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1.
CHAPTER I
THE PROBLEM AND ITS SETTING
Every person gets old and when this happens, many
problems in the body occur. Getting old is often associated
with having problems with the joint like rheumatism and
other forms of the said disease that continually hunts not
just aged people but even ordinary people with unfortunate
fate of having the rheumatic problems.
Rheumatoid arthritis (RA) is a
chronic, systemic inflammatory disorder that may affect many
tissues and organs, but principally attacks synovial joints.
The process produces an inflammatory response of the
synovium (synovitis) secondary to hyperplasia of synovial
cells, excess synovial fluid, and the development
of pannus in the synovium. The pathology of the disease
process often leads to the destruction of articular
cartilage and ankylosis of the joints. Rheumatoid arthritis
can also produce diffuse inflammation in
the lungs, pericardium, pleura, and sclera, and also nodular
lesions, most common in subcutaneous tissue. Although the
cause of rheumatoid arthritis is
2.
unknown, autoimmunity plays a pivotal role in chronicity
and progression, and RA is considered a systemic autoimmune
disease.
Home Cures are possible for almost every health
disorder existing in the world. The old age people used to
have higher living rates and they lived a healthy life as
compared to the modern day human being. The sole logic
behind the fact is that they were dependent on the herbal
remedies and home cures and not on the chemically treated
drugs. Herbal medicines can be grown in your backyard and
using them is as simple as growing them. The home cures have
least side effects and they do not obstruct the normal
growth of body. The herbal medicines contain all the
essential ingredients to treat any disease and that's why
they are becoming more and more popular.
Apparently, rheumatism is something that can be taken
care of from home. The best point concerning a home remedy
is that you have many options and, if you think that a
particular ingredient does not suit you, you can try an
alternative. You should give each remedy at least a week
before trying another. This type of natural treatment
3.
avoids the conventional medicine that is used in various
treatments done today.
General Objectives
This study aimed to determine the alternative and most
effective home management practices for rheumatism. As a
member of the health care provider aims to provide health
teaching to manage this chronic illness effectively.
Specific Objectives
At the end of ten days of intensive care affiliation
the student nurse will be able to:
Assess the client and the complication of the disease.
Teach to accept the findings as an awareness to promote
Healthy lifestyle and Safety living condition.
Teach the client how to manage on her own condition
especially at home management.
Gain and widen knowledge about the entire disease
process formulate appropriate plan of care for the major.
4.
Client Profile
Patient: Leticia Rullan
Address: 201 Brgy. Manacnac Palayan City
Age: 60 years old
Gender: Female
Nationality: Filipino
Religion: Roman Catholic
Educational Attainment: High School Graduate
Occupation: Storekeeper
Family History of Illness
The patient’s family has history of hypertension on both
side of the family.
History of Present Illness
The patient was diagnosed with Rheumatoid Arthritis and
Hypertension at Good Samaritan Hospital,4 months ago . Few
day prior to consultation at the said hospital she
experienced headache, pain around nape area and stiffness
and joint pain. The doctor submitted her to several test
like x-ray, pulse oximeter.
Past and Current Medical Condition
Before she was diagnosed with rheumatism she is known to
have Hypertension. She was advised to take rest everytime
she feels stressed and avoid salty and fatty foods and
strenuous activities.
History of Hospitalization and Surgical Operation
The patient was hospitalized because of her hypertension and
knows she preferred to have monthly check-up to a private
doctor and did not undergo from any surgery.
Nutrition and Metabolic Pattern
Usual food intake
The patient usual fluid intake in the breakfast was 1
cup of rice, egg, and 1 glass of milk. Then in lunch time
she preferred pork giniling. In dinner time, she has least
food intake ½ cup of rice and pinakbet.
Usual Fluid Intake:
The usual fluid intake of my patient was 8-10 glasses
of water a day.
Food restriction:
The doctor advised my patient to avoid salty and fatty
foods.
Problems with ability to eat:
My patient told that she has no problem regarding
ability to eat.
Supplementation:
My patient vitamin was vitaplus.
Elimination Pattern
Urination:
She urinate 5 times a day with a yellowish color and
has no complaint.
Bowels:
My patient has bowel movement a day with a formed stool
and no complaint about it.
Activity and Exercise Pattern
Usual daily activities:
The usual daily activities of my patient was walkind
around their house, cooking dish.
Limitation of Physical activities:
The patient doesn’t engage in heavy work
Sleep and Rest Pattern
She usually sleeps at around 9pm to 5am with a total of 8
hours of sleep.
Vital Signs
Wt- 58kg
Ht- 5’2
Date Bp T P R
11-14-11 130/80
mmHg
°C 75 20
11-15-11 130/80
mmHg
36°C 70 20
11-17-11 130/80
mmHg
36.1°C 73 21
11-18-11 130/80 36°C 70 19
mmHg
11-21-11
11-22-11
SUMMARY PRESENTATION OF PATIENT ASESSMENT
Body Parts Assessment Findings
Skull No tenderness
noted upon
palpation,
generally round
with prominent
in the frontal
and occipital
area
Normal
Scalp Lighter in color
than the
complexion; no
scars noted
Normal
Hair Slight dryness,
brittle
Hair can be black or brown.
