Health issues regarding a patient with chronic Rheumatoid Arthritis

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Introduction

This report will discuss the health issues regarding a patient with chronic Rheumatoid Arthritis. It will contain a brief biographical detail of the patient, discuss in detail the cause and effect of the disease, outline the biopsychosocial impacts the disease has had on the patient and finally it will analyse therapies that there are available and will discuss the effectiveness of these therapies.

Section 1 – Brief Biographical Detail

Following the guidelines set by the Nursing and Midwifery Council’s code of conduct (NMC 2002) “protect confidential information” the patient under observation will be named Carol.

Carol is a 74 year old, widowed female who suffers with rheumatoid arthritis (RA) and is a retired factory worker. Carol has been retired for approximately 27 years and lives alone in her bungalow. Her onset of Arthritis began shortly after her husband’s death around 4 years ago.

Before her acute onset of Arthritis, Carol, who is an ex-smoker, enjoyed her social life and gardening. Unfortunately Arthritis has affected her hands mainly and is no longer able to do the things she loves. She finds it increasingly difficult to tidy her garden and do simple tasks such as the weekly shopping and ironing. Whilst discussing Carol’s condition she stated “I can’t do anything strenuous, just a little bit of weeding and I can’t carry heavy bags so my Daughter does the shopping for me.” Carol finds that if she does participate in these tasks she requires 24 hours bed rest to recover from the flare up.

This causes Carol to suffer depression and after observing many patients who suffer with Arthritis; this seems to be a very common trend within the disease. Along with depression, Carol feels that her physical health has suffered also. She believes that she is more susceptible to illnesses such as colds and flu and finds she gets these frequently. Carol also considers her age to have a great impact on her mental and physical state. She believes her age is a factor preventing her doing things she used to love such as going to the local labour club in the evening. All of these thoughts and feelings lead to her feelings of depression which contributes to flare ups of her Arthritis becoming more frequent.

Along with RA, Carol also has a past medical history of Inflammatory Osteoarthritis, Inflammatory Arthroplathy, high blood pressure, hyperlipidemia and she is a non-insulin dependent diabetic.

Section 2 – Cause and Effect of Condition

The exact cause of RA is unknown to medical professions and years of research has gone into finding an exact cause, however, as of yet, none have been found. Some scientists believe that the disease is caused by some kind of infection, viral or bacterial, but there is no solid evidence to support this theory. Even though an exact cause cannot be determined, scientists do believe that the disease does carry some hereditary traits and can be passed from family member to family member through generations. This does not, however, mean that if a family member does suffer from arthritis someone of the same gene pool will.

RA is “a disease in which the joints in the body become inflamed.” It is classed as an autoimmune disease as the immune cells in the body attack the effected joint. A normal joint unaffected by Arthritis is covered with cartilage allowing the end of each bone to move alongside each other with little or no friction. A normal joint also has a membrane surrounding it called the Synovium, which produces a thick fluid to act as lubrication. This fluid is known as Synovial Fluid. In a patient with Rheumatoid Arthritis such as Carol, the Synovium becomes swelled and sore. In addition to the membrane becoming sore, it also gets an angry red colour which is caused by the increased blood flow to the area. This happens because the body believes there is an infection in the membrane and begins to attack it causing pain and heat.

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Joints swell due to the Synovial membrane increasing its production of fluid which is kept stored in the joint space and surrounding areas of the joint. This can also lead to the pain that the patient feels during an Arthritic flare. Due to swelling in the joints, tendons surrounding the joint are stretched to accommodate it. This causes the nerve endings in the muscle to become irritated not only by the swelling but also by the chemicals in the Synovial Fluid.

RA affects different people in different ways. “Most people with Rheumatoid Arthritis have some damage in a number of ...

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