1.
CHAPTER I THE PROBLEM AND ITS SETTING Ever Every y
pers person on
gets gets
old old
and and
when when
this this
happ happen ens, s,
many many
problems problems in the body occur. Getting Getting old is often associated associated with with
havi having ng prob problem lems s
with with the the
join joint t
like like
rheu rheuma mati tism sm and
other forms of the said disease that continually hunts not just aged people but even ordinary people with unfortunate fate of having the rheumatic problems. Rheumatoid
arthritis (RA)
chronic, systemic inflamm inflammato atory ry
is
disorde disorder r that
a
may
affect
many many tissue tissues s and organs organs, , but princip principall ally y attack attacks s synovial joints. joints. the the
The The proce process ss prod produc uces es an infl inflamm ammat ator ory y resp respons onse e of
syno synovi vium um
(syn (synov ovit itis is) )
seco second ndar ary y
to
hyperplasia of
synovial cells, excess synovial fluid, and the development of pannus in process
the the
often
syno synovi vium um. .
leads
to
The The the
path pathol olog ogy y
of
destruction
the the
of
dise diseas ase e
articular
cartilage cartilage and ankylosis of the joints. Rheumatoid arthritis can
also
produce
diffuse
the lungs, lungs, pericardium, pericardium , pleura, pleura, nodu nodula lar r
lesi lesion ons, s,
most most
comm common on
inflammation
and sclera, sclera, in
and
subcut subcutane aneous ous
Although the cause of rheumatoid arthritis is
in also tissue tissue. .
2. unknown, autoimmunity plays a pivotal pivotal role in
chronicity chronicity
and progression, and RA is considered a systemic autoimmune disease . Home ome
Cures
are
possible
for
alm almost
ever very
health
disorder existing in the world. The old age people used to have higher living rates and they lived a healthy life as comp compar ared ed
to
the the
mode modern rn
day day
huma human n
bein being. g.
The The
sole sole
logi logic c
behind the fact is that they were dependent on the herbal remedies and home cures and not on the chemically treated drugs. Herbal medicines can be grown in your backyard and usin using g them them is as simp simple le as grow growin ing g them them. . The The home home cures cures have least side effects and they do not obstruct obstruct the normal grow growth th
of
body body. .
The The
herb herbal al
medi medici cine nes s
cont contai ain n
all all
the the
essential ingredients to treat any disease and that's why they are becoming more and more popular. Apparently, rheumatism is something that can be taken care of from home. The best point concerning a home remedy is that that you you have have many many opti option ons s and, and, if you you thin think k that that a part partic icula ular r ingre ingredi dien ent t does does not not suit suit you, you, you you can can try try an alternative. You should give each remedy at least a week before trying another. This type of natural treatment
2. unknown, autoimmunity plays a pivotal pivotal role in
chronicity chronicity
and progression, and RA is considered a systemic autoimmune disease . Home ome
Cures
are
possible
for
alm almost
ever very
health
disorder existing in the world. The old age people used to have higher living rates and they lived a healthy life as comp compar ared ed
to
the the
mode modern rn
day day
huma human n
bein being. g.
The The
sole sole
logi logic c
behind the fact is that they were dependent on the herbal remedies and home cures and not on the chemically treated drugs. Herbal medicines can be grown in your backyard and usin using g them them is as simp simple le as grow growin ing g them them. . The The home home cures cures have least side effects and they do not obstruct obstruct the normal grow growth th
of
body body. .
The The
herb herbal al
medi medici cine nes s
cont contai ain n
all all
the the
essential ingredients to treat any disease and that's why they are becoming more and more popular. Apparently, rheumatism is something that can be taken care of from home. The best point concerning a home remedy is that that you you have have many many opti option ons s and, and, if you you thin think k that that a part partic icula ular r ingre ingredi dien ent t does does not not suit suit you, you, you you can can try try an alternative. You should give each remedy at least a week before trying another. This type of natural treatment
3. avoids avoids the conven conventio tional nal medici medicine ne that that is used used in various various treatments done today.
General Objectives This study aimed to determine the alternative and most effect effective ive home home managem management ent practic practices es for rheuma rheumatis tism. m. As a member of the health care provider aims to provide health teaching to manage this chronic illness effectively.
Specific Objectives At the end of ten days of intensive care affiliation the student nurse will be able to: Assess the client and the complication of the disease. Teac each
to
accept
the
findings
as
an
awareness
to
promote Healthy lifestyle and Safety living condition. Teach the client how to manage on her own condition especially at home management. Gain Gain
and and
wide widen n
know knowle ledg dge e
abou about t
the the
enti entire re
dise diseas ase e
process formulate appropriate plan of care for the major.
4.
Client Profile Leticia Rullan
Patient:
201 Brgy. Manacnac Palayan City
Address:
60 years old
Age:
Female
Gender:
Filipino
Nationality:
Roman Catholic
Religion:
Educational Attainment: High School Graduate Storekeeper
Occupation:
Family History of Illness The patien patient’s t’s family family has histor history y of hyperte hypertensi nsion on on both side of the family.
History of Present Illness The The
pati patien ent t
was was
diagn diagnos osed ed
with with
Rheu Rheumat matoi oid d
Arthr Arthrit itis is
and
Hypertension at Good Samaritan Hospital,4 months ago . Few day
prior
to
consultation
at
the
said
hospital
she
experienced headache, pain around nape area and stiffness
and joint pain. The doctor submitted her to several test like x-ray, pulse oximeter.
Past and Current Medical Condition Before she was diagnosed with rheumatism she is known to have Hypertension. She was advised to take rest everytime she she
feel feels s
stre stress ssed ed
and and
avoi avoid d
salt salty y
and and
fatt fatty y
food foods s
and and
strenuous activities.
History of Hospitalization and Surgical Operation The patien patient t was hospit hospitali alized zed becaus because e and and
know knows s
she she
pref prefer erre red d
to
have have
of her hyperte hypertensi nsion on
mont monthl hly y
chec checkk-up up
to
a
private doctor and did not undergo from any surgery.