Nor brittle nor brown
Face No involuntary
movement noted,
shape is oval
and rounded
Normal
Eyes Slight blurred
vision, pupil
clear, Decreased
visual activity
No decrease visual acuity
Pupils react to light
and accommodation
Ear No drainage
No ringing of ears
Skin is same color with complexion
No hearing loss
Normal
Nose and
paranasal
sinuses
No discharges,
no tenderness
noted on
palpation
Nasal septum normally straight and not perforated
Normal
Neck and Throat Soft, no swollen
lymph nodes
Normal
Chest With expansion
and respiration
Normal breath sounds
No cough
Thorax
is symmetric
RR-20
Normal
Abdomen soft, non
tender,
Umbilicus is
midline and
inverted with no
signs of
discoloration
Normal
Upper
extremities
Swelling pain of
the fingers
symmetrically even in color, warmth and moisture without swelling
No edema
lower
Extremities
Swelling pain of
the joints
Both legs are symmetric in size
No swelling or atrophy
CHAPTER II
CASE DISCUSSION/PRESENTATION
PATHOPHYSIOLOGY
Figure 1. medical surgical nursing
In RA, the autoimmune reaction primarily occurs in the
synovial tissue. Phagocytosis produces enzymes within the
Presentation of antigen to T cells
T- and B-cell proliferation. Angiogenesis in synovial lining
Synovitis. Early pannus invasion. Chondrocyte activation. Degradation of cartilage by
proteinase.
Swelling in small joints, associated with pain,
stiffness and fatigue.
Warm, swollen, effusion, pain, and decreased motion with possible rheumatoid nodules.
Increase in severity of physical sign and symptoms.
Neutophil accumulation in synovial fluid. Cell proliferation. No cartilage invasion
joint. The enzymes break down collagen causing edema,
proliferation of the synovial membrane, and ultimately
pannus formation. Pannus destroy cartilage and erodes the
bone. The consequence is loss of articular surface and joint
motion. Muscle fibers undergo degenerative changes. Tendon
and ligament elasticity and contractile power are lost.
Pathophysiology of my client
Sign and symptoms
Stiffness: The joint does not move as well as it once did. Its range of motion (the extent to which the appendage of the joint, such as the arm, leg, or finger, can move in different directions) may be reduced. Typically, stiffness is most noticeable in the morning and improves later in the day.
Inflammation: Redness, tenderness, and warmth are the hallmarks of inflammation.
Swelling: The area around the affected joint is swollen and puffy.
Risk Factors
Age
Although rheumatoid arthritis can occur at any age from childhood to old age, onset usually begins between the ages of 30 - 50.
Gender
Women are more likely to develop RA than men.
Family History
Some people may inherit genes that make them more susceptible to developing RA, but a family history of RA does not appear to increase an individual's risk.
Smoking
Heavy long-term smoking is a very strong risk factor for RA, particularly in patients without a family history of the disease.
Female gender. After the age of 65, women have a much higher risk of developing osteoporosis
Diagnostic Exam
When she was hospitalized last year because of hypertension,
she diagnosed also with rheumatoid arthritis she undergo
with an x-ray. The result was she has a rheumatoid
arthritis.
Prevention
The first step in helping to prevent or reverse arthritis is proper cellular nutrition. You want to fill your body with good antioxidants, so the free radicals roaming around in your system are neutralized and flushed out of your body before they can do more harm.
In the past, good cellular nutrition meant eating the right fruits and veggies every day, but things are more complicated now. Because of the degradation of our food supply, it's harder to get the good antioxidants you need straight from the grocery store. Of course, eating a healthy balanced diet full of fruits and veggies is still a good start, but you need to make sure you're properly supplementing your diet with antioxidants and minerals.
Complication
Rheumatoid arthritis can affect other parts of the body as well as the joints. Some patients with severe disease may then be at higher risk for complications, such as the following:
Peripheral Neuropathy. This condition affects the nerves, most often those in the hands and feet. It can result in tingling, numbness, or burning.
Muscle problems. Many patients have weakness of the muscles.
Anemia. People with RA may develop anemia, which involves a decrease in the number of red blood cells.
Scleritis and Episcleritis. This is an inflammation of the blood vessels in the eye that can result in corneal damage. Symptoms include redness of the eye and a gritty sensation.
Infections. Patients with RA have a higher risk for infections, particularly if they are treated only with immune-suppressing drugs (corticosteroids, anti-tumor necrosis factors, disease modifying drugs).
Skin Problems. Skin problems are common, particularly on the fingers and under the nails. Some patients develop severe skin complications that include rash, ulcers, blisters (which may bleed in some cases), lumps under the skin, and other problems. Severe skin disease can reflects a more serious case of RA in general.
Kidney. Although rheumatoid arthritis only rarely involves the kidney, many of the drugs used to treat it can damage kidneys.
Heart Disease. Patients with RA have increased risk for death from coronary artery disease. Research suggests that he chronic inflammation associated with RA may be a factor.
Nursing Management
Physical therapy helps preserve and improve range of motion, increase muscle strength, and reduce pain.
Hydrotherapy involves exercising or relaxing in warm water. Being in water reduces the weight on your joints. The warmth relaxes your muscles and helps relieve pain.
Relaxation therapy teaches techniques for releasing muscle tension, which helps relieve pain.
Both heat and cold treatments can relieve pain and
reduce inflammation. Some people's pain responds better to
heat and other's to cold. Heat can be applied by ultrasound,
microwaves, warm wax, or moist compresses. Most of these are
done in the medical office, although moist compresses can be
applied at home. Cold can be applied with ice packs at home.
( Medical Surgical Nursing)
Medical Management
In some cases, reconstructive surgery and/or joint replacement operations provide the best outcome
Rheumatoid arthritis was traditionally treated in the past with a stepwise approach starting with nonsteroidal antiinflammatory drugs (NSAIDs) and progressing through more potent drugs such as glucocorticoids, disease-modifying antirheumatic drugs (DMARDs), and biologic response modifiers.
In the past, DMARDs were avoided early in the disease because of their potentially serious side effects and because they did not often bring on remission. DMARDs were
usually reserved for people who showed signs of joint damage.
Over time, however, this strategy was recognized as being faulty, because people treated early with DMARDs have better long-term outcomes, with greater preservation of function, less work disability, and a smaller risk of premature death.
