Case Study_rheumatoid Arthritis

 

I.  Objective General Objective: To be able to understand how to manage and prevent the autoimmune diseases. Specific Objective: To be able to know how rheumatoid arthritis affects one body system.

II.  Introduction A.  Definition Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints. Rheumatoid arthritis can also cause inflammation of the tissue around the joints, as well as in other organs in the body. Autoimmune diseases are illnesses that occur when the body's tissues are mistakenly attacked by their own immune system. The immune system contains a complex organization of cells and antibodies designed normally to "seek and destroy" invaders of the body, particularly infections. Patients with autoimmune diseases have antibodies in their blood that target their own body tissues, where they can be associated with inflammation. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic s ystemic illness. RA can affect body parts besides besi des joints, such as your eyes, mouth and lungs. No one knows what causes rheumatoid arthritis. Genes, environment and hormones horm ones might contribute. Treatments include medicine, lifestyle changes and surgery. These can ca n slow or stop joint damage and reduce pain and swelling. It can affect any joint but is common in the wrist and fingers.

B.  Incidence More women than men get rheumatoid arthritis. It often starts between ages 25 and 55. You might have the disease for only a short time, or symptoms might come and go. The severe form can last a lifetime. The onset of rheumatoid arthritis, also known as RA, can occur at any age and affects women more than men. In general, the younger a person is when he or she develops rheumatoid arthritis, the more rapidly the disease progresses. The severity of rheumatoid arthritis varies greatly among individuals. i ndividuals. In some cases, people with the disease become severely disabled. In addition, life expectancy may be shortened by b y about three to seven years, and those with the most severe forms of RA may die 10 to 15 years earlier than expected. C.  Etiology The exact cause of rheumatoid arthritis is not known, but it is classified as an autoimmune disease. In an autoimmune disease, the body’s immune system mistakes healthy tissues as

 

dangerous to the body and attacks them. This d estroy T his results in inflammation that can eventually destroy  joints and damage blood vessels and organs. organs. It may also be the cause of genetic, environmental, hormonal, immunologic, and in infectious fectious factors may play significant roles. Socioeconomic, psychologic, and lifestyle factors (eg, tobacco use; main environmental risk) may influence disease outcome.  outcome.  

III. 

Anatomy and Physiology

Joint involvement is the characteristic feature of rheumatoid arthritis (RA). In general, the small joints of the hands and feet are affected in a relatively symmetric distribution. The most m ost commonly affected joints, in order of decreasing frequency, include the metacarpophalangeal (MCP), wrist, proximal interphalangeal (PIP), knee, metatarsophalangeal (MTP), shoulder, ankle, cervical spine, hip, elbow, and temporomandibular joints. Bone is a constantly changing bodily tissue that has several functions. All the bones together make up the skeleton. The skeleton, muscles, tendons, ligaments, and other components com ponents of joints all together form the musculoskeletal system. The skeleton provides strength, stability, and a frame for muscles to work against in producing movement. movem ent. Bones also serve as shields to protect delicate internal organs. Bones have two main shapes: shap es: flat bones, such as the plates of the skull and the vertebrae, and long bones, such as thighbone and arm bones. But their internal structure is essentially the same. The hard outer part consists largely of proteins, such as collagen, col lagen, and a substance called h hydroxyapatite. ydroxyapatite. Hydroxyapatite is composed mainly of calcium and other minerals; in fact it stores much of the body's calcium and is largely responsible for the strength of bones. The marrow in the center of each bone is softer and less dense than the rest of the bone and contains specialized cells that produce blood cells. ce lls. Blood vessels run through a bone, and nerves surround it.