Nutrition and Metabolic Pattern Usual food intake The patient usual fluid intake in the breakfast was 1 cup of rice, egg, and 1 glass of milk. Then in lunch time she preferred pork giniling. In dinner time, she has least food intake ½ cup of rice and pinakbet. Usual Fluid Intake:
The usual fluid intake of my patient was 8-10 glasses of water a day. Food restriction: The doctor advised my patient to avoid salty and fatty foods. Problems with ability to eat: My
patient
told
that
she
has
no
problem
regarding
ability to eat. Supplementation: My patient vitamin was vitaplus.
Elimination Pattern Urination: She urinate 5 times a day with a yellowish color and has no complaint. Bowels: My
patient
has
bowel
movement
stool and no complaint about it.
Activity and Exercise Pattern Usual daily activities:
a
day
with
a
formed
The usual daily activities of my patient was walkind around their house, cooking dish. Limitation of Physical activities: The patient doesn’t engage in heavy work
Sleep and Rest Pattern She usually sleeps at around 9pm to 5am with a total of 8 hours of sleep.
Vital Signs Wt- 58kg Ht- 5’2
Date 11-14-11
Bp 130/80
T °C
P 75
R 20
11-15-11
mmHg 130/80
36°C
70
20
11-17-11
mmHg 130/80
36.1°C
73
21
mmHg 11-18-11
130/80 mmHg
11-21-11 11-22-11
36°C
70
19
SUMMARY PRESENTATION OF PATIENT ASESSMENT Body Parts Skull
Assessment No tenderness noted
Findings Normal
upon
palpation, generally with in
prominent the
and
Scalp
round
frontal occipital
area Lighter in color than
the
complexion;
Hair
Face
no
scars noted Slight dryness, Hair can be black or brown. brittle Nor brittle nor brown No involuntary Normal movement shape
Eyes
Normal
is
noted, oval
and rounded Slight blurred vision,
No decrease visual acuity
pupil Pupils
clear,
Decreased
react
to
light
visual activity No drainage
Ear
and accommodation Normal
No ringing of ears Skin is same color with complexion
Nose paranasal sinuses
No hearing loss and No discharges, no
Normal
tenderness
noted
on
palpation Nasal septum normally straight and not perforated
Neck and Throat
Chest
Soft, no swollen
Normal
lymph nodes With expansion
Normal
and respiration Normal breath sounds No cough Thorax is symmetric
Abdomen
RR-20 soft,
non
tender, Umbilicus
is
Normal
midline
and
inverted with no signs
of
Upper
discoloration Swelling pain of
extremities
the fingers
symmetrically even in color, warmth and moisture without swelling No edema
lower Extremities
Swelling pain of Both legs are symmetric in size the joints No swelling or atrophy
CHAPTER II
CASE DISCUSSION/PRESENTATION
PATHOPHYSIOLOGY
Presentation of antigen to T cells
T- and B-cell proliferation. Angiogenesis in synovial lining
Swelling in small joints, associated with pain, stiffness and fatigue.
Neutophil accumulation in synovial fluid. Cell proliferation. No cartilage invasion
Synovitis. Early pannus invasion. Chondrocyte activation. Degradation of cartilage by
Warm, swollen, effusion, pain, and decreased motion with possible rheumatoid nodules.
Increase in severity of physical sign and symptoms.
proteinase.
Figure 1. medical surgical nursing In RA, the autoimmune reaction primarily occurs in the synovial tissue. Phagocytosis produces enzymes within the joint. The enzymes break down collagen causing edema, proliferation of the synovial membrane, and ultimately pannus formation. Pannus destroy cartilage and erodes the bone. The consequence is loss of articular surface and joint motion. Muscle fibers undergo degenerative changes. Tendon and ligament elasticity and contractile power are lost.
Pathophysiology of my client Sign and symptoms
Stiffness: The joint does not move as well as it once did. Its range of motion (the extent to which the appendage of the joint, such as the arm, leg, or finger, can move in different directions) may be reduced. Typically, stiffness is most noticeable in the morning and improves later in the day. Inflammation: Redness, tenderness, and warmth are the hallmarks of inflammation. Swelling: The area around the affected joint is swollen and puffy.
Risk Factors
Age Although rheumatoid arthritis can occur at any age from childhood to old age, onset usually begins between the ages of 30 - 50.
Gender Women are more likely to develop RA than men.
Family History Some people may inherit genes that make them more susceptible to developing RA, but a family history of RA does not appear to increase an individual's risk.
Smoking Heavy long-term smoking is a very strong risk factor for RA, particularly in patients without a family history of the disease.
Female gender. After the age of 65, women have a much higher risk of developing osteoporosis Diagnostic Exam
When she was hospitalized last year because of hypertension, she diagnosed also with rheumatoid arthritis she undergo with an x-ray. The result was she has a rheumatoid arthritis.
Prevention
The first step in helping to prevent or reverse arthritis is proper cellular nutrition. You want to fill your body with good antioxidants, so the free radicals roaming around in your system are neutralized and flushed out of your body before they can do more harm. In the past, good cellular nutrition meant eating the right fruits and veggies every day, but things are more complicated now. Because of the degradation of our food supply, it's harder to get the good antioxidants you need straight from the grocery store. Of course, eating a healthy balanced diet full of fruits and veggies is still a good start, but you need to make sure you're properly supplementing your diet with antioxidants and minerals.
Complication
Rheumatoid arthritis can affect other parts of the body as well as the joints. Some patients with severe disease may then be at higher risk for complications, such as the following: Peripheral Neuropathy. This condition affects the nerves, most often those in the hands and feet. It can result in tingling, numbness, or burning. Muscle problems. Many patients have weakness of the muscles. Anemia. People with RA may develop anemia, which involves a decrease in the number of red blood cells.
Scleritis and Episcleritis. This is an inflammation of the blood vessels in the eye that can result in corneal damage. Symptoms include redness of the eye and a gritty sensation. Infections. Patients with RA have a higher risk for infections, particularly if they are treated only with immune-suppressing drugs (corticosteroids, anti-tumor necrosis factors, disease modifying drugs). Skin Problems. Skin problems are common, particularly on the fingers and under the nails. Some patients develop severe skin complications that include rash, ulcers, blisters (which may bleed in some cases), lumps under the skin, and other problems. Severe skin disease can reflects a more serious case of RA in general. Kidney. Although rheumatoid arthritis only rarely involves the kidney, many of the drugs used to treat it can damage kidneys. Heart Disease. Patients with RA have increased risk for death from coronary artery disease. Research suggests that he chronic inflammation associated with RA may be a factor.