The goal of drug treatment is to induce remission or at
least eliminate evidence of disease activity.
DRUG STUDY
NAME ACTION INDICATI-ON
CONTRAINDICATION
SIDE EFFECT
NSG RESPONSIBILITIES
Leflunomide(Activan) 10-20 mg once daily
AnalGesic/antiPyretics and muscle relaxant
Active RA in adult patients
Severe deficiency of the immune system
Incresase BP; diarrhea, nausea and vomiting, abdo-minal pain
Watch forimpairment of liver function, severe hypoproteinemiaMay be taken with or without food
Methylprednisolone (medrol) 200 mg/day
Hormones and related drugs
Endocrine, rheumatic And hemaTological disorders
Systemic fungal infection
Fluid and elecrtro-
Lyte, muscoskeletal , GIT disturbances
W/draw from long-term therapy gradually.Monitor BP, salt, water & K. Pregnancy & lactation.
DOLO-Neurobion Analge-Sic/ anti-Pyretic andmusclerelaxant
Neuri tis, neural-gia
Acute intermittent porphyria, decompensated cardiac insuffici-ency
Rarely allergy caused by vit. B1.
May be taken with or without food (May be taken w/ meals to reduce GI discomfort.). Watch
for rash & other allergic reaction
NURSING CARE PLAN
Rheumatoid Arthritis
ASSESSMENT DIAGNOSIS NSG. OBJECTIVES
INTERVENTION RATIONALE
SUBJECTIVE:
“Napakasakit ng mga kasukasuhan ko” (I'm having severe joint pain) as verbalized by the patient.
Acute pain r/t distension of tissues by accumulation of fluid.
After 2 weeks of nursing intervention the patient will:
>Report pain is relieved/
controlled
>Appear relaxed, able to sleep/rest
Independent
Investigate reports of pain, noting location and intensity(scale of 0–10). Note precipitating factors and nonverbal pain cues.
Recommend/provide firm
Helpful in determining pain management needs and effectiveness of program
Soft/sagging mattress, large pillows prevent maintenance
OBJECTIVE:
Guarding/protective behavior
Restless
ness
facial grimacing
pain scale of 7 out of 10
V/S taken as follows
T: 37.5˚C
P: 100
R: 20
BP: 120/ 80
and participate in activities appropriately
>Follow prescribed pharmacological regimen.
>Incorporate relaxation skills and diversional activities into pain control program
mattress or bedboard, small pillow. Elevate linens with bed cradle as needed.
Suggest patient assume position of comfort while in bed or sitting in chair. Promote bedrest as indicated.
Collaborative
Apply ice or cold packs when indicated Assist with physical therapies, e.g., paraffin glove,
of proper body alignment, placing stress on affected joints. Elevation of bed linens reduces pressure on inflamed/painful joints.
In severe disease/acute exacerbation, total bedrest may be necessary (until objective and subjective improvements are noted) to limit pain/injury to joint.
Cold may relieve pain and swelling during acute episodes.
Provides sustained heat to reduce pain and improve ROM of affected joints
ASA exerts an anti-inflammatory and mild analgesic effect,
whirlpool baths.
Administer medications as indicated
Salicylates, e.g., aspirin (ASA) (Acuprin, Ecotrin, ZORprin);
decreasing stiffness and increasing mobility. ASA must be taken regularly to sustain a therapeutic blood level. Research indicates that ASA has the lowest toxicity index of commonly prescribed NSAIDs.
Characteristics of anti-inflammatory and immune modifier effects coupled with ability to block metalloproteinases
ASSESSMENT
DIAGNOSIS
PLANNING INTERVENTION RATIONALE
EVALUATION
SUBJECTIVE:
IMPAIRED TO
“SUMASAKIT RAYUMA KO, HIRAP AKONG LUMAKAD”
OBJECTIVE:
>PAIN ON BOTH EXTREMITIES PAIN SCALE OF 3/5
>DISCOMFORT
>RESTLESSNESS
>UNABLE TO WALK
>SWELLING ON BOTH EXTREMITIES
PHYSICAL MOBILITY RELATED TO PAIN ON BOTH EXTREMITIES, AS EVIDENCED BY DISCOMFORT AND RESTLESSNESS
PROMOTE COMFORT AND PREVENT OTHER COMPLICATION.
>SUPPORT AREAS
>ASSIST WITH TREATMENT OF UNDERLYING CONDITION CAUSING PAIN LIKE ADMINISTER MEDICATION PRIOR TO ACTIVITY AS NEEDED FOR PAIN RELIEF
>ENCOURAGE PARTICIPATION IN SELF CARE, DIVERTIONAL ACTIVITY
READING NEWSPAPER
SOCIALIZATION
>ENCOURAGE ADEQUATE INTAKE OF FLUIDS/ NUTRITIOUS FOOD
>TO PERMIT MAXIMAL EFFORT IN ACTIVITY
>ENHANCE SELF CONCEPT IN SENSE OF INDEPENDENT.
AFTER RENDERING OF NURSING CARE PROMOTION OF MOVEMENT AND PREVENTION OF OTHER COMPLICATION ATTAINED
GOAL WAS MET.
COLLABORATIVE:
REFERRAL TO A PHYSICAL THERAPIST.
>PROMOTES WELL BEING IN MAXIMIZES ENERGY PRODUCTION.
ASSESSMENT DIAGNOSIS
PLANNING INTERVENTION
RATIONALE EVALUATION
SUBJECTIVE
NANGHIHINA AKO AS VERBALIZED BY THE PATIENT.
OBJECTIVE:
FATIGUE RELATED TO INCREASED DISEASE ACTIVITY
AFTER 5 DAYS OF NURSING INTERVEN TION THE PATIENT WILL:
VERBA
INDEPENDENT
PROVIDE PERIODS OF UNINTER- RUPTED REST THROUGHOUT
●CLIENT OFTEN HAVE LIMITED ENERGY RESERVE.
