ASSESSMENT Subjective: sumasakit at namamaga ang kasu- kasuan ng kamay ko Objective: Vital sign T 36.

7;R 23;P 95;BP 130/90 mmHg; Pain Scale 10 out of 10 Inspection Extremities are symmetrical No deformity No atrophy + swelling Palpation + joint lining thickening + nodules at flexor tendons + swelling at wrist; thumb wrist and forearm pain Soft spongy

DIAGNOSIS Chronic pain related to joint inflammation and increased disease activity

EXPECTED OUTCOME The patient will verbalize decrease in pain. From 10 out of 10 it will became 5

INTERVENTION

EVALUATION The patient verbalized decrease in pain with a pain scale of 7/10 The patient verbalized effective pain management strategies such as watching TV. The patient verbalized a plan to reduce responsibilities for home maintenance. She done simple chores. The patient demonstrated understanding of the prescribed therapeutic regimen and its importance.

Independent: >Monitor the level of pain and duration of morning stiffness. >Encourage patient The patient will to assume verbalize effective anatomically pain management correct position. strategies. Use small flat pillow under head. Do not The patient will use pillow to prop verbalize a plan to knees. reduce >Encourage use of responsibilities for ambulation aids home maintenance. when pain is related to weight The patient will bearing. demonstrate >Apply bed cradle understanding of to keep pressure of the prescribed bed covers off therapeutic inflamed lower regimen and its extremities. importance. >Encourage use of alternative methods of pain control such as relaxation, guided imagery or distraction.

Collaborative: >Administer antiinflammatory medication as prescribed. Give first dose of day as early as possible, with small snack. Anti-inflammatory drugs should not be given on an empty stomach. >Teach the use of heat and cold compress. Apply heat when taking a bath and when experiencing morning stiffness. If heat increases pain and swelling during periods of acute inflammation, apply cold compress. (Both heat and cold have analgesic effects and can help relieve associated muscle spasm). >Encourage patient to wear splints as
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prescribed. Splints provide rest to inflamed joint; may reduce muscle spasm. Consult occupational therapist for proper splinting of affected joint ASSESSMENT Subjective: ngayon di na ako makagawa ng gawaing bahay dahil sumasakit na talaga ang aking kamay lalo na pagmabibigat na gawain katulad ng paglalaba. Objective: Flexion extension: restriction and with DIAGNOSIS Impaired physical mobility related to pain EXPECTED OUTCOME The patient will verbalize/ demonstrate increased ability to move purposefully. INTERVENTION Independent: >Allow the patient adequate time for all activities. Pain may need more time than others to complete same tasks. >Instruct the patient to avoid excessive exercise during acute inflammatory flareup. Collaborative: >Reinforce techniques of therapeutic exercise taught by
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EVALUATION The patient verbalized increased ability to move purposefully.

therapist. ROM, muscle strengthening, and endurance exercise promote joint function and increase physical stamina.

ASSESSMENT Subjective: siguro kaya hindi ako makatulog gawa ng stress sa school at sa bahay na din. A quiet environment makes her relax. The patient verbalized that bago ko maramdaman ito, hindi naman ako

DIAGNOSIS Fatigue related to interrupted sleep

EXPECTED OUTCOME The patient will verbalize a higher level of energy and will appear rested.

INTERVENTION

EVALUATION

Independent: The patient >Encourage warm appeared well shower or bath rested. immediately before bedtime. Warm water relaxes muscles, facilitating total body relaxation. >Encourage gentle ROM exercise(after shower/bath) to

nahihirapang matulog pero simula ng mamaga ito hindi na ako makatuolg sa sakit at kakaisip kung ano ito kaya nag pa-check up na ako. She also added that naramdaman ko na din ang ganitong sakit pero ngayon mas masakit. Objective: Appeared not rested with facial grimace. Pain Scale 10 out of 10

maximize effects of heat. >Encourage patient to sleep in anatomically correct position. Should changes position frequently during night. >Avoid stimulating foods (caffeine) and activities before bedtime. >Encourage use of progressive muscle relaxation techniques. Collaborative: >Administer nighttime analgesic/longacting antiinflammatory drug as prescribed.