Nursing Management
Physical therapy helps preserve and improve range of motion, increase muscle strength, and reduce pain. Hydrotherapy involves exercising or relaxing in warm water. Being in water reduces the weight on your joints. The warmth relaxes your muscles and helps relieve pain. Relaxation therapy teaches techniques for releasing muscle tension, which helps relieve pain.
Both heat and cold treatments can relieve pain and reduce inflammation. Some people's pain responds better to heat and other's to cold. Heat can be applied by ultrasound, microwaves, warm wax, or moist compresses. Most of these are done in the medical office, although moist compresses can be applied at home. Cold can be applied with ice packs at home.( Medical Surgical Nursing)
Medical Management
In some cases, reconstructive surgery and/or joint replacement operations provide the best outcome Rheumatoid arthritis was traditionally treated in the past with a stepwise approach starting with nonsteroidal antiinflammatory drugs (NSAIDs) and progressing through more potent drugs such as glucocorticoids, diseasemodifying antirheumatic drugs (DMARDs), and biologic response modifiers. In the because because usually damage.
past, DMARDs were avoided early in the disease of their potentially serious side effects and they did not often bring on remission. DMARDs were reserved for people who showed signs of joint
Over time, however, this strategy was recognized as being faulty, because people treated early with DMARDs have better long-term outcomes, with greater preservation of function, less work disability, and a smaller risk of premature death. The goal of drug treatment is to induce remission or at
least eliminate evidence of disease activity.
DRUG STUDY
NAME
ACTIO N
Leflunomide (Activan) 10-20
Anal Gesic /anti Pyretic s and muscle relaxa nt
mg once daily
Methylprednisol one (medrol) 200 mg/day
DOLO-Neurobion
Hormo nes and related drugs
Analge Sic/ antiPyreti c and muscle relaxa nt
INDICAT ION Active RA in adult patients
CONTRAINDIC ATION
SIDE EFFECT
NSG RESPONS IBILITIES
Severe deficiency of the immune system
Incresase BP; diarrhea, nausea and vomiting, abdominal pain Fluid and elecrtro-
Watch for impairment of liver function, severe hypoproteine mia May be taken with or without food W/draw from long-term therapy gradually. Monitor BP, salt, water & K. Pregnancy & lactation.
Endocri Systemic ne, fungal rheumat infection ic And hema Tologica l disorder s Neuri tis, neuralgia
Acute intermittent porphyria, decompensate d cardiac insufficiency
Lyte, muscosk eletal , GIT disturban ces Rarely allergy caused by vit. B1.
May be taken with or without food (May be taken w/ meals to reduce GI discomfo rt.). Watch for rash & other allergic reaction
NURSING CARE PLAN Rheumatoid Arthritis
ASSESSMENT
SUBJECTIVE:
“Napakasakit ng mga kasukasuhan ko” (I'm
DIAGNOSIS
NSG. OBJECTIVES
INTERVENTION
Acute pain r/t distension of tissues by accumulation of fluid.
After 2 weeks of nursing intervention the patient will:
Independent
joint pain) as
>Report pain is relieved/
verbalized by the patient.
controlled
having severe
OBJECTIVE:
•
•
ness
Guarding /protect ive behavior
Restless
•
•
>Appear relaxed, able to sleep/rest and participate in activities appropriately
•
>Follow prescribed pharmacologica l regimen.
>Incorporate
RATIONALE
Investig ate reports of pain, noting location and intensit y(scale of 0– 10). Note precipit ating factors and nonverba l pain cues.
Recommen d/provid e firm mattress or bedboard , small pillow. Elevate linens
Helpful in determi ning pain managem ent needs and effecti veness of program
Soft/sagging mattress, large pillows prevent maintenance of proper body alignment, placing stress on affected joints. Elevation of bed linens reduces pressure on inflamed/painf ul joints. •
•
In severe
•
•
•
T:
facial grimacin g
pain scale of 7 out of 10
relaxation skills and diversional activities into pain control program
with bed cradle as needed.
V/S taken as follows
disease/acute exacerbation, total bedrest may be necessary (until objective and subjective improvements are noted) to limit pain/injury to joint.
Cold may relieve pain and swelling during acute episodes. •
•
37.5˚C
P: 100 R: 20 BP: 120/ 80
Suggest patient assume position of comfort while in bed or sitting in chair. Promote bedrest as indicate d.
Provides sustained heat to reduce pain and improve ROM of affected joints •
ASA exerts an antiinflammatory and mild analgesic effect, decreasing stiffness and increasing mobility. ASA must be taken Collaborative regularly to sustain a therapeutic blood level. Research Apply ice or indicates that cold packs ASA has the when indicated lowest toxicity index Assist with of commonly physical prescribed therapies, •
•
•
NSAIDs.
e.g., paraffin glove, whirlpool baths.
Characterist ics of antiinflammatory and immune modifier effects coupled with ability to block metalloprotein ases •
Administer medications as indicated Salicylates, e.g., aspirin (ASA) (Acuprin, Ecotrin, ZORprin); •
ASSESSMEN T
DIAGNOSI S
PLANNING
INTERVENTION
RATIONAL E
EVALUATI ON
SUBJECTIV E: “SUMASAKI T RAYUMA KO, HIRAP AKONG LUMAKAD”
OBJECTIVE : >PAIN ON BOTH EXTREMITI ES PAIN SCALE OF 3/5 >DISCOMFO RT >RESTLESS NESS >UNABLE TO WALK
IMPAIRED PHYSICAL MOBILITY RELATED TO PAIN ON BOTH EXTREMIT IES, AS EVIDENCE D BY DISCOMFO RT AND RESTLESS NESS
TO PROMOTE COMFORT AND PREVENT OTHER COMPLICAT ION.