AFTER RENDERING OF NURSING CARE PROMOTION OF MOVEMENT AND PREVENTION
DECREASED FUNCTIONAL ACTIVITY RESTLESSNESS
FACIAL EXPRESSION: YAWNING, SADNESS
INTERRUP-TED SLEEP
V/S
BP- 130/80 MMHG
T- 36.3°C
PR -75
RR-19
LIZED/ DEMONSTRATES INCREASED ABILITY TO MOVE PURPOSE FULLY
DAY (30 MIN 3-4 TIMES A DAY)
ALTERNATING ACTIVITY WITH REST
INTERRUP-TED SLEEP:
ENCOURAGE WARM SHOWER OR BOTH IMMEDIA-TELY BEFORE BEDTIME
ENCOURAGE GENTLE ROM EXERCISE AFTER BATH
COLLABORA-TIVE:
●CLIENT OFTEN USES ENERGY THAN OTHER TO COMPLETE SAME TASKS.
●WARM WATER RELAXES MUSCLE , FACILITATING TOTAL BODY RELAXATION
●TO MAXIMIZE EFFECTS OF HEAT
●REDUCES MODERATE
OF OTHER COMPLICATION ATTAINED
GOAL WAS MET.
ADMINIS-TER NIGHTIME ANALGESIC/ LONG-ACTING ANTI-INFLAMA TORY DRUGS AS PRES-CRIBED
INFLAM-MATION
Foreign Literature
In Philippines as well as in many other countries
there is a general overview of the health of the
population based on a national survey. Therefore it is the
time to look at the population risk groups. Rheumatism is
the most frequent illness diagnosed in population. For
example, in the United Kingdom more than 12% of the
population aged 65 years and over are affected with
rheumatoid arthritis. In Finland, the age adjusted incidence
of rheumatoid arthritis in the adult population was
31.7/100,000. Projecting to the year 2020, an estimated
18.2% of Americans will be affected by arthritic disorders,
equivalent to 60 million people. The spread of these
illnesses will increase in the coming years for several
reasons. First, the trends in demographic changes indicate
that the proportion of older people in population is
constantly growing. Secondly, ageing is accompanied by
chronic diseases, including musculoskeletal disorders.
According to Dr. Edward R. Laskowski of the Mayo
Clinic, the application of heat or ice may be useful in the
healing process. In general, you should use ice for swollen,
red and painful joints. Acute inflammation is often damaging
to our own tissues; in cases of rheumatism, the inflammation
is actually doing more damage than the original problem.
Therefore, ice is recommended in order to inhibit
inflammation; this occurs via reduced blood flow and
decreased swelling.
However, if the condition has been present for a
significant period of time, blood flow should be stimulated
in order to promote an active healing process. Chronic
inflammation may lead to the deposition of scar tissue,
which acts to inhibit your body's natural repair processes.
By applying heat, your blood vessels are forced to dilate
and allow more blood to enter the area.
(http://www.livestrong.com/article/330159-exercises-for-rheumatism/,
mayoclinic.com , www.google.com)
Overall, the body's immune response has one primary function: to protect the body from an object that the body does not recognize as a normal object. The immune response can be either normal or abnormal. Inflammation is also one of the body's first responses to infections as the body tries to rush immune cells and cytotoxic chemicals to the infected tissue to defend against the infections or foreign particles. Arthritis tends to develop inflammation in the joints and their surrounding tissues. Rheumatoid arthritis is an autoimmune disease where the body perceives tissue in the joints as being a foreign object and fights the tissue through an immune response. Tests for rheumatoid arthritis are rather simple and readily available. Rheumatoid arthritis has many options available for treatment such as medications and minor surgeries. Future advancements are continually being tested in clinical settings to help in improving treatment for rheumatoid arthritis patients.
(Lethbridge Research Journal. 2007. Volume 2 Number 1.)
There are many alternative methods a person can do to
treat their rheumatism. Especially if they have rheumatism
in their knees. Put on a good liniment like icy hot or Ben
Gay before you go to sleep. When you awake, your knees will
not be stiff. Do not walk or stand when you are in pain. Sit
down and take a rest for a while.
Do not push yourself. Know your limitations. Get the
right kind of exercise. Exercises like bike riding,
swimming, walking and floor exercises are all good for the
joints. Make sure you get your doctor's permission before
starting any exercise program. Three time a week for 30
minutes at a time is plenty of time for a exercise regime.
Do you or someone that you love suffer from rheumatoid
arthritis? If so, the pain and discomfort that is commonly
associated with rheumatoid arthritis may be too much to
handle. When it is, there are many rheumatism sufferers who
turn to over-the-counter medications to seek relief. Yes,
these over-the-counter medications will work in most cases,
but did you also know that there are natural and safe ways
to manage and treat rheumatism? There are and a few of
these natural remedies are highlighted below.
The consumption of raw juices is an effective and
natural remedy for rheumatoid arthritis. Two specific types
that come highly rated and recommended are green juices, as
well as potato juice. In fact, potato juice has been used
to treat the pain and discomfort commonly associated with
rheumatoid arthritis for years on end. For potato juice,
cut a potato into thin slices. When doing so, leave the
skin intact. Place the potato slices in a glass of cold
water and leave sitting for a few hours, overnight is best.
Then drink.
The consumption of Omega 3 Fatty Acids are another
natural way to treat many of the symptoms of arthritis.
Omega 3 Fatty Acids are found in most fish. Those who do
not like eating fish are encouraged to examine Omega 3 Fatty
Acid supplements, which are available for sale at most drug
stores and health stores. This natural remedy can provide
relief from all forms of arthritis; however, those with
rheumatoid arthritis see and feel the best results.