 

Bones come together to form joints. j oints. The configuration of a joint determines the degree and direction of possible motion. Some joints, such as those between the plates of the skull, called sutures, don't move in adults. Others allow a range of motion. For example, the shoulder joint, which has a ball-and-socket design, allows inward and outward rotation as well as forward, backward, and sideways sidewa ys motion of the arm. Hinge joints in the elbows, fingers, and toes allow onl only y bending (flexion) and straightening (extension). Other components of joints provide stability and reduce the risk of damage from constant use. In a joint, the ends of bones are covered with cartilage - a smooth, sm ooth, tough, protective tissue that acts as a shock absorber and reduces friction. Joints also have a lining (called synovial tissue) enclosing them to form the joint capsule. Cells in the synovial tissue produce a clear fluid (synovial fluid) that fills the capsule, which further reduces friction and aids movement. Tendons are tough bands of connective tissue, attaching each end of a muscle to a bone. Ligaments, which are similar tissues, surround joints and connect one bone to another. They The y help strengthen and stabilize joints, permitting movement only in certain directions. The Joints Fibrous Fibrous joints connect bones without allowing any movement. The bones of your skull and pelvis are held together by fibrous joints. The union of the spinous processes and vertebrae are fibrous joints. Cartilaginous Cartilaginous joints are joints in which the bones are attached by cartilage. These joints allow for only a little movement, such as in the spine or ribs. Synovial Synovial joints allow for much more movement than cartilaginous joints. Cavities between bones in synovial joints are filled with synovial fluid. This fluid helps lubricate and protect the bones. Bursa sacks contain* the synovial fluid.

IV.  Patients Profile Biographic Data Patient’s Initial: Address: Age: Birthday: Birthplace: Civil Status: Nationality: Religion: Educational Attainment: Occupational:

Mrs. A.D. N. Pag asa Quezon City 64 years old October 6, 1947 Quezon City Married Filipino Catholic College Graduate None

 

History of patient Family History Mother

Father

HPN

+

-

DM

-

-

Asthma

-

+

Past History: HPN

+

Present History Rheumatoid Arthritis Physical assessment Normal Findings

Actual Findings

Analysis

Measurement a.

Height

5’6 

b.

Weight

154lbs

c.

BMI

Large Built

d.

Vital signs Temperature Pulse rate Respiratory rate Blood pressure

37.5°c 100 bpm 20 cpm 120/80 mmhg

   

Hair

Face

Eyes

Black, evenly distributed, covers

Short Hair, shinny and black, evenly

the whole scalp, thick, shinny and free from split ends. Oval, symmetrical facial features and movements, facial expression depends on mood, smooth, free from wrinkles, no involuntary movements. Symmetrically aligned, raises and lowers pupil. Eye brows well

distributed, covers the whole scalp.

distributed, parallel with each other.

distributed, parallel with each other.

Oval, symmetrical facial features and movements, facial expression depends on mood, smooth, free from wrinkles, no involuntary movements. Symmetrically aligned, raises and lowers pupil. Eye brows well

Normal

Normal

Abnormal

Normal

 

Ears

Nose

Mouth Lips Teeth

Tongue

Cheeks

Pinkish, clean with scant amount of cerumen, has cilia. Pinna recoils when folded. Nasal system intact in midline, symmetrical, no

No lesions. Firm cartilage, not tender, pinna recoils after it is folded.

Normal

Nasal system intact in midline, symmetrical, with

Normal

discharges, no flaring. patent,

no discharges, patent, presence of flaring. Able to purse lips, well-defined, symmetrical, pale, dry lips. Partially black in color, presence of cavities.

Ability to purse lips. Pinkish, smooth, moist, well-defined, symmetrical. Well-aligned, free from caries or filling, no halitosis. 32 in number. Central position, pink in color (some brown pigmentation on tongue borders in dark-skinned clients); moist; slightly rough, thin whitish coating. Moves freely; no tenderness. Pinkish, Smooth

Central position, pink in color (some brown pigmentation on tongue borders in dark-skinned clients); moist; slightly rough, thin whitish coating. Moves freely; no tenderness. Pale

Normal

Normal

Normal

Normal