Case study of arthritis patient

May be not all of us are familiar with arthritis particularly about what kind of disease is this. But older folks perhaps are more aware of this as arthritis is known to be common among adults and elderly people.

What really is this disease?

Robert George Lahita defines rheumatoid arthritis as a “chronic inflammatory disorder of the movable joints”. Lahita explained that rheumatic arthritis is different from osteoarthritis as “it is not caused by wear and tear”. Lahita said that rheumatoid arthritis appears to be an immune disorder in which the body’s own immune system produces anti bodies against its tissues, causing inflammation and pain, the good news is, it is not contagious and it is not hereditary, so there is no need to worry about being contaminated by the diease. Lahita noted that rheumatoid arthritis is not a terminal illness if diagnosed early and treated appropriately. It affects people who are in the prime of their lives. It can be controlled but if it is left untreated it can be progressive too.

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Dr. Gary Null noted that more than forty million Americans suffer from arthritis and some 300,000 children have the disease, but this number is rapidly increasing. Quoting from the Times Dr. Null said “the Times estimated that arthritis cost this nation $8 billion to $10 billion annually in medical bills and add to those figures another $7 billion in lost wages and taxes resulting from absenteeism” but the total estimated annual cost of arthritis to the economy is $150 billion. Null further noted the estimates of drug companies, which suggest, “arthritis relief accounts for anywhere from one-third to one-half of the $900 million in annual aspirin sales”  and arthritis medications are one of the pharmaceutical industry’s biggest and most lucrative product. Thus in the United States arthritis is not only a health issue, for Dr. Null, it is also a very lucrative growth industry  that offers tremendous profit- making opportunities for those involved in the arthritis industry.

What really causes rheumatoid arthritis? Robert Lahita explains that human body produces anti bodies that rid the body of foreign invaders called antigen. The immune system produces anti bodies to cells and tissues that make the body but it can also make other antibodies against its own body, which is called auto immune response. The resulting combination causes the existence of rheumatoid arthritis. Prime targets of arthritis in the human body according to Lahita are the musculoskeletal system or the structural support of the body. This system is composed of bones and muscles, tendons, ligaments; cartilage attached to the skeleton. Another is the joints, which is the point at which two or more bones connect. Thus a person suffering from rheumatoid arthritis complains primarily of pain from those mention body parts. Below is a case study of rheumatoid arthritis patient.

Palliative client assessment

Personal profile

The patient is 69 years old, woman, and a mother.

Biological profile

She has been diagnosed with seropositive rheumatoid arthritis. She complains of increasing pain and stiffness in her hands and knees.

Spiritual profile

Prior to being diagnosed as having seropositive rheumatoid arthritis, she had been a very healthy and busy person. She was first diagnosed four years earlier.

Palliative treatment objective

Pharmacological management

On diagnoses of the rheumatoid arthritis, she was treated with sulfasalazene to control pain and inflammation it had only little effect.

Kathleen Marion Brophy, and Karen Webber, said that the “primary goals of treatment are to control pain and inflammation and to minimize immobilization and disability”. They pointed out that Acetaminophen may relieve pain. They suggested that ASA may relieve inflammatory pain its adverse effect are intolerable. Thomas Schroenherr and Alex Christian Klixbull Jorgensen, contends that “acetylsalicylic acid popularly known as aspirin, is still the most widely used analgesic, anti-inflammatory, and antipyretic agent”. They point out that on the restricted drugs; fentanyl is a very strong opioid drug 80 times stronger than analgesic properties of morphine. They noted that narcotics law regulates its use and were “used in major surgery and treatment of pain”.

Going back to the patient, she was not administered with these drugs as the patient had previous medication. The pharmacological management done to the patient was more careful to avoid side effects. Since the patient was taking ibuprofen 200mg, and co-codamol 8/500 it would be best to give the patient just one medication which is a bit stronger, either aspirin or opioid as her former medication is now less effective to deal with her pain.