Warm olive oil massaged over the area is another easy
and natural way to relieve the pain and discomfort
associated with arthritis. What is nice about this approach
is that most individuals already have olive oil in their
homes. When using warm olive oil, be sure to let cool a
little, as olive oil that is too hot can result in painful
skin burns. In addition to plain olive oil, sage, rosemary,
or garlic can be diluted with olive oil, with about ten more
parts of olive oil. When applied to the impacted area,
relief should be felt immediately.
Baths are another natural way to treat the pain and
discomfort often associated with arthritis. When using
baths to seek relief, warm baths are advised. In fact, cold
bathes can result in increased pain, which is not the goal.
In addition to a traditional warm bath, many of those
suffering from arthritis recommend adding about three or
four tablespoons of Epson salt to the bathwater. Those
diagnosed with arthritis should remain in a warm bath for at
least thirty minutes.
Small amounts of exercise is another natural way to
relieve the pain and discomfort commonly associated with
arthritis. The only problem is that those suffering from
arthritis must proceed with caution where exercise is
concerned. Moving around, whether it be through walking or
squeezing a stress ball, can help, but it also important not
to over do it. Those who overexert themselves are likely to
experience even more pain and discomfort.
As you can see, there are a number of natural remedies
and home remedies that can be used to seek relief from
arthritis. If you are not suffering from arthritis, but if
you know someone who is, you may want to pass these easy and
natural remedies onto that person. Unfortunately, many
individuals are unaware of natural remedies and their many
benefits.(http://www.knrn.org/natural-remedies-for-arthritis.html,
www.google.com)
Local Literature
Holistic Healing in the Philippines Located on the
tropical island of Cebu, Philippines, AM Wellness is a
center using holistic healing and natural therapy to
overcome disease and achieve total health and well-being. We
also teach our students the keys to life-long health through
the practice of yoga, meditation and vegetarian diet.
Rather than use the word “patient”, we prefer to call
the people who come here “students” because they are here
not only to be cured but also to experience how to remain
healthy and disease-free for the rest of their lives.
Our naturopathy treatments courses run between 12 days
and 4 weeks or more, and include detoxification, herbal
colon cleansing, mud/water/sun therapies, water cleansing,
fasting, alternative medicines, and exercise. These are
complemented by music, art, classes, outings and games. We
do not offer “out-patient” short-term care.
The Wellness Center Situated in a quiet neighborhood of
Pagsabungan, Mandaue, Cebu, the Ananda Marga Wellness Center
is the country’s first affordable stay-in alternative
healing center. It practices a holistic approach to health
through various natural therapies, the practice of yoga,
meditation and vegetarian diet. We do not only assist our
students in their healing, but we also teach them the path
to life-long health.
EMPOWERS PEOPLE
- to overcome problems caused by excess fat, stress and
disease
- to cure themselves through a system of natural therapy
without depending on medicines
- to become physically fit, mentally relaxed and fully
conscious
- to learn new healthy systems of eating, exercise, drinking
water and harmonious thought
We offer a complete systematic, in-patient natural therapy
program. Daily activities are not only therapeutic but also
entertaining and educative.
OUR MAIN THERAPIES
- a nutritious, delicious DIET of alkaline food (fruits,
vegetables and other light vegetarian food), freeing the
digestive system from its normal burdens so the body can
naturally heal itself
- our unique SUPER HERBAL DETOX, which is superior to any
leading colon cleansing herbal products. It not only absorbs
toxins from the digestive system, but also ultimately from
the entire body. It is vital for getting a new start in your
life.
- an exercise program with a wide range: a) gentle YOGA
POSTURES for the glands and nerves b) SLOW EXERCISE of
walking and mild games c) VIGOROUS EXERCISE of brisk walking
& running, treadmill, swimming (at a nearby pool), aerobic
dance and active games
- various individually prescribed treatments include
MUD PACK applying hygienic mud to specific areas of
need, or in some cases to the whole body both absorbing
toxins and attracting healing blood
STEAMBATH to sweat out toxins, while keeping the face
in fresh air (not like sauna, which compels one to breathe
in toxic air)
HOT FOOTBATH also to sweat out toxins, with a
particular effect on lower body and lung problems
COLEMA (in between COLonic machine and EnEMA) internally
cleansing the intestines
SPINAL BATH to cool the spine only, our best physical
treatment for releasing stress
WARM CIDER VINEGAR BATH done only just before sleeping
for those who have difficulty to sleep, enabling nerves to
thoroughly relax
HYDRO BUBBLE BATH with 300 jets of warm or hot water,
directed at specific areas of the needy body, together with
aromatic oils
SYSTEMATIC SUNBATH alternating in and out of the sun,
with water or oil massage according to need, for fixed
number of minutes and during a fixed interval
HIPBATH attracting healing blood to the lower internal
organs including the digestive organs and the female organs
HOT WATER BAGS AND ICE PACKS depending on whether one
needs heat for relaxation or cold for healing
- WATER-DRINKING SYSTEM, 3 to 4 litres or more daily, to
cleanse toxins
- MENTAL EXERCISE & MEDITATION (including deep relaxation
and visualization) to convert stress into calm positivism
- a graduated program of specialized ELIMINATION DIETS &
FASTING on juices, broths, fruits and/or vegetables for
several days.(http://manilasector.org/?p=92, www.google.com)
Autoreactivity plays a major role in the pathogenesis
of RA. The rheumatoid factor has been and still is
for now more than 50 years the only autoreactivity that is
clinically applied in the diagnosis of RA. This
well reflects the current way of thinking that a single
antigen or a single cause drives an individual into
disease. Although by now many other autoantigens and
autoreactivities have been described, their
discovery was always on the search for the one and only
autoreactivity that causes RA. This includes also
immune reactivities directed against xenogenic antigens.