>SUPPORT AREAS
>ASSIST WITH TREATMENT OF UNDERLYING CONDITION CAUSING PAIN LIKE ADMINISTER MEDICATION PRIOR TO ACTIVITY AS NEEDED FOR PAIN RELIEF
>ENCOURAGE PARTICIPATION IN SELF CARE, DIVERTIONAL ACTIVITY •
•
>SWELLING ON BOTH EXTREMITI ES
READING NEWSPAPER SOCIALIZA TION
>ENCOURAGE ADEQUATE INTAKE OF FLUIDS/
>TO PERMIT MAXIMAL EFFORT IN ACTIVITY
AFTER RENDERIN G OF NURSING CARE PROMOTIO N OF MOVEMENT AND PREVENTI ON OF OTHER COMPLICA TION ATTAINED
GOAL WAS MET.
>ENHANCE SELF CONCEPT IN SENSE OF INDEPEND ENT.
NUTRITIOUS FOOD
COLLABORATIVE:
REFERRAL TO A PHYSICAL THERAPIST.
>PROMOTE S WELL BEING IN MAXIMIZE S ENERGY PRODUCTI ON.
ASSESSMENT
DIAGNOS IS
SUBJECTIVE
FATIGUE RELATED TO INCREAS ED DISEASE ACTIVIT Y
NANGHIHINA AKO AS VERBALIZED BY THE PATIENT. OBJECTIVE: DECREASED FUNCTIONAL ACTIVITY RESTLESSNE SS FACIAL EXPRESSION : YAWNING, SADNESS
PLANNING
AFTER 5 DAYS OF NURSING INTERVEN TION THE PATIENT WILL: VERBA LIZED/ DEMONSTRAT ES INCREASED ABILITY TO MOVE PURPOSE FULLY
INTERVENTI ON
RATIONALE
INDEPENDEN T PROVIDE PERIODS OF UNINTERRUPTED REST THROUGHOUT DAY (30 MIN 3-4 TIMES A DAY) ALTERNATIN G ACTIVITY WITH REST
●CLIENT OFTEN HAVE LIMITED ENERGY RESERVE.
●CLIENT OFTEN USES ENERGY THAN OTHER TO COMPLETE SAME TASKS.
INTERRUPTED SLEEP
V/S BP- 130/80 MMHG
INTERRUPTED SLEEP: ENCOURAGE WARM SHOWER OR BOTH
●WARM WATER RELAXES MUSCLE ,
EVALUATION
AFTER RENDERING OF NURSING CARE PROMOTION OF MOVEMENT AND PREVENTION OF OTHER COMPLICATI ON ATTAINED
GOAL WAS MET.
IMMEDIATELY BEFORE BEDTIME
T- 36.3°C PR -75
ENCOURAGE GENTLE ROM EXERCISE AFTER BATH
RR-19
FACILITATI NG TOTAL BODY RELAXATION
●TO MAXIMIZE EFFECTS OF HEAT
COLLABORA -TIVE: ADMINISTER NIGHTIME ANALGESIC / LONGACTING ANTIINFLAMA TORY DRUGS AS PRESCRIBED
●REDUCES MODERATE INFLAMMATION
Foreign Literature In Philippines as well as in many other countries there
is
a
general
overview
of
the
health
of
the
population based on a national survey. Therefore it is the time to look at the population risk groups. Rheumatism is
the
most
example,
frequent in
population rheumatoid
the aged
illness United
65
Kingdom
years
arthritis.
diagnosed
In
and
in
more over
population.
than are
Finland,
12%
of
affected
the
For
age
the with
adjusted
incidence of rheumatoid arthritis in the adult population was 31.7/100,000. Projecting to the year 2020, an estimated 18.2% of Americans will be affected by arthritic disorders, equivalent
to
60
million
illnesses will increase
people.
in the
The
spread
of
coming years for
these
several
reasons. First, the trends in demographic changes indicate that
the
proportion
constantly
growing.
of
older
Secondly,
people ageing
in is
population
is
accompanied
by
chronic diseases, including musculoskeletal disorders. According
to
Dr.
Edward
R.
Laskowski
of
the
Mayo
Clinic, the application of heat or ice may be useful in the healing swollen,
process. red
and
In
general,
painful
you
joints.
should Acute
use
ice
inflammation
for is
often damaging to our own tissues; in cases of rheumatism, the
inflammation is
actually doing more damage
than the
original problem. Therefore, ice is recommended in order to inhibit
inflammation; this occurs via reduced blood flow
and decreased swelling.
However,
if
the
condition
has
been
present
for
a
significant period of time, blood flow should be stimulated in
order
to
inflammation
promote may
lead
an
active
to the
healing
process.
deposition of
Chronic
scar tissue,
which acts to inhibit your body's natural repair processes. By applying heat, your blood vessels are forced to dilate and
allow
more
blood
to
enter
the
area.
(http://www.livestrong.com/article/330159-exercises-for-rheumatism/, mayoclinic.com , www.google.com)
Overall, the body's immune response has one primary function: to protect the body from an object that the body does not recognize as a normal object. The immune response can be either normal or abnormal. Inflammation is also one of the body's first responses to infections as the body tries to rush immune cells and cytotoxic chemicals to the infected tissue to defend against the infections or foreign particles. Arthritis tends to develop inflammation in the joints and their surrounding tissues. Rheumatoid arthritis is an autoimmune disease where the body perceives tissue in the joints as being a foreign object and fights the tissue through an immune response. Tests for rheumatoid arthritis are rather simple and readily available. Rheumatoid arthritis has many options available for treatment such as medications and minor surgeries. Future advancements are continually being tested in clinical settings to help in improving treatment for rheumatoid arthritis patients. (Lethbridge
Research Journal. 2007. Volume 2 Number 1.)
There are many alternative methods a person can do to treat their rheumatism. Especially if they have rheumatism in their knees. Put on a good liniment like icy hot or Ben Gay before you go to sleep. When you awake, your knees will not be stiff. Do not walk or stand when you are in pain. Sit down and take a rest for a while. Do not push yourself. Know your limitations. Get the right
kind
of
exercise.
Exercises
like
bike
riding,
swimming, walking and floor exercises are all good for the joints. Make sure you get your doctor's permission before starting any exercise program. Three time a week for 30 minutes at a time is plenty of time for a exercise regime. Do you or someone that you love suffer from rheumatoid arthritis? associated handle.
