Cuidado Del Paciente

The purpose of this case study is to examine, discuss and management the assessment and care from a patient suffering a long term condition. The World Health Organisation defines a ‘long term condition’ as a health problem that requires ongoing management over a period of years or decades (Department of Health, 2005). A patient will be identified and their needs assessed utilising a frameworkbased upon ‘Activities of Daily Living’ (Roper et al, 1990). It will be carrying out on which to base a plan of nursing care for the patient.

Whilst undertaking a community placement, a woman patient with Rheumatoid Arthritis was encountered. Rheumatoid arthritis (RA) is a chronic autoimmune systemic inflammatory illness, which can develop into a particularly painful and debilitating diseasethat can lead to irreversible disability (Le Gallez, 1994). Symptoms are pain, swelling, and painful joint stiffness. Many patients also notice increased fatigue, anxiety, loss of appetite and depression. RA is unpredictable and patients experience periods of remission and exacerbations (flares). Acute exacerbations are usually accompanied by fever with additional and accumulative pain and loss offunction (Le Gallez, 1994). Other problems throughout the body may also develop, including vasculitis, rheumatoid nodules, lung disease, cardiac abnormalities, anaemia and peripheral neuropathy (Brooks, 1998). Patients with RA have a great risk of early death (Callahan and Pincus, 1993; NICE, 2008). Furthermore, studies have suggested that the condition can shorten people’s lives to the same degreeas stroke and heart disease (BBC News, 2003). In the UK, a significant rheumatic disease affects one in seven of the population and is responsible for one third of all severe disabilities (Hill, 1998). There is no cure for RA. However, drug therapy such as analgesics, non steroidal anti-inflammatory (NSDAIDS), corticosteroids, disease modifying anti-rheumatic drugs (DMARDS) and tumour necrosisfactor treatment (Anti-Tnf) can be used to alleviate symptoms. Surgery may be considered in the long-term to relieve pain, improve mobility, and to prevent disease complications (Emery, 2006). This must all be borne in mind whilst assessing the patient.

In order to maintain confidentiality (NMC, 2008), the patient will be given a pseudonym, Sara. Permission to use patient details was sought andconsent gained (Hunt, 2001).
Sara was of particular interest to me because of her RA diagnosis and it was thought to be an interesting topic to explore more closely and in greater depth. I have had the opportunity to see the process step by step from the beginning of a newly diagnosed patient with RA. I could see also in detail the effect the disease process has on a sufferer, how even simpletasks such as getting out of bed or walking the dog can be difficult. In addition, I have been impressed seeing the important role that the nurse plays in the management of RA. The nurse has an integral role to play in the care of patients with rheumatic diseases, as the one member of the multidisciplinary team with whom the patient is likely to have the most contact (Hill, 1992).
Sara is a 48 yearold female school teacher. The disease strikes women four times more than men and it can affect all ages, including children, although the peak onset period is usually between the ages of 35 and 50 (Hill, 1998). She began noticing vague joint pain, fatigue, poor appetite, tiredness and general malaise, which she initially attributed to a case of the flu. She made an appointment with her GP whenshe noticed feeling very stiff in the morning, aching, swelling and heat in her finger joints, hands and wrists. Noting that Sara had lost weight and significantly elevated sedimentation rare (ESR), which indicates the presence of an inflammatory process in the body (Fries et al, 1980). The GP refers Sara to the rheumatology clinic for further investigation and evaluation. Following examination...