But, none of the known RA-associated
autoreactivities is present in all RA patients and none of
them occurs exclusively in RA. Thus, the
observed sensitivities and specificities are well below
100%. Therefore, RA has often been postulated to
consist of various immunological subentities with similar
clinical symptoms. Nevertheless, none of the
autoreactivities correlates with a distinct clinical feature
or course of disease. It is about time to say goodbye to the
idea that a single antigen or immunoreactvity causes and
maintains rheumatoid arthritis. In this
paper we present RA as the clinical outcome of an immune
system that has shifted from a healthy to an
autoimmune steady state. This is accomplished by many
different reactivities and autoreactivities that
occur either in parallel or one after the other. The
entirety of the known RA-associated reactivities and
(auto)antigens is presented in detail. The major RA-relevant
autoantigens comprise BiP, citrulline, the Saantigen, hnRNP
A2, p205, IgG, calpastatin, calreticulin, collagen and the
shared HLA-DR epitope. The
accumulation of factor--involving autoreactivities,
cytokines, environmental and genetic factors--that
challenge the normal regulatory mechanisms of the immune
system lead to a regulatory catastrophe.
(Z Rheumatol. 2007 Feb;60(1):1-1)
Foreign Studies
Recent studies using tumor necrosis factor-alpha
inhibitors, both alone and in combination with other
medications, have shown that patients demonstrate
significant improvement based on American College of
Rheumatology criteria (Felson et al.,2006)
Respondents to a population pain survey who had
reported having musculoskeletal pain in the survey and who
had consulted about their pain in primary care in the
previous 12 months as well as consenting to further research
and agreeing to an interview. Information was gathered about
their pain and the use of all treatments for pain, including
CAM, in the previous year.
Background
Surveys have suggested that use of complementary and
alternative medicines (CAM) is high and increasing
worldwide. Longitudinal studies in the UK between 1993 and
1999, 1995 and 2001 and between 1998 and 2006 and in the USA
between 1990 and 1997 have confirmed the trend. CAM is most
commonly used for chronic pain and in particular
musculoskeletal pain and is often used in combination with
conventional therapies. GPs are the conventional medical
practitioners most frequently consulted for chronic pain in
the UK.
A number of surveys have been conducted in the UK to explore
CAM use. Some of these were general population surveys,
surveys among patients with definitive rheumatologic
diagnoses attending hospital clinics, or surveys of
healthcare professionals exploring their patients' use of
CAM and access to it.
In primary care in the UK, surveys targeted healthcare
professionals rather than patients. We are not aware of
surveys conducted in the UK that have directly explored CAM
use among primary care patients who suffer from chronic
musculoskeletal pain. Evidence suggests that users do not
necessarily access CAM through primary care and also they
are often reluctant to inform their doctors of their use of
these treatments. Figures on access to CAM through primary
care and on health professionals' provision of CAM,
therefore, might have under-represented actual CAM use among
primary care patients.
We are not aware of previous surveys of primary care
patients that have enquired about the perceived helpfulness
of treatments from the patients' perspectives. This is
important for understanding healthcare seeking behaviour
among chronic pain sufferers, for informing effective pain
management in primary care and because of potential safety
issues related to CAM use.
We wanted to address these issues with particular focus
on musculoskeletal pain sufferers who are using primary care
in the UK. We have therefore investigated the pattern of CAM
use in a sample of chronic musculoskeletal pain patients who
were consulting primary care in the UK. Our hypothesis was
that this group of patients would have a higher prevalence
of CAM use than general population samples or pain sufferers
generally. This was based on the idea that this group will
have selectively more severe problems than the general
population because they have sought health care and because
chronic musculoskeletal pain is often unresponsive to
conventional primary care treatment http://www.google.com
An alternative treatment approach for RA has emerged in
the area of biologic therapies. Biologic response modifiers
are a group of agents that consist of molecules produced by
cells of the immune system or by cells that participate in
the inflammatory reaction. (Koopman,2006)
Local Study
In initiating a community oriented programme for the
control of rheumatic disease (COPCORD), 1685 people of all
ages from a rural area in the Philippines were questioned by
primary health care workers (PHW) for limb and spinal
rheumatic pain and disability. The total complaint rate was
15.3% for men and 18.5% for women. For those 15 years and
older the age adjusted rheumatic pain rates for pain present
at the time of survey were 28.4% for the Philippines and
22.6% for Lawrence's UK population. The most common
rheumatic pain sites in this community were knee, lumbar
spine, neck and the trapezius muscle. The disability rate
was 4.5% for those 15 years and older. One quarter of those
with pain had received medical attention and the remainder,
herbal treatment, massage, various faith and/or self-
treatment methods.
(http://www.springerlink.com/content/gg813l16x4690623/, www.google.com)
The Study of Active Controlled Monotherapy Used for
Rheumatoid Arthritis, An IL-6 Inhibitor (SAMURAI) study
demonstrated that, compared with DMARDs, tocilizumab
monotherapy significantly inhibited progression of
structural damage in Japanese RA patients.[21] In addition,
preliminary results reported from the Tocilizumab Safety and
the Prevention of Structural Joint Damage (LITHE) study
showed that, compared with MTX alone, tocilizumab plus MTX
treatment resulted in significantly less progression of
joint destruction.[22] In the present study, X-ray images at
baseline and at Week 52 of tocilizumab treatment were
available for 149 of 232 patients, allowing us to evaluate
the radiographic effect of tocilizumab. As stated above, the
duration of disease in patients enrolled in this study was
12.4 years, and estimated yearly progression was
significantly high, with 20.8 (1.3) at baseline. Considering
the results of the impact on radiographic and clinical
response to infliximab therapy concomitant with methotrexate
in patients with rheumatoid arthritis by trough serum level
in a dose escalating (RISING) study, in which we reported a
disease duration of ~8 years and mean estimated yearly
progression of 8.1 (9.1) the present study included
patients with remarkably severe clinical features with long
disease duration and progressive joint destruction.
