Juvenile Rheumatoid Arthritis Description of condition Juvenile pertains to childhood, immaturity, or youth.

. Rheumatoid a nodule or other skin eruption that may accompany rheumatism. Arthritis inflammation of a joint, often accompanied by pain, swelling, stiffness, and structural changes. Chronic inflammation of the synovium with joint effusion. Primarily involves the joints of the body. Although it also affects blood vessels and other connective tissues. Cause is unknown. Probably an autoimmune process or the child has developed circulating antibodies (immunoglobulins) against his or her own body cells.

Occurs two time in childhood: 1 to 3 years 8 to12 years To be classified as JRA, symptoms must: Begin before 16 years of age and last longer than 3 months. 3 types of JRA Polyarticular Juvenile Rheumatoid Arthritis Monoarticular or Pauciarticular Juvenile Rheumatoid Arthritis Systemic Juvenile Rheumatoid Arthritis.

PATHOPHYSIOLOGY T cells are activated and cause development of antigen antibody complexes that release cytokines into specific organs such as joints and skin. JRA is characterized by inflammation of the synovium with joint effusion and eventual destruction of the articular cartilage lasting 6 weeks or longer. RISK FACTORS More common in females. Children as young as 6 months. ASSESSMENT The effect their disease is having on self care such as eating, dressing, ambulating, toileting etc. Child and parents understanding of the illness and planned therapy. Signs and symptoms of the disease.

SIGNS AND SYMPTOMS Persistent fever and rash. (before joint involvement is present) Fatigue Malaise Anorexia Weight loss Lymphadenopathy localized articular symptoms - fingers at proximal interphalangeal (PIP) - metacarpophalengeal joints (MCP) - metatarsophalangeal joints - also may extend to wrists, knees, elbows, and ankles.

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DIAGNOSTIC EXAMS X-ray Synovial Fluid analysis WBC count Serum Protein Electrophoresis Erythrocyte Sedimentation CBC C-reactive Protein Test MEDICATIONS Salicylates (particularly aspirin) Nonsteroidal anti-nfalmmatory (indomethacin, fenoprofen, and ibuprofen) Anitmalarials (hydroxychloroquine) Golds salts Penisillamine Corticosteroids (prednisone) Nursing Diagnosis
Knowledge deficit related to care necessary to control disease symptoms.

Goal
Parents and child will demonstrate knowledge of care regimen by 1 week.

Outcome Criteria
Parents and child follow instructions regarding exercise and medication.

TREATMENT Synovectomy Joint reconstruction Total joint arthroplasty THERAPEUTIC MANAGEMENT Exercise Heat application Splinting Nutrition Medication NURSING INTERVENTIONS If the patient requires knee or hip arthroplasty, provide appropriate teaching and postoperative care. Inspect all joints carefully for deformities, contractures, immobility and inability to perform everyday activities. Monitor vital signs and note weight changes, sensry disturbances and level of pain. Give maticulous skin care. Encourage patient to eat a balanced diet. Explain all diagnostic tests and procedures to parents. Monitor the duration not the intensity of morning stiffness. Explain the nature of RA to the parents. Urge the patient to perform activites of daily living such as dressing and feeding him/herself etc, resting for 5 to 10mins ou of each hour and alternating sitting and standing tasks. Before discharge, make sure the parent knows how and when to give the prescribed medication and how to reorganize its possible adverse effects. Teach the patient how to stand, walk and sit correctly: upright and erect.

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EXPECTED OUTCOME Parents of the patient will verbalize understanding of the condition. Patient will be able to perform activities such as walking, feeding him/herself independently. Pain will decrease. Patients mobility will increase. Inflammation will decrease. EVALUATION Increase in mobility. Decrease in pain and inflammation. No longer feel uncomfortable. Weight returned to normal.