4 Juvenile Rheumatoid Arthritis Nursing Care Plans

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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):

  1. Chronic Pain
  2. Self-Care Deficit
  3. Disturbed Body Image
  4. Compromised Family Coping
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Disturbed Body Image

Nursing Diagnosis

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May be related to

  • Biophysical and psychosocial factors

Possibly evidenced by

  • Verbal and nonverbal responses to body appearance changes (joint deformity, side effects of steroid)
  • Multiple stressors
  • Negative perceptions about own body
  • Change in daily living limitations and social relationships

Desired Outcomes

  • Child will express feelings about illness.
  • Child will identify at least 1 positive thing about his or her body.
Nursing Interventions Rationale
Assess child’s feelings regarding multiple restrictions in lifestyle, chronic illness, difficulty in school and social situations,
inability to keep up with peers and
participate in activities.
Provides information about the status of self-concept and body image that necessitate special regard.
Observe for signs of depression and withdrawal behavior. Shows responses to body image changes and possible poor adjustment to changes.
Observe for presence of joint deformities,  need to use splints, weight gain, a shift in fat distribution, edema and effect on the child. Reveals side effects of steroid therapy and disease manifestations that affect body image.
Discourage any negative comments and stress positive activities and accomplishments. Improves body image and confidence.
Encourage expression of feelings and
concerns, and support communications with parents, teachers, and peers.
Provides an opportunity to express feelings and decrease negative feelings about changes in appearance.
Show support and acceptance of changes in the appearance of the child; provide privacy as needed. Promotes trust and demonstrates respect for the child.
Teach parents about maintaining support
for the child.
Encourages acceptance of the child with special needs (long-term steroid therapy and side effects, lifelong activity restrictions).
Discuss with parents and child the impact of the disease on the body systems and risk for deformity and disabilities; correct
misinformation and inform of ways to cope with body changes.
Gives accurate information in assisting on how to deal with negative feelings about the body.
Encourage parents to be adaptable in the care of the child and to integrate care and routines into family activities; to allow the child to participate in peer activity. Promotes the well-being of the child and a sense of belonging and control of life events by engaging in normal activities for age and improving developmental task
achievement.
Discuss with parents and child how to
deal with peer judgments of appearance and how to describe others about change in appearance.
Prevents child stigmatization by those who are not familiar with the child’s disease; Perception and stand of others will affect the body image of the child.
Suggest psychological counseling or child
life worker and educate on the functions offered by these professionals.
Assists to enhance self-esteem and to acquire coping and problem-solving skills.
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See Also

You may also like the following posts and care plans:

Musculoskeletal Care Plans

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Care plans related to the musculoskeletal system:

Pediatric Nursing Care Plans


Nursing care plans for pediatric conditions and diseases: 

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