If so, the pain and discomfort that is commonly with rheumatoid
arthritis may
be
too
much
to
When it is, there are many rheumatism sufferers
who turn to over-the-counter
medications to seek
relief.
Yes, these over-the-counter medications will work in most cases, but did you also know that there are natural and safe ways to manage and treat rheumatism?
There are and a
few of these natural remedies are highlighted below. The natural types
consumption remedy
that
come
for
of
raw
juices
rheumatoid
highly
rated
is
an
arthritis. and
effective Two
recommended
and
specific are
green
juices, as well as potato juice.
In fact, potato juice has
been
and
used
to
treat
the
pain
discomfort
commonly
associated with rheumatoid arthritis for years on end. potato juice, cut a potato into thin slices. so, leave the skin intact. glass
of cold water
overnight is best.
and
For
When doing
Place the potato slices in a
leave
sitting
for
a
few
hours,
Then drink.
The consumption
of Omega
3
Fatty
Acids are
another
natural way to treat many of the symptoms of arthritis. Omega 3 Fatty Acids are found in most fish. not
like
Fatty
eating
fish
are
Acid supplements,
encouraged
which
are
to
Those who do
examine
available
most drug stores and health stores.
for
Omega sale
3 at
This natural remedy
can provide relief from all forms of arthritis; however, those
with
rheumatoid
arthritis
see
and
feel
the
best
results. Warm olive oil massaged over the area is another easy and
natural
associated
way
with
to
relieve
arthritis.
the What
pain is
and nice
discomfort about
this
approach is that most individuals already have olive oil in their homes.
When using warm olive oil, be sure to let
cool a little, as olive oil that is too hot can result in painful skin burns.
In addition to plain olive oil, sage,
rosemary, or garlic can be diluted with olive oil, with
about ten more parts of olive oil.
When applied to the
impacted area, relief should be felt immediately. Baths are another natural way to treat the pain and discomfort
often
associated
with
arthritis.
When
baths to seek relief, warm baths are advised.
using
In fact,
cold bathes can result in increased pain, which is not the goal.
In addition to a traditional warm bath, many of
those suffering from arthritis recommend adding about three or four tablespoons of Epson salt to the bathwater.
Those
diagnosed with arthritis should remain in a warm bath for at least thirty minutes. Small amounts of exercise is another natural way to relieve
the pain
arthritis. arthritis concerned.
and discomfort commonly associated with
The only problem is that those suffering from must
proceed
with
caution
where
exercise
is
Moving around, whether it be through walking or
squeezing a stress ball, can help, but it also important not to over do it.
Those who overexert themselves are
likely to experience even more pain and discomfort. As you can see, there are a number of natural remedies and
home remedies that can
arthritis.
be used to seek relief from
If you are not suffering from arthritis, but if
you know someone who is, you may want to pass these easy and natural remedies onto that person.
Unfortunately, many
individuals are unaware of natural remedies and their many benefits.( http://www.knrn.org/natural-remedies-for-arthritis.html, www.google.com)
Local Literature
Holistic tropical center
Healing
island using
of
in
the
Cebu,
holistic
Philippines
Philippines,
healing
and
AM
Located
on
Wellness
natural
the
is
therapy
a to
overcome disease and achieve total health and well-being. We also teach our students the keys to life-long health through
the
practice
of
yoga,
meditation
and
vegetarian
diet. Rather than use the word “patient”, we prefer to call the people who come here “students” because they are here not only to be cured but also to experience how to remain healthy and disease-free for the rest of their lives. Our naturopathy treatments courses run between 12 days and
4
weeks
or
more,
and
include
detoxification, herbal
colon cleansing, mud/water/sun therapies, water cleansing, fasting,
alternative
medicines,
and
exercise.
These
are
complemented by music, art, classes, outings and games. We do not offer “out-patient” short-term care.
The Wellness Center Situated in a quiet neighborhood of Pagsabungan, Mandaue, Cebu, the Ananda Marga Wellness Center
is
alternative
the
country’s
healing
center.
first It
affordable
practices
stay-in
a
holistic
approach to health through various natural therapies, the practice of yoga, meditation and vegetarian diet. We do not only
assist
our
students
in
their
healing,
but
we
also
teach them the path to life-long health. EMPOWERS PEOPLE - to overcome problems caused by excess fat, stress and disease - to cure themselves through a system of natural therapy without depending on medicines -
to
become
physically
fit,
mentally
relaxed
and
fully
conscious -
to
learn
new
healthy
systems
of
eating,
exercise,
drinking water and harmonious thought We offer a complete systematic, in-patient natural therapy program. Daily activities are not only therapeutic but also entertaining and educative.
OUR MAIN THERAPIES
- a nutritious, delicious DIET of alkaline food (fruits, vegetables and other light vegetarian
food), freeing the
digestive system from its normal burdens so the body can naturally heal itself - our unique SUPER HERBAL DETOX, which is superior to any leading
colon
cleansing
absorbs
toxins
from
herbal
the
products.
