A client with rheumatoid arthritis (RA) tells the home health nurse, "My fatigue and stiffness are getting worse and I'm having trouble moving around, especially in the morning. What can I do?" Which intervention would be best for the client to perform first?

Question

Quizplus · Accepted Answer

Prolonged morning stiffness of the affected joints is a major complication of rheumatoid arthritis (RA). Taking a warm shower or bath first on awakening would be the best intervention as heat decreases stiffness and promotes muscle relaxation and mobility. With increased flexibility and decreased stiffness, the client's usual morning activities (eg, dressing, making breakfast) would be easier and less painful and tiring to perform. (Option A) A balanced diet and weight control are important. Diet and exercise should be proportional, especially during periods of disease exacerbation and decreased physical activity as excess weight exerts additional stress on weight-bearing joints. (Option B) Range of motion exercises are more effective after a warm bath or shower as stiffness is decreased, thereby improving flexibility. (Option D) Nonsteroidal anti-inflammatory drugs (NSAIDS) (eg, naproxen [Naprosyn], ibuprofen [Motrin]) should not be taken on an empty stomach as these can cause gastrointestinal upset. If prescribed once daily, these are probably best taken in the evening after dinner as RA symptoms slowly increase during the night and worsen in the morning. A higher serum drug level in the morning can help to reduce inflammation and stiffness. Therefore, if NSAIDS are prescribed twice daily, taking them in the morning with breakfast and in the evening with dinner is recommended. Educational objective: A nonpharmacologic intervention such as taking a warm bath/shower or applying heat can decrease morning stiffness and improve flexibility in clients with RA.

A Client with Rheumatoid Arthritis (RA) Tells the Home Health