Irrespective of these severe conditions, the 95% inhibitory
effect of tocilizumab indicates how powerful its inhibition
of joint destruction is. Surprisingly, we found that
tocilizumab inhibits the radiographic damage, not only in
patients treated without TNF inhibitors, but also in those
treated with TNF inhibitors. Although further research is
needed, our findings suggest that the pathological condition
of RA is dependent on TNF. The good results obtained with
tocilizumab are consistent with those of both domestic and
foreign studies.
( http://www.medscape.com/viewarticle/750779_4)
CHAPTER III
METHODS AND PROCEDURE FOR DATA GATHERING
DATA GATHERING TECHNIQUE
The Data Gathering Technique used is Interview, Survey
Home Visits and Questionnaires.
To answer the research problems the student nurse used
a non-experimental design, questionnaires, survey study.
Questionnaire aim to gather information for purposes of
research for market surveys, analysis or even to corroborate
other research findings. They are one of the cheapest and
most feasible ways of gathering data. It is important to
remember that for any questionnaire to be really effective
it has to be designed well. Interview is used to collect
facts, structured interviews in their simplest form are
sometimes little more than oral questionnaires. The student
nurse interview the client by asking the questions in the
questionnaire prepared by the Clinical Instructor, it is
done to obtain a higher response rate with respondents,
especially children, who might not be literate or capable of
correctly completing a complex questionnaire. The student
nurse also brought instruments for assessment of the
client’s present condition.
ADMINISTRATION OF INSTRUMENT
The student nurses of Nueva Ecija University of Science and
Technology together with their Clinical Instructors first
asked for the permission of the Barangay Captain before
conducting their case study. We also gathered that Barangay
Manacnac have a total population of 1652 and total house
hold of 457. After gaining the Barangay Captain’s approval
the student nurse first visited one of the respondents house
which became her client. She gather information by means of
an interview, certain questions were asked about the
client’s profile and her past and present medical status.
Basic instruments such as thermometer, BP cuff and
sphygmomanometer was used to assess the client’s vital
signs. Weighing scale was also used to get the client’s
weight, the information acquired serves as the primary
information about the client for the case study.
LOCALE OF THE STUDY
History of Manacnac
Ang kabisera ng lalawigan ng Nueva Ecija ay ang lungsod
ng Palayan. Dito matatagpuan ang Barangay Manacnac. Ayon sa
kasaysayan, ang Manacnac ay dating sitio ng Maligaya na
sakop ng Laur, Nueva Ecija na may kaunting populasyon, taong
1953 si Ginoong Anong Simanero ang naging kapitan sa lugar
na ito. Kung iyong makikita ang Barangay na ito, para kang
nasa isang bundok na malayo sa kabayanan. Ang lugar na ito
ay may gulod na ang makikita ay puro mga damo at talahib
maliban lamang sa piggery na pag-aari ng mga Wycoco.
Tanong 1965 ng mapagpasyahan ng kongreso ng Pilipinas
na ang Palayan City ang magiging bagong kapital ng Nueva
Ecija. December 5, 1965 ang inaguration ng City Government
sa Palayan napagpasyahan ito ni ex-official Mayor Eduardo L.
Joson.Sina Mayor Elpidio O. Cucio at kanyang Vice Mayor na
si Felipe Bautista ay nahalal bilang unang subsequent local
official.
Taong 1966 nang naging Kapitan si G. Romulo V. Sandoval
sa Barangay Manacnac noong ang barangay na ito ay sakop
parin ng Laur. Nang panahong iyon may isang dayuhan na
nanggaling sa Novaliches Q.C. ang nag interas na bumili ng
lupa sa nasabing barangay at dito na rin siya nanirahan.
Siya ay si Ginoong Pedro Valenzuela. Nag-donate ng
kalahating hektaryang lupa para sa eskwelahan ng Cabanatuan
City at Atate, pumapasol ang mga batang nag-aaral noon dito.
Taong 1972 nang dahil sa ordinansang pinasa bg
Sanggunian, Ang barangay Manacnac ay naging isang barangay
sa Palayan City at nang panahong iyon ay kapitan parin si
Ginoong Sandoval.
Taong 1976 tumaas muli ang populasyon ng barangay mula
sa bilang na 662 ay naging 852 at may bilang na 128 ang
bubong ng bahay, may pamilyang 131 nang sumapit ang EDSA
Revolution taong 1986 itinalaga ni Kgg. Presidente Aquino si
Don Pacifico M. Fajardo na OIC ng Palayan City at Vice si
Flor Agustib na kasalukuyang kapitan parin si Romulo V.
Sandoval.
LOCATION MAP
Sampling Design
Purposive sampling starts with a purpose in mind and the sample is thus selected to include people of interest and exclude those who do not suit the purpose.
This method is popular with newspapers and magazines which want to make a particular point. This is also true for marketing researchers who are seeking support for their product. They typically start with people in the street, first approaching only 'likely suspects' and then starting with questions that reject people who do not suit.
Purposive sampling is non-probability and hence can be subject to bias and error. http://changingminds.org/explanations/research/sampling/purposive_sampling.htm)
CHAPTER IV
CONCLUSION AND RECOMMENDATION
CONCLUSIONS
In the light of above findings of the study, the
following conclusions were arrived at:
1. That the most common problems encountered in physical
aspect of the respondents is pain, followed by fatigue,
eating disorder, weight loss, anemia.