digestive
It
system,
not
only
but
also
ultimately from the entire body. It is vital for getting a new start in your life. - an exercise program with a wide range: a) gentle YOGA POSTURES walking
for and
the mild
glands games
and
nerves
b)
c)
VIGOROUS
SLOW
EXERCISE
EXERCISE
of
of
brisk
walking & running, treadmill, swimming (at a nearby pool), aerobic dance and active games - various individually prescribed treatments include MUD PACK applying hygienic mud to specific areas of need, or in some cases to the whole body both absorbing toxins and attracting healing blood STEAMBATH to sweat out toxins, while keeping the face in fresh air (not like sauna, which compels one to breathe in toxic air) HOT
FOOTBATH
also
to
sweat
out
toxins,
particular effect on lower body and lung problems
with
a
COLEMA (in between COLonic
machine and EnEMA) internally
cleansing the intestines SPINAL BATH to cool the spine only, our best physical treatment for releasing stress WARM CIDER VINEGAR BATH done only just before sleeping for those who have difficulty to sleep, enabling nerves to thoroughly relax HYDRO BUBBLE BATH with 300 jets of warm or hot water, directed at specific areas of the needy body, together with aromatic oils SYSTEMATIC SUNBATH alternating in and out of the sun, with
water
or
oil
massage
according
to
need,
for
fixed
number of minutes and during a fixed interval HIPBATH attracting healing blood to the lower internal organs including the digestive organs and the female organs HOT WATER BAGS AND ICE PACKS depending on whether one needs heat for relaxation or cold for healing - WATER-DRINKING SYSTEM, 3 to 4 litres or more daily, to cleanse toxins - MENTAL EXERCISE & MEDITATION (including deep relaxation and visualization) to convert stress into calm positivism
- a graduated program of specialized ELIMINATION DIETS & FASTING
on
juices,
broths,
fruits
and/or
vegetables
for
several days.( http://manilasector.org/?p=92, www.google.com) Autoreactivity plays a major role in the pathogenesis of RA. The rheumatoid factor has been and still is for now more than 50 years the only autoreactivity that is clinically applied in the diagnosis of RA. This well reflects the current way of thinking that a single antigen or a single cause drives an individual into disease. Although by now many other autoantigens and autoreactivities have been described, their discovery was always on the search for the one and only autoreactivity that causes RA. This includes also immune reactivities directed against xenogenic antigens. But, none of the known RA-associated autoreactivities is present in all RA patients and none of them occurs exclusively in RA. Thus, the observed sensitivities and specificities are well below 100%. Therefore, RA has often been postulated to consist of various immunological subentities with similar clinical symptoms. Nevertheless, none of the autoreactivities correlates with a distinct clinical feature or course of disease. It is about time to say goodbye to the idea that a single antigen or
immunoreactvity causes and maintains rheumatoid arthritis. In this paper we present RA as the clinical outcome of an immune system that has shifted from a healthy to an autoimmune steady state. This is accomplished by many different reactivities and autoreactivities that occur either in parallel or one after the other. The entirety of the known RA-associated reactivities and (auto)antigens is presented in detail. The major RArelevant autoantigens comprise BiP, citrulline, the Saantigen, hnRNP A2, p205, IgG, calpastatin, calreticulin, collagen and the shared HLA-DR epitope. The accumulation of factor--involving autoreactivities, cytokines, environmental and genetic factors--that challenge the normal regulatory mechanisms of the immune system lead to a regulatory catastrophe. (Z Rheumatol. 2007 Feb;60(1):1-1)
Foreign Studies Recent studies using tumor necrosis factor-alpha inhibitors, both alone and in combination with other medications, have shown that patients demonstrate
significant improvement based on American College of Rheumatology criteria (Felson et al.,2006) Respondents
to
a
population
pain
survey
who
had
reported having musculoskeletal pain in the survey and who had
consulted
about
their
previous
12
months
as
research
and
agreeing
pain
well to
an
in
as
primary
care
consenting
to
interview.
in
the
further
Information
was
gathered about their pain and the use of all treatments for pain, including CAM, in the previous year.
Background Surveys
have
alternative
suggested medicines
that (CAM)
use
of
complementary
is
high
and
and
increasing
worldwide. Longitudinal studies in the UK between 1993 and 1999, 1995 and 2001 and between 1998 and 2006 and in the USA between 1990 and 1997 have confirmed the trend. CAM is most
commonly
used
for
chronic
pain
and
in
particular
musculoskeletal pain and is often used in combination with conventional
therapies.
GPs
are
the
conventional
medical
practitioners most frequently consulted for chronic pain in the UK. A
number
explore surveys,
of
CAM
surveys use.
surveys
rheumatologic
have
Some
of
among
diagnoses
been
conducted
these
were
patients
attending
in
the
UK
to
general
population
with
definitive
hospital
clinics,
or
surveys
of
healthcare
professionals
exploring
their
patients' use of CAM and access to it. In
primary
care
in
the
professionals rather
UK,
surveys
targeted
than patients. We are
healthcare
not
aware
of
surveys conducted in the UK that have directly explored CAM use
among
primary
care patients
who
suffer
from chronic
musculoskeletal pain. Evidence suggests that users do not necessarily access CAM through primary care and also they are often reluctant to inform their doctors of their use of these treatments. Figures on access to CAM through primary care
and
therefore,
on
health
might
professionals'
have
provision
under-represented
of
actual
CAM,
CAM
use
among primary care patients. We are not aware of previous surveys of primary care patients that have enquired about the perceived helpfulness of
treatments
important
for
from
the
patients'
understanding
perspectives.
healthcare
seeking
This
is
behaviour
among chronic pain sufferers, for informing effective pain management in primary care and because of potential safety issues related to CAM use. We focus
wanted
on
to
address
musculoskeletal
these pain
issues
sufferers
with who
particular are
using
primary care in the UK. We have therefore investigated the pattern of CAM use in a sample of chronic musculoskeletal
pain patients who were consulting primary care in the UK. Our hypothesis was that this group of patients would have a higher
prevalence
of
CAM
use
than
general
population
samples or pain sufferers generally. This was based on the idea
that
problems
this than
group the
will
general
have
selectively
population
more
because
severe
they
have
sought health care and because chronic musculoskeletal pain is
often
unresponsive
to
conventional
primary
care
treatment http://www.google.com An alternative treatment approach for RA has emerged in
the
area
of
biologic
therapies.
