K.R., a 42-yr-old married white woman, comes to the rheumatology clinic with tenderness and pain in the small joints of her hands.Subjective DataReports tenderness, joint pain, and stiffness in her hands for the last 3 moHaving fatigue, anorexia, and morning stiffnessMother diagnosed with ankylosing spondylitis 8 yr agoExpresses doubt about her ability to manage the diseaseObjective DataPhysical ExaminationSwelling, warmth, and tenderness of third and fourth metacarpophalangeal joints of both handsMild pain with neck motionTenosynovitisDiagnostic StudiesPositive ESR, RF, and anti-CCPMild bone demineralization present bilaterally in hand x-raysInterprofessional CareDiagnosed with RAStarted on methotrexate 7.5 mg PO once per week, etanercept (Enbrel) 50 mg subcutaneously once per week, prednisone 10 mg/dayDiscussion QuestionsHow will you explain the pathophysiology of RA to K.R.?K.R. asks you if genetic factors are related to a diagnosis of RA. How will you respond?Based on the assessment data presented, what are the priority nursing diagnoses?Why is an exercise program important in the treatment plan for K.R.?
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