Juvenile rheumatoid arthritis (JRA), also known as juvenile idiopathic arthritis (JIA), is a chronic inflammatory disease that primarily affects the synovium of the joints resulting in effusion and eventual erosion and destruction of the joint cartilage.
JRA is categorized into different classification and manifested by remissions and exacerbations with the onset usually occurs between ages 2 to 5 and 9 to 12 years old. Pauciarticular arthritis is the most common form of JRA that involves 4 or fewer joints; polyarticular arthritis involves many joints, usually more than four. Systemic arthritis involves the presence of joints swelling, and associated fever, light-pink rash, and affect internal organs such as the heart, lungs, eyes, liver, spleen, and lymph nodes.
Prognosis is based on the type of arthritis, the severity of the disease, and response to treatment with the most severe complications of permanent deformity, hip disease, and iridocyclitis with visual loss.
Nursing Care Plans
Nursing care planning goals for a child with juvenile rheumatoid arthritis aims to provide relief of pain, improve coping ability, preserve muscle and joint function, prevent joint deformity, promote positive body image, and increase confidence in the performance of self-care activities.
Here are four (4) nursing care plans (NCP) and nursing diagnosis for juvenile rheumatoid arthritis (JRA):
Chronic Pain
Nursing Diagnosis
May be related to
- Long-term physical incapacity
Possibly evidenced by
- Verbalization or noted evidence of pain experienced for more than 6 months
- Single or multiple joints involvement
- Joint stiffness, loss of motion, edema, and warmth in joint and painful to touch
- Guarding behavior
- Difficulty ability to continue activities
- Fear of reinjury
- Social and physical withdrawal
Desired Outcomes
- Child will report that pain has reduced using a pain scale.
Nursing Interventions | Rationale |
---|---|
Assess joint pain including its location, duration, severity, remissions and exacerbations, stiffness and aggravating factors such as weight gain, activity, fatigue; effect on mobility and participation in ADL; presence of joint deformity. | Reveals symptomatic of the effect of the disease on the musculoskeletal system: guides for the selection of analgesia/anti-inflammatory medication and better management of activity involvement; inflammatory process causes pain while limited motion resulting from muscle spasms, joint effusion, synovial thickening results in edema; joint destruction causes joint deformity. |
Administer medications as prescribed and monitor its effectiveness in relieving pain. | Decreases pain and inflammation related with the pain; drugs may be given alone or in combination including the nonsteroidal anti-inflammatory drugs that act as an analgesic, antipyretic and anti-inflammatory; if NSAIDs are not effective slower acting antirheumatic drugs which may be added for optimal effect; low effective dose corticosteroids are administered for a short period of time particularly during a life-threatening situation. |
Allow the child to assume a position of comfort; elevate and support painful joints during positional changes. | Detracts pain through diversionary activities. |
Apply warm application or moist heating pads to painful areas; paraffin baths and whirlpool as ordered. | Provides the area with circulation through vasodilation to ease pain; moist heat soothes painful, stiff joints. |
Apply splint as ordered for night use. | Immobilizes inflamed joints to relieve pain during movement. |
Provide adequate rest periods during the day and quiet environment for sleep. | Lessens stimulation that increases pain, and it promotes rest, especially during acute episodes. |
Explain to the child about causes of pain and interventions to take in relieving the pain. | Provides understanding on the treatments and medications. |
Educate child and parents about factors (stress, climate movement) that heighten pain episodes, and to express or report the presence of pain at the onset. | Promotes an opportunity to prevent those situations or activities that contribute to pain exacerbations and to provide for quick relief. |
Instruct parents and child to avoid overactivity or movement of affected joints. | Avoids injury to affected joints during the acute episode when immobilization is important. |
Teach parents to provide a warm bath daily for 10 minutes or warm wet packs with a towel bath to painful areas. | Supplies heat to affected joints to relieve pain and stiffness. |
Encourage and teach the child with relaxation techniques such as music, arts, reading, television. | Provides nonpharmacologic measures to relieve pain. |
Instruct parents and child in the proper administration of medications including side effects and importance of compliance with the regimen. | Promotes compliance with the medical regimen to manage pain and inflammation. |
Recommended Resources
Recommended nursing diagnosis and nursing care plan books and resources.