Biologic
response
modifiers are a group of agents that consist of molecules produced by cells of the immune system or by cells that participate in the inflammatory reaction. (Koopman,2006)
Local Study In initiating a community oriented programme for the control of rheumatic disease (COPCORD), 1685 people of all ages from a rural area in the Philippines were questioned by primary health care workers (PHW) for limb and spinal rheumatic pain and disability. The total complaint rate was 15.3% for men and 18.5% for women. For those 15 years and
older
the
present
at
Philippines most knee,
age the and
adjusted time 22.6%
rheumatic of
for
survey
pain
rates
were
28.4%
Lawrence's
UK
common rheumatic pain sites in this lumbar
spine,
neck
and
the
for for
population. community
trapezius
muscle.
pain the The were The
disability rate was 4.5% for those 15 years and older. One quarter of those with pain had received medical attention and the remainder, herbal treatment, massage, various faith and/or self-treatment methods. (http://www.springerlink.com/content/gg813l16x4690623/, www.google.com) The Study of Active Controlled Monotherapy Used for Rheumatoid Arthritis, An IL-6 Inhibitor (SAMURAI) study demonstrated that, compared with DMARDs, tocilizumab monotherapy significantly inhibited progression of structural damage in Japanese RA patients. [21] In addition, preliminary results reported from the Tocilizumab Safety and the Prevention of Structural Joint Damage (LITHE) study showed that, compared with MTX alone, tocilizumab plus MTX treatment resulted in significantly less progression of joint destruction. [22] In the present study, X-ray images at baseline and at Week 52 of tocilizumab treatment were available for 149 of 232 patients, allowing us to evaluate the radiographic effect of tocilizumab. As stated above, the duration of disease in patients enrolled in this study
was 12.4 years, and estimated yearly progression was significantly high, with 20.8 (1.3) at baseline. Considering the results of the impact on radiographic and clinical response to infliximab therapy concomitant with methotrexate in patients with rheumatoid arthritis by trough serum level in a dose escalating (RISING) study, in which we reported a disease duration of ~8 years and mean estimated yearly progression of 8.1 (9.1)
the present
study included patients with remarkably severe clinical features with long disease duration and progressive joint destruction. Irrespective of these severe conditions, the 95% inhibitory effect of tocilizumab indicates how powerful its inhibition of joint destruction is. Surprisingly, we found that tocilizumab inhibits the radiographic damage, not only in patients treated without TNF inhibitors, but also in those treated with TNF inhibitors. Although further research is needed, our findings suggest that the pathological condition of RA is dependent on TNF. The good results obtained with tocilizumab are consistent with those of both domestic and foreign studies. ( http://www.medscape.com/viewarticle/750779_4)
CHAPTER III METHODS AND PROCEDURE FOR DATA GATHERING DATA GATHERING TECHNIQUE The Data Gathering Technique used is Interview, Survey Home Visits and Questionnaires. To answer the research problems the student nurse used a
non-experimental
design,
Questionnaire aim research
for
questionnaires,
survey
study.
to gather information for purposes of
market
surveys,
analysis
corroborate other research findings.
or
even
to
They are one of the
cheapest and most feasible ways of gathering data.
It is
important
to
to
remember
that
for
any
questionnaire
be
really effective it has to be designed well. Interview is used
to
simplest
collect form
facts, are
structured
sometimes
interviews
little
more
in
their
than
oral
questionnaires. The student nurse interview the client by asking the questions in the questionnaire prepared by the Clinical Instructor, it is done to obtain a higher response rate with respondents, especially children, who might not be literate or capable of correctly completing a complex
questionnaire. The student nurse also brought instruments for assessment of the client’s present condition.
ADMINISTRATION OF INSTRUMENT The student nurses of Nueva Ecija University of Science and Technology together with their Clinical Instructors first asked
for
the
permission
of
the
Barangay
Captain
before
conducting their case study. We also gathered that Barangay Manacnac have a total population of 1652 and total house hold of 457. the
student
After gaining the Barangay Captain’s approval nurse
first
visited
one
of
the
respondents
house which became her client. She gather information by means of an interview, certain questions were asked about the
client’s
profile
and
her
past
and
present
medical
status. Basic instruments such as thermometer, BP cuff and sphygmomanometer
was
used
to
assess
the
client’s
vital
signs. Weighing scale was also used to get the client’s weight,
the
information
acquired
serves
as
information about the client for the case study.
LOCALE OF THE STUDY History of Manacnac
the
primary
Ang
kabisera
ng lalawigan
ng Nueva
Ecija
ay ang
lungsod ng Palayan. Dito matatagpuan ang Barangay Manacnac. Ayon
sa
Maligaya
kasaysayan, na
sakop
ng
ang
Manacnac
Laur,
Nueva
ay
dating
Ecija
na
sitio
may
ng
kaunting
populasyon, taong 1953 si Ginoong Anong Simanero ang naging kapitan sa lugar na ito. Kung iyong makikita ang Barangay na ito, para kang nasa isang bundok na malayo sa kabayanan. Ang lugar na ito ay may gulod na ang makikita ay puro mga damo at talahib maliban lamang sa piggery na pag-aari ng mga Wycoco. Tanong 1965 ng mapagpasyahan ng kongreso ng Pilipinas na ang Palayan City ang magiging bagong kapital ng Nueva Ecija. December 5, 1965 ang inaguration ng City Government sa Palayan napagpasyahan ito ni ex-official Mayor Eduardo L. Joson.Sina Mayor Elpidio O. Cucio at kanyang Vice Mayor na si Felipe Bautista ay nahalal bilang unang subsequent local official. Taong
1966
nang
naging
Kapitan
si
G.
Romulo
V.
Sandoval sa Barangay Manacnac noong ang barangay na ito ay sakop parin ng Laur. Nang panahong iyon may isang dayuhan na nanggaling sa Novaliches Q.C. ang nag interas na bumili ng lupa sa nasabing barangay at dito na rin siya nanirahan. Siya
ay
si
Ginoong
Pedro
Valenzuela.
Nag-donate
ng
kalahating hektaryang lupa para sa eskwelahan ng Cabanatuan City at Atate, pumapasol ang mga batang nag-aaral noon dito. Taong
1972
nang
dahil
sa
ordinansang
pinasa
bg
Sanggunian, Ang barangay Manacnac ay naging isang barangay sa Palayan City at nang panahong iyon ay kapitan parin si Ginoong Sandoval. Taong 1976 tumaas muli ang populasyon ng barangay mula sa bilang na 662 ay naging 852 at may bilang na 128 ang bubong ng bahay, may pamilyang 131 nang sumapit ang EDSA Revolution taong 1986 itinalaga ni Kgg. Presidente Aquino si Don Pacifico M. Fajardo na OIC ng Palayan City at Vice si Flor Agustib na kasalukuyang kapitan parin si Romulo V. Sandoval.
