Nursing Process
The Patient with a Rheumatic Disease
Assessment
The depth and focus of the nursing assessment depend on several factors: the health
care setting (clinic or office, home, extended care facility, or hospital), the role of the
nurse (home care nurse; nurse practitioner; hospital, clinic, or office nurse), and the
needs of the patient. The nurse is often the first health care team member to come in
contact with the patient. This enables the nurse to assess the patient's perceptions of the
disorder and situation, actions taken to relieve symptoms, plans for treatment, and
expectations. The nurse's assessment may lead to identifying issues and concerns that
can be addressed by nursing interventions and, through collaboration with other team
members, to achieving the expected patient outcomes.
The health history and physical assessment focus on current and past symptoms, such
as fatigue, weakness, pain, stiffness, fever, or anorexia, and the effects of these
symptoms on the patient's lifestyle and self-image. Because the rheumatic diseases
affect many body systems, the history and physical assessment include a review and
examination of all systems, with particular attention given to those areas most
commonly affected, including the musculoskeletal system (see Chart 54-1).
The patient's psychological and mental status and social support systems are also
assessed, as well as his or her ability to participate in daily activities, comply with the
treatment regimen, and manage self-care. The information obtained can give insight
into the patient's understanding of the medication regimen and may reveal misuse of
medications, failure to follow the treatment regimen, or use of potentially harmful
unproven remedies. Additional areas assessed include the patient's understanding,
motivation, knowledge, coping abilities, past experiences, preconceptions, and fears.
The effects of the disease on the patient's self-concept and coping abilities are also
assessed. The patient's perception of the condition and its impact influences the
decisions, choices, and actions associated with treatment recommendations.
In addition, the patient's response to having a chronic disorder or a disability is
assessed. Patients' and families' responses to illness are discussed in detail in Chapter 7,
and chronic illness and disability are addressed in detail in Chapter 10.
Diagnosis
Nursing Diagnoses
Although many nursing diagnoses are appropriate for the patient with a rheumatic
disease, the following are a few of the most common ones:
Acute and chronic pain related to inflammation and increased disease activity,
tissue damage, fatigue, or lowered tolerance level
Fatigue related to increased disease activity, pain, inadequate sleep/rest,
deconditioning, inadequate nutrition, and emotional stress/depression
Disturbed sleep pattern related to pain, depression, and medications
Impaired physical mobility related to decreased range of motion, muscle
weakness, pain on movement, limited endurance, lack of or improper use of
ambulatory devices
Self-care deficits related to contractures, fatigue, or loss of motion
Disturbed body image related to physical and psychological changes and
dependency imposed by chronic illness
Ineffective coping related to actual or perceived lifestyle or role changes