case study_rheumatoid arthritis

8/4/2019 Case Study_rheumatoid Arthritis

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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

illness. RA can affect body parts besides joints, such as your eyes, mouth and lungs. No one

knows what causes rheumatoid arthritis. Genes, environment and hormones might contribute.

Treatments include medicine, lifestyle changes and surgery. These can 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. In some cases, people with

the disease become severely disabled. In addition, life expectancy may be shortened by aboutthree 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 results in inflammation that can eventually destroy

joints and damage blood vessels and organs.

It may also be the cause of genetic, environmental, hormonal, immunologic, and infectious factors

may play significant roles. Socioeconomic, psychologic, and lifestyle factors (eg, tobacco use;

main environmental risk) may influence disease 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 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 of joints all together form the

musculoskeletal system. The skeleton provides strength, stability, and a frame for muscles to work

against in producing movement. Bones also serve as shields to protect delicate internal organs.

Bones have two main shapes: flat bones, such as the plates of the skull and the vertebrae, and longbones, 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, and a substance called hydroxyapatite.

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. Blood vessels run through a bone, and nerves surround it.



Bones come together to form joints. 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 motion of the

arm.

Hinge joints in the elbows, fingers, and toes allow only 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, 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 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: Mrs. A.D. N.

Address: Pag asa Quezon CityAge: 64 years oldBirthday: October 6, 1947Birthplace: Quezon CityCivil Status: MarriedNationality: FilipinoReligion: CatholicEducational Attainment: College GraduateOccupational: None

http://www.shockfamily.net/skeleton/RIBS.MOV

http://www.shockfamily.net/skeleton/RIBS.MOV



History of patient

Family History

Mother Father

HPN + -

DM - -

Asthma - +

Past History:

HPN +

Present History

Rheumatoid Arthritis

Physical assessment

Normal Findings Actual Findings AnalysisMeasurement

a. Height

b. Weight

c. BMI

d. Vital signs

Temperature

Pulse rate Respiratory rate

Blood pressure

5’6

154lbs

Large Built

37.5°c100 bpm20 cpm120/80 mmhg

Normal

Hair Black, evenlydistributed, coversthe whole scalp,thick, shinny andfree from split ends.

Short Hair, shinnyand black, evenlydistributed, coversthe whole scalp.

Normal

Face Oval, symmetricalfacial features andmovements, facialexpression dependson mood, smooth,

free from wrinkles,no involuntarymovements.

Oval, symmetricalfacial features andmovements, facialexpression dependson mood, smooth,

free from wrinkles,no involuntarymovements.

Abnormal

Eyes Symmetricallyaligned, raises andlowers pupil. Eyebrows welldistributed, parallelwith each other.

Symmetricallyaligned, raises andlowers pupil. Eyebrows welldistributed, parallelwith each other.

Normal



Ears Pinkish, clean withscant amount ofcerumen, has cilia.Pinna recoils whenfolded.

No lesions. Firmcartilage, nottender, pinna recoilsafter it is folded.

Normal

Nose Nasal system intact

in midline,symmetrical, nodischarges, patent,no flaring.

Nasal system intact

in midline,symmetrical, withno discharges,patent, presence offlaring.

Normal

Mouth

Lips

Ability to purse lips.Pinkish, smooth,moist, well-defined,symmetrical.

Able to purse lips,well-defined,symmetrical, pale,dry lips.

Normal

Teeth Well-aligned, freefrom caries or filling,no halitosis. 32 innumber.

Partially black incolor, presence ofcavities.

Normal

Tongue Central position,pink in color (somebrown pigmentationon tongue bordersin dark-skinnedclients); moist;slightly rough, thinwhitish coating.Moves freely; notenderness.

Central position,pink in color (somebrown pigmentationon tongue bordersin dark-skinnedclients); moist;slightly rough, thinwhitish coating.Moves freely; notenderness.

Normal

Cheeks Pinkish, Smooth Pale Normal

case study_rheumatoid arthritis

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