LOCATION MAP
Sampling Design Purposive sampling starts with a purpose in mind and the sample is thus selected to include people of interest and exclude those who do not suit the purpose. This method is popular with newspapers and magazines which want to make a particular point. This is also true for marketing researchers who are seeking support for their product. They typically start with people in the street, first approaching only 'likely suspects' and then starting with questions that reject people who do not suit. Purposive sampling is non-probability and hence can be subject to bias and error. http://changingminds.org/explanations/research/sampling/purposive_samplin g.htm)
CHAPTER IV CONCLUSION AND RECOMMENDATION CONCLUSIONS In
the
light
of
above
findings
of
the
study,
the
following conclusions were arrived at: 1. That the most common problems encountered in physical aspect
of the
respondents is
pain,
followed
by fatigue,
eating disorder, weight loss, anemia. 2. The most common problem encountered in emotional aspect is feeling helplessness followed by loneliness, anxiety and fear. 3. The most common problem encountered in social aspect is delaying
on
immediate
job
or
meeting
followed
by
withdrawing from social activities, and decreased number of friends. 4. The most common
problem
encountered
in
economical
is
shortage of money followed by delayed pension, change of employment, early retirement. 5.
The
physical
most
common
aspect
is
home wearing
management pajamas
when
because
it
comes
that
is
to the
simplest way to prevent too much exposure to cold climate.
Followed by sleeping 8 hours a day, taking steam bathing, massage
the
affected
area,
wearing
stocky
net/socks,
applying hot compress on the affected area, and applying cold packs on affected area. 6. All remedies they choose, the most effective remedies is efficascent oil followed by pau linament oil, white flower and Betet were used as home remedies. 8.
Pain
reliever
medications
were
prescribed
because
of
effectiveness of drug followed by taking over the counter medicine, and taking extra supplement. 9. Maintaining proper body position is the simplest way to prevent further deterioration of the cartilages that’s why it
prevents
too
much
pain.
Followed
by
avoiding
heavy
works, elevating their legs, attending aerobics exercise at least twice a week, always engage in brisk walking every morning. 10. Home management for eating disorder the most convenient is eating fruits and vegetables because they can acquired it immediately and affordable to their backyards. Followed by eating green leafy vegetables like malungay, talbos ng kamote, eating food rich in omega 3 fatty acids and fish oil such as canned tuna etc., avoiding eating food rich in
uric
acid
such
as
mongo,
sitaw,
gizzards,
nuts,
and
drinking at least one glass of milk a day. 11.
The
home
management
television because
in
social
aspect
is
watching
they divert their attention to forget
the pain. Followed by playing with their grandson, reading books
and
newspaper,
and
going
to
mall
with
their
relatives, going to amusement park, and playing chess with their friends.
RECOMMENDATIONS The researchers of the study hereby recommend that: 1. Relatives must
provide
knowledge to the elderly
with
regards to home remedies and proper practices because old aged
are
easily
forget
their
activities.
Practices
vary
according to the individual but tasked could be done with encouragement. 2.
Patient
should
able
to
manage
their
activity
daily
living to lessen the factor that can cause Rheumatism to occur. They should also practice to limit eating rich in uric acid such as monggo, sitaw, gizzards etc., because the crystals
of
causing pain.
uric
acid
are
deposited
in
the
joints
that
3.
Patient
should
have
awareness
about
Rheumatism
by
discussing this home management and affective practices as the primary prevention for further deteriorations of body functions, the disease process of Rheumatism
BIBLIOGRAPHY Bautista Joy,THEORETICAL FOUNDATION OF NURSING. A Beginner Journey Into Professional Nursing. first edition 2008 Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. eleventh edition 2008 Cacanindin,Nursing research : study notes and guide. 2010. by C&E Publishing, inc. 839 EDSA South Triangle, Quezon city Concise Oxford English Dictionary eleventh edition Seeley, Stephens, & Tate Essentials Physiology sixth edition 2007.
Of
Anatomy
And
www.google.com;rheumatismworldhealthorganization http://www.disabled-world.com/health/autoimmunediseases /rheumatoid-arthritis/ra-diagnosis.php article 5 Galanes feb 2006/
www.google.com ; http://www.livestrong.com/article/330159exercises-for-rheumatism/ mayoclinic.com article 1 Puzas January 2006 www.google.com; http:// www.knrn.org/natural-remedies-forarthritis.html/2005 article7 Gulanik
www.google.com ; http://manilasector.org/?p=92,/2007 aricle3 klopp
ww. Google.com www.google.com; http://www.springerlink.com/content/gg813l16x4690623/ , dec 2009
ACKNOWLEDGEMENT As their
a
student
deep
nurse
wish
appreciation
and
to acknowledge and gratitude
for
express
the
kind
assistance given by numerous people who helped them in the preparation of this case study. First
and
foremost,
I
want
to
offer
sincerest
gratitude to my clinical instructor, Mrs. Girlie Tayao, RN, who was supported and guided me throughout my case study, for the humble sharing of her knowledge and experiences, for the motivation and overwhelming encouragement, and for her patience and understanding in checking my case.
To my staffing, Mr. Christian Gabuya for her wholehearted assistance and suggestions. To
the
Dean
of
College
of
Nursing,
Mrs.
Eppie
DC.
Bugarin, RM, RN, Ph.D for her valuable contribution to this study. To the personnel of Barangay Manacnac Palayan City for providing
necessary
information
to
my
research
in
conducting this study. Lastly and most importantly, the God almighty who has given His great mercy and blessings for the years of study of the researchers and who has given them a great privilege to be His children. Angelica P. Bravo
DEDICATION
After sufferings,
all
the
efforts
challenges,
and
sleepless
trials, nights,
hardships, I
made
this
humble piece of work a successful one. So, with love and respect, I dedicate this priceless output to the following persons: To
my clinical
instructor
Mrs. Girlie
Tayao
RN who
lend her helping hands to guide me in the success of this study; To my loving parents who always extend their best love and care that serve as their inspiration in my studies; To
my
staffing
who
always
give
their
everlasting
support; Above all, to the Lord Jesus Christ who is the divine source
of
their
strength,
knowledge
and
abilities
for
without Him, this work would have been in vain. To all of them, I am humbly dedicate this piece of work. Angelica P. Bravo
TABLE OF CONTENS