Non-pharmacological management

According to Derek G. Waller, Andrew G. Renwick, and Keith Hillier, non-pharmacological treatment “often minimizing changes in ambient temperature with insulating clothing is enough to reduce the numbers of attacks although electrically heated gloves or socks maybe useful for more severely affected patients.

Smoking should be strongly discouraged as nicotine promotes vasospasm and may also the threshold for other provoking factors. Howard S. An and J. Michael Simpson, pointed out that “many forms are available including hot packs, short wave and microwave diathermy, and ultrasound”, for the treatment of arthritis.  They also added that in case of arthritic pain, devices such as “moist air cabinets and whirlpool” may use.  Generally, heat can help reduce the tenacity of arthritis however, it has contradictions like inflammation and acute infection.  Aside from heat, electrical devices may be used like TENS. According to An and Simpson, TENS is of two types: the conventional and the electro-acupuncture; both are effective in reducing pain and not a cure, as the author stated.

William St Claire, David S. Pisetsky and Barton F. Haynes noted that people having rheumatoid arthritis generally experience major depression by 80 percent.  Some reason for depression of patients with depression is due to lack of social support, decreased mobility, low income, and reduced self-esteem.

Among the highly recommended anti-depressant for patients with arthritis, the S-Adenosylmethionine (SAMe) is believed to have positive effects.  SAMe is “a derivative of the amino acid methionine that is formed in the body when methionine combines with ademosine triphosphate, the major source of cellular energy”.  Balch stated that SAMe is very effective antidepressant.

Alternative management

Alternative management for arthritis patients is through the application of aromatherapy.  Roberta Wilson provides varied uses of aromatherapy, and among the many ingredients she mentioned some of them that can used to soothe arthritis.  Cypress oil helps decrease joint inflammation while Elemi oil prevents rheumatic arthritis from developing in the area of the break.

On the other hand, ginger oil is also proven effective analgesic for arthritis; it relieves the pain and soothes sprains and muscle spasms especially in the lower back Helichrysum oil can help ease spasms including the muscle spasm; it reduces the swelling and inflammation, backache, carpal tunnel syndrome, rheumatism and sciatica.  Juniper oil is also good for arthritis and rheumatism. Laurel oil contains anti-inflammatory element that reduces swelling which is good for arthritis.  Marjoram oil, which was popular in Greek myth, is effective treatment for arthritis because it eases the pain and muscle spasms.  Neroli oil, which was a component of Hungary water created by Queen Elizabeth, helps disfiguring arthritis. Aromatherapy is known as the centuries-old practice of using botanical scents and oils for physical benefits.  It is also popular today by providing healing recipes by baths, inhalants, air fresheners, and skin care.

Proposed model of caring

Arthritis is a chronic disease, which is associated with old age, almost everyone suffer from it.  People who have arthritis experience chronic pain in the musculoskeletal system due to the swelling and inflammation of joints.  This disease is chronic which means, this may affect other organs in the body as it continues to develop.  In many countries, patients having arthritis are taken care of by means of proposed model of caring.

Nursing involvement

In many hospitals, there is observance of nursing involvement in the management of Rheumatoid Arthritis.  According to Margaret Alexander, Josephine Fawcett and Phyllis Runciman, the aim of care is “to maintain independence as long as possible and provide comfort and support”.  The authors stated that there are major comfort measures that are mainly “nursing responsibilities”, such as in controlling pain, maintaining and fostering well-being.  In giving analgesic treatment and other medications, it is important that a nurse be aware of the serious side effects of these medicines that according to the authors can be life-threatening (p. 418).  It is also the responsibility of the nurse to explain to the patients and the patient’s family about these medications and the chronic nature of arthritis.  A nurse must also employ the use of lightweight splint to hold the joints in position, and bathing aids such as non-slip bath mat and a bath stool.  A nurse understands basically the kind of weather suitable for the patient, which is warm or low temperature.