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- Nursing Care Plans: Nursing Diagnosis and Intervention (10th Edition)
An awesome book to help you create and customize effective nursing care plans. We highly recommend this book for its completeness and ease of use. - Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
A quick-reference tool to easily select the appropriate nursing diagnosis to plan your patient’s care effectively. - NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023Â (12th Edition)
The official and definitive guide to nursing diagnoses as reviewed and approved by the NANDA-I. This book focuses on the nursing diagnostic labels, their defining characteristics, and risk factors – this does not include nursing interventions and rationales. - Nursing Diagnosis Handbook, 12th Edition Revised Reprint with 2021-2023 NANDA-I® Updates
Another great nursing care plan resource that is updated to include the recent NANDA-I updates. - Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5(TM))
Useful for creating nursing care plans related to mental health and psychiatric nursing. - Ulrich & Canale’s Nursing Care Planning Guides, 8th Edition
Claims to have the most in-depth care plans of any nursing care planning book. Includes 31 detailed nursing diagnosis care plans and 63 disease/disorder care plans. - Maternal Newborn Nursing Care Plans (3rd Edition)
If you’re looking for specific care plans related to maternal and newborn nursing care, this book is for you. - Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care (7th Edition)
An easy-to-use nursing care plan book that is updated with the latest diagnosis from NANDA-I 2021-2023. - All-in-One Nursing Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health (5th Edition)
Definitely an all-in-one resources for nursing care planning. It has over 100 care plans for different nursing topics.
See also
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch. - Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other nursing care plans for musculoskeletal disorders and conditions:
- Amputation | 4 Care Plans
- Congenital Hip Dysplasia | 4 Care Plans
- Fracture | 11 Care Plans
- Juvenile Rheumatoid Arthritis | 4 Care Plans
- Laminectomy (Disc Surgery) | 8 Care Plans
- Osteoarthritis | 4 Care Plans
- Osteoporosis | 4 Care Plans
- Rheumatoid Arthritis | 6 Care Plans
- Scoliosis | 4 Care Plans
- Spinal Cord Injury | 12 Care Plans
- Total Joint (Knee, Hip) Replacement | 5 Care Plans
Other nursing care plans for pediatric conditions and diseases:
- Acute Glomerulonephritis | 4 Care Plans
- Acute Rheumatic Fever | 4 Care Plans
- Apnea | 4 Care Plans
- Brain Tumor | 3 Care Plans
- Bronchiolitis | 5 Care Plans
- Cardiac Catheterization | 4 Care Plans
- Cerebral Palsy | 7 Care Plans
- Child Abuse | 4 Care Plans
- Cleft Lip and Cleft Palate | 6 Care Plans
- Congenital Heart Disease | 5 Care Plans
- Congenital Hip Dysplasia | 4 Care Plans
- Croup Syndrome | 5 Care Plans
- Cryptorchidism (Undescended Testes) | 3 Care Plans
- Cystic Fibrosis | 5 Care Plans
- Diabetes Mellitus Type 1 (Juvenile Diabetes) | 4 Care Plans
- Dying Child | 4 Care Plans
- Epiglottitis | 5 Care Plans
- Febrile Seizure | 4 Care Plans
- Guillain-Barre Syndrome | 6 Care Plans
- Hospitalized Child | 5 Care Plans
- Hydrocephalus | 5 Care Plans
- Hypospadias and Epispadias | 4 Care Plans
- Intussusception | 3 Care Plans
- Juvenile Rheumatoid Arthritis | 4 Care Plans
- Kawasaki Disease | 6 Care Plans
- Meningitis | 7 Care Plans
- Nephrotic Syndrome | 5 Care Plans
- Osteogenic Sarcoma (Osteosarcoma) | 4 Care Plans
- Otitis Media | 4 Care Plans
- Scoliosis | 4 Care Plans
- Spina Bifida | 7 Care Plans
- Tonsillitis and Adenoiditis | 4 Care Plans
- Umbilical and Inguinal Hernia | 4 Care Plans
- Vesicoureteral Reflux (VUR) | 5 Care Plans
- Wilms Tumor (Nephroblastoma) | 4 Care Plans