective Data
• Is a concert pianist
• Experiencing joint pain and stiffness in both hands for the past 6 weeks
• Experiencing fatigue, anorexia, and morning stiffness
• Gave birth to her first child 2 months ago
Objective Data
Physical Examination
• Swelling and tenderness of third and fourth MCP joints of both hands
• Mild pain with neck motion
Diagnostic Studies
• Elevated ESR, positive RF and ACPA
• Evidence of moderate bone demineralization on bilateral hand radiographs
Collaborative Care
• Diagnosis: RA
• Therapy: started on methotrexate, 7.5 mg PO once per week; etanercept (Enbrel), 50 mg subcutaneously once per week; and prednisone, 10 mg daily
Discussion Questions
1. How might the nurse explain the pathophysiology of RA to Ms. Kim?
2. How might the recent childbirth have influenced the symptoms that she is currently experiencing?
3. What are some home and work modifications that the nurse can suggest to Ms. Kim that will reduce her symptoms?
4. What suggestions can the nurse make to Ms. Kim about coping with fatigue?
5. Priority decision: On the basis of the assessment data presented, what are the priority nursing diagnoses? Are there any collaborative problems?
6. Evidence-informed practice: Why is an exercise program important in the treatment plan for Ms. Kim?