Fill in the concept map linked below with the information you have on your most recent patient. Then look at opportunities, real or imagined, for collaborative and/or interdisciplinary care. What could you do to make everything and everyone work together for the good of the patient?

Evaluation may be real or imagined as well. Think “outside” the realm of the clinical picture you’re presented. If you believe the suggested improvements to care will benefit the patient, say so! If you are not convinced that the prescribed collaboration will be effective, say that as well.

Clinical Manifestations:

Subjective:

Objective:

Patient’s Medical Diagnosis

Nursing Diagnosis:

Short Term Goal:

Long Term Goal:

Patient’s Past Medical History and Significant Findings:

Collaboration:  With whom will the nurse be working and why?

Patient’s Laboratory & Test Results:

Nursing Interventions (at least 4):

Evaluation of Plan or Anticipated Evaluation of Plan:

ANSWER

Concept Map for Collaborative Care: Rheumatoid Arthritis Exacerbation

Clinical Manifestations

Subjective
Worsening joint pain
Increased morning stiffness
Fatigue
Difficulty with daily activities

Objective
Swollen and tender joints
Decreased joint mobility
Erosions on X-rays
Elevated CRP, RF, anti-CCP antibodies

Patient’s Medical Diagnosis: Rheumatoid Arthritis Exacerbation

Nursing Diagnosis: Impaired Physical Mobility related to joint pain and inflammation

Short Term Goal: Patient will experience reduced joint pain and improved mobility within 48 hours.

Long Term Goal: Patient will achieve optimal joint function and be able to perform activities of daily living independently.

Patient’s Past Medical History and Significant Findings
Known history of RA for 10 years
Methotrexate and prednisone treatment
Positive anti-CCP antibodies

Collaboration
Rheumatologist: Expertise in managing autoimmune disorders like RA.
Physical Therapist: Provide exercises for joint mobility improvement.
Occupational Therapist: Offer strategies for daily activities.

Patient’s Laboratory & Test Results
Elevated CRP, RF, anti-CCP antibodies
X-rays showing joint erosions

Nursing Interventions

1. Administer prescribed NSAIDs and adjust prednisone dosage for pain relief and inflammation control.
2. Educate patient on joint protection techniques and energy conservation strategies.
3. Coordinate with rheumatologist to adjust DMARD therapy and consider biologic DMARDs if necessary.
4. Collaborate with physical therapist to develop an exercise plan to improve joint mobility and strength.

Evaluation of Plan or Anticipated Evaluation of Plan
Monitor patient’s response to pain management and DMARD adjustments.
Assess patient’s ability to perform joint exercises and daily activities.
Measure improvement in joint pain, mobility, and patient’s ability to perform activities independently.

Opportunities for Collaborative Care
Collaborative care with the rheumatologist ensures specialized treatment adjustments.
Physical therapist’s interventions contribute to improved joint mobility and function.
Occupational therapist’s strategies enhance patient’s ability to manage daily activities.

Anticipated Evaluation of Plan
Anticipate improved joint mobility, reduced pain, and enhanced quality of life.
Evaluate patient’s adherence to medications and exercise regimen.
Measure success in achieving short-term and long-term goals.

Conclusion

Collaborative and interdisciplinary care involving the rheumatologist, physical therapist, and occupational therapist optimizes the management of the patient’s rheumatoid arthritis exacerbation. Coordinated efforts address both the medical and functional aspects of the patient’s condition, leading to improved outcomes and quality of life.