2. The most common problem encountered in emotional aspect
is feeling helplessness followed by loneliness, anxiety and
fear.
3. The most common problem encountered in social aspect is
delaying on immediate job or meeting followed by withdrawing
from social activities, and decreased number of friends.
4. The most common problem encountered in economical is
shortage of money followed by delayed pension, change of
employment, early retirement.
5. The most common home management when it comes to physical
aspect is wearing pajamas because that is the simplest way
to prevent too much exposure to cold climate. Followed by
sleeping 8 hours a day, taking steam bathing, massage the
affected area, wearing stocky net/socks, applying hot
compress on the affected area, and applying cold packs on
affected area.
6. All remedies they choose, the most effective remedies is
efficascent oil followed by pau linament oil, white flower
and Betet were used as home remedies.
8. Pain reliever medications were prescribed because of
effectiveness of drug followed by taking over the counter
medicine, and taking extra supplement.
9. Maintaining proper body position is the simplest way to
prevent further deterioration of the cartilages that’s why
it prevents too much pain. Followed by avoiding heavy works,
elevating their legs, attending aerobics exercise at least
twice a week, always engage in brisk walking every morning.
10. Home management for eating disorder the most convenient
is eating fruits and vegetables because they can acquired it
immediately and affordable to their backyards. Followed by
eating green leafy vegetables like malungay, talbos ng
kamote, eating food rich in omega 3 fatty acids and fish oil
such as canned tuna etc., avoiding eating food rich in uric
acid such as mongo, sitaw, gizzards, nuts, and drinking at
least one glass of milk a day.
11. The home management in social aspect is watching
television because they divert their attention to forget the
pain. Followed by playing with their grandson, reading books
and newspaper, and going to mall with their relatives, going
to amusement park, and playing chess with their friends.
RECOMMENDATIONS
The researchers of the study hereby recommend that:
1. Relatives must provide knowledge to the elderly with
regards to home remedies and proper practices because old
aged are easily forget their activities. Practices vary
according to the individual but tasked could be done with
encouragement.
2. Patient should able to manage their activity daily living
to lessen the factor that can cause Rheumatism to occur.
They should also practice to limit eating rich in uric acid
such as monggo, sitaw, gizzards etc., because the crystals
of uric acid are deposited in the joints that causing pain.
3. Patient should have awareness about Rheumatism by
discussing this home management and affective practices as
the primary prevention for further deteriorations of body
functions, the disease process of Rheumatism
BIBLIOGRAPHY
Bautista Joy,THEORETICAL FOUNDATION OF NURSING. A Beginner Journey Into Professional Nursing. first
edition 2008
Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. eleventh edition 2008
Cacanindin,Nursing research : study notes and guide. 2010. by C&E Publishing, inc. 839 EDSA South Triangle, Quezon city
Concise Oxford English Dictionary eleventh edition
Seeley, Stephens, & Tate Essentials Of Anatomy And Physiology sixth edition 2007.
www.google.com;rheumatismworldhealthorganization http://www.disabled-world.com/health/autoimmunediseases /rheumatoid-arthritis/ra-diagnosis.php article5 Galanes feb 2006/
www.google.com; http://www.livestrong.com/article/330159-exercises-for-rheumatism/ mayoclinic.com article 1 Puzas January 2006
www.google.com; http:// www.knrn.org/natural-remedies-for-arthritis.html/2005 article7 Gulanik
www.google.com ; http://manilasector.org/?p=92,/2007 aricle3 klopp
ww. Google.com www.google.com; http://www.springerlink.com/content/gg813l16x4690623/, dec 2009
ACKNOWLEDGEMENT
As a student nurse wish to acknowledge and express
their deep appreciation and gratitude for the kind
assistance given by numerous people who helped them in the
preparation of this case study.
First and foremost, I want to offer sincerest gratitude
to my clinical instructor, Mrs. Girlie Tayao, RN, who was
supported and guided me throughout my case study, for the
humble sharing of her knowledge and experiences, for the
motivation and overwhelming encouragement, and for her
patience and understanding in checking my case.
To my staffing, Mr. Christian Gabuya for her whole-
hearted assistance and suggestions.
To the Dean of College of Nursing, Mrs. Eppie DC.
Bugarin, RM, RN, Ph.D for her valuable contribution to this
study.
To the personnel of Barangay Manacnac Palayan City for
providing necessary information to my research in conducting
this study.
Lastly and most importantly, the God almighty who has
given His great mercy and blessings for the years of study
of the researchers and who has given them a great privilege
to be His children.
Angelica P. Bravo
DEDICATION
After all the challenges, trials, hardships,
sufferings, efforts and sleepless nights, I made this humble
piece of work a successful one.
So, with love and respect, I dedicate this priceless
output to the following persons:
To my clinical instructor Mrs. Girlie Tayao RN who lend
her helping hands to guide me in the success of this study;
To my loving parents who always extend their best love
and care that serve as their inspiration in my studies;
To my staffing who always give their everlasting
support;
Above all, to the Lord Jesus Christ who is the divine
source of their strength, knowledge and abilities for
without Him, this work would have been in vain.
To all of them, I am humbly dedicate this piece of
work.
Angelica P. Bravo
TABLE OF CONTENS
Pages
Title ……………………………………………………………………………………………………………………………………………i
Acknowledgement …………………………………………………………………………………………………………………ii
Dedication …………………………………………………………………………………………………………………………… iii
Table of Contents ……………………………………………………………………………………………………….vi
I. THE PROBLEM AND ITS SETTING
Introduction ………………………………………………………………………………………………………… 1
General Objectives
………………………………………………………………………… 4
Specific Objectives
……………………………………………………………………………… 4
Client’s Profile
Foreign Studies …………………………………………………………………………………………………… 21
Local Studies ……………………………………………………………………………………………………… 24