FAR EASTERN UNIVERSITY

Nicanor Reyes St. Sampaloc, Manila

Institute of Nursing

A Case of Chronic Paint R/T Juvenile Idiopathic

Arthritis
 Family History

According to the client’s family history, three of the client’s family members have heart disease,
one who died, the client’s grandfather from the mother side, and the other two are from the father side.
Hypertension is also observed on both clans. There are also family members with Down syndrome and
stroke. There will be a possibility or there is already a risk that the client can have hypertension or heart
disease when she reached the old age since it exists in both sides of her family.

72
52 66
66 [Hypertension]
[Stroke] (heart disease) [Hypertension]
[Heart Disease]
]

42 37 40 29
42
[Heart Disease] A/W [Down
A/W A/W Syndrome]

3
CLIENT
A/W
Pathophysiology

Primary cause of JIA is not well known, but is thought to be influenced by both genetics and
environmental variables.

Clinical symptoms of the systemic-onset occurring with JIA mostly resemble auto inflammatory
syndromes. But then again, many consider that the systemic-onset of JIA should be concluded as
a separate disease, distinct from the other auto inflammatory syndromes.

Other possible factors that have been thought to be contributing in the pathogenesis of JIA
include; immunologic dysregulation, psychological stress, trauma, hormonal abnormalities,
and infectious triggers.

The progression of symptoms generally starts off with a persistent inflammation of a synovial
membrane which then result in joint destruction which can cause long term bone, tendon, and
ligament problems. With the three major types, they tend to present slightly different amongst
each other. Oligoarticular JIA which is almost half of the cases of JIA, female clients are more
commonly affected than males and it’s between the first 2 to 3 lifespan of the client. It would be
a rare case for this case to present after 10+ years of age. Polyarticular JIA is about a third of the
known cases, 35%. And again, Female clients tend to be more affected by male clients. This case
however has two different period of time in which it shows up the most, between 2 to 5 and then
10 to 14. Systemic JIA is the minority of cases, only about one in 10 and either gender are
equally affected by this type of JIA. It can happen at any point of the age period under 17 years
of age.

Oligoarticular JIA involves usually less than five or at the very least, less than 6 joints. It
includes Medium and Large joints, the disease tends to be asymmetric on how it affects the child,
rarely involves hips, and tends to be a non-destructive arthritis. Polyarticular JIA differs from
Oligoarticular JIA in a manner that it involves multiple joints. It affects any, if not all joints that
it afflicts. This disease is also more symmetric than the latter. Usual cases of Polyarticular JIA
affects the hands, feet, and ankles but it rarely affects the hips as well. And again, unlike the
Oligoarticular JIA, this type is destructive. Lastly, Systemic JIA may affect any joint or no joint
at all. If it does involve joints, it is often a destructive arthritis. Clients affected by this type
usually reports daily high fever.

PROBLEM IDENTIFICATION AND PRIORITIZATION

NURSING RANK JUSTIFICATION

DIAGNOSIS
CUES

Chronic Pain Unpleasant sensory and emotional experience arising from actual or
potential tissue damage or described in terms of such damage
(International Association for the Study of Pain); sudden or slow
1ST onset of any intensity from mild to severe, constant or recurring
without an anticipated or predictable end and a duration of greater
than 6 months.

Self-Care Deficit Impaired ability to perform or complete activities of daily living for
oneself, such as feeding, dressing, bathing, toileting.
2ND
Compromised A usually supportive primary person (family member, significant
Family Coping other, or close friend) insufficient, ineffective, or compromised
support, comfort, assistance or encouragement that may be needed
by the individual to manage or master adaptive tasks related to his
or her health challenge.
3RD

Nursing Care Plan

Assessment Diagnosis Planning Implementation Rationale Evaluation

Subjective: Chronic pain After 8 hours Assess for Patient with Goal met.
“Lagi related toof nursing signs and chronic pain After 8 hours
siyang Juvenile interventions, symptoms may not exhibit of nursing
parang may Idiopathic the patient associated with the interventions,
iniinda sa Arthritis aswill at least chronic pain physiological the patient
mga kamay evidenced by be able to such as fatigue, changes and was able to
niya, tapos pain scale of 8verbalize decreased behaviors verbalize
minsan sa acceptable appetite, associated with acceptable
paa din.” As Definition: level of pain weight loss, acute pain. level of pain
verbalized Chronic pain relief and changes in relief and
by the is an ability to body posture, ability to
client’s unpleasant engage in sleep pattern engage in
guardian sensory and some desired disturbance, desired
 emotional activities. anxiety, activities
Objective: experience irritability,
Wong’s arising from restlessness, or
baker faces actual or depression.
pain rating potential Patients with
scale: 8 tissue damage chronic pain
or described may not exhibit
PR:112 in terms of the
such damage; physiological
RR:21 constant or changes and
recurring behaviors
BP: 110/80 without an associated with Patients with
anticipated or acute pain. chronic pain
Restlessnes predictable have a long
s end and a Assess the history of using
duration of patient’s many
Fatigue greater than Perception of pharmacological
6months the and non-
Guarding in effectiveness of pharmacological
the area Reference: methods used methods to
Gulanick, for pain relief control their
Klopp, in the past. pain
Galanes,
Gradishar,
Puzas,Nursin
g Care

Evidence Based Nursing (EBN)

Chronic Pain R/T JIA

Providing chronic pain management in the “Fifth Vital Sign” Era: Historical and treatment
perspectives on a modern-day medical dilemma

Population Intervention Comparison Output

Women are more likely A systematic review The data show that The management of
to report chronic pain was completed in opioids, pain killers, or JIA is usually focused
than men (34.3% vs. preparation for the NSAIDs are much around restricting the
26.7% in a nationally 2016 CDC guidelines more effective than any inflammation observed
representative sample on the use of opioids other pain relieving in a joint in the client.
in the US) for the treatment of therapy presented by NSAIDs, Nonsteroidal
chronic non-malignant the Physicians. anti-inflammatory
pain in primary care. drugs, are the first line
of therapy used in the
clients. Usually, long
acting NSAIDs like
 naproxen are provided
to control the swelling
and pain experienced
by the client.

CRITICAL SUMNMARY:

The assessment and treatment of chronic pain will continue to be one of the most common
functions of a health care provider. To move beyond an over reliance on opioid medications, the
addiction and pain research communities must unite with chronic pain patients to increase the
evidence base supporting non-opioid analgesic strategies.