Exercise and mobility is a good program for these patients with arthritis, which should be done under the supervision of a nurse.

Self-management of palliative illness

Frederick J. Manning and Jeremiah A. Barondess noted that patient self-management is “viewed as central to the design of any care system for chronic disease. The concept behind this self-management according to Manning and Barondess is self-efficacy.  Based on the study quoted by the authors, patients who administered self-management over a four-year period can lead to “a twenty percent reduction in pain and forty percent decrease in physician visits.  The program includes latest management techniques, individualized exercise program, stress and fatigue management, proper use of medication and treatment, proper handling of emotional problem, appropriate nutrition for everyday, and many others.

In coping with arthritis, patients and their family members and caregivers must understand that they should address not only the physical well-being of the person but also their emotional struggles.  Part of the program is handling emotional stress and fatigue.  Family and friends must be supportive of the patients so they can cope up with negativism on their own.  The patient must honestly acknowledge the disease and be open to deal with it properly through the aid of medicine and people around him.

Preparation for death of patients with arthritis

Different religion provides different preparations for dying patients; however, the general procedure observed by most people is providing hospice care for them.  Hospice care provides or sustains the life of the dying patients by enabling the patient to live fully and comfortably as possible.  It aims to sustain the life of these patients pain-free and with dignity. During this period, the patient will stay in one room for many days; and, family and friends can plan a mini-vacation or any recreation or plan to have a party so patient can experience a normal-like situation.  In case the patient gets well he can be discharged from the hospice.

Funeral preparation once the patient died is done by immediate family members.  This includes finding if the patient left a ‘last will and testament,’ if not, the family has to make the arrangement for the funeral.  Check also if the deceased has a pre-paid funeral plan, or any bank account and pension.  If there is, make an arrangement with the agency about the payment to be made for the funeral. If none, the family has to shoulder the expenses.

After making preparations, proceed by registering the dead to the Registry Office for the issuance of death certificate. The family then, has to contact a funeral service and follow the ritual based on the faith of the person.  The immediate family may also process necessary document to the Social Security Services for any claims for funeral.

References

1. Alexander, M., Fawcett, J., & Runciman, P. 2000.  Nursing Practice: Hospital and Home: the Adult.  UK: Elsevier Health Sciences
2. An, H. & Simpson, M. 1994. Surgery of the Cervical Spine. UK: Martin Dunitz, Ltd.
3. Balch, P. 2006.  Prescription for Nutritional Healing. USA: Penguin Group Society.
4. Brophy, K.M. & Webber, K. 2007.  Clinical Drug Therapy for Canadian Practice. Canada: Lippincott Williams & Wilkins
5. Dodds, L. 2004.  Drugs in Use: Clinical Case Studies in Pharmacist. Great Britain: Pharmaceutical Press.
6. Lahita, R.G. 2003. Rheumatoid Arthritis: Everything You Need to Know about Juvenile Arthritis. New York: Rosen Publishing Group, Inc.
7. Manning, F. & Barondess, J. 1996.  Changing Health System and Rheumatic Disease.  National Academies Press.
8. Null, G. 2001.  Get Healthy Now!  A Complete Guide to Prevention, Treatment and Healthy Living (2nd Edition).  New York: Seven Stories Press.
9. Schoenherr, T. & Jorgensen, A.C. 2004. Optical Spectra and Chemical Bonding in Inorganic Compounds: Special Volume.  Germany: Springer-Verlag.
10. St. Claire, E.W., Pisetsky, D., & Haynes, B. 2004. Rheumatoid Arthritis. Canada: Lippincott Williams & Wilkins
    Waller, D., Renwick, A. & Hillier, K. 2001. Medical Pharmacology and Therapeutics. London: Harcourt Publishers, Ltd.
11. Wilson, R. 2002.  Aromatherapy: Essential Oils for Vibrant Health and Beauty.  USA: Penguin Group Society.

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