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A nurse is caring for a 57-year-old female client in the emergency department who presents with joint pain and stiffness in her hands. The client has a history of hypertension and type 2 diabetes.

 

Exhibits

 

Nurses’ Notes (0700hrs):

 

• The client reports experiencing joint pain and stiffness in her hands for the past few months.
• The pain is described as aching and is worse in the morning, lasting for about an hour before improving.
• The client mentions difficulty in performing daily tasks such as buttoning clothes and opening jars.
• There is visible swelling in the small joints of both hands.
• The client denies any recent trauma or injury to the hands.
• The client reports feeling fatigued and has had occasional low-grade fevers.
• The client is currently taking medication for hypertension and diabetes.

 

Medical History:

 

• Hypertension for 10 years, managed with medication.
• Type 2 diabetes for 5 years, managed with oral hypoglycemic agents.
• No known allergies.
• Family history of autoimmune diseases.

 

Vital Signs (0700hrs):

 

• Temperature: 37.8°C (100°F)
• Blood Pressure: 140/90 mmHg
• Heart Rate: 82 bpm
• Respiratory Rate: 18 breaths per minute
• Oxygen Saturation: 98% on room air

 

Physical Examination Results (0700hrs):

 

• Swelling and tenderness in the metacarpophalangeal and proximal interphalangeal joints of both hands.
• Limited range of motion in the affected joints.
• No deformities observed.
• Skin over the joints appears slightly erythematous.
• No signs of infection or injury.

 

Diagnostic Results (0700hrs):

 

• Complete Blood Count (CBC): WBC 8,000/mm³ (4,000-11,000/mm³), Hemoglobin 13.5 g/dL (12-16 g/dL), Platelets 250,000/mm³ (150,000-450,000/mm³)
• Erythrocyte Sedimentation Rate (ESR): 40 mm/hr (0-20 mm/hr)
• C-Reactive Protein (CRP): 15 mg/L (0-10 mg/L)
• Rheumatoid Factor (RF): Positive

 

A nurse is analyzing the assessment findings. Which findings are indicative of rheumatoid arthritis? Select all that apply.

Choice A rationale: Small joints of the hand are commonly affected in rheumatoid arthritis (RA). RA typically involves the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints, leading to pain, swelling, and stiffness in these areas.

Choice B rationale: Joint swelling is a hallmark of RA. The inflammation in RA causes synovial membrane thickening and fluid accumulation, leading to visible swelling in the affected joints.

Choice C rationale: Symmetrical involvement is characteristic of RA. The disease often affects the same joints on both sides of the body, which helps differentiate it from other types of arthritis.

Choice D rationale: Pain increases with motion is not specific to RA. While joint pain can worsen with movement in many types of arthritis, it is not a distinguishing feature of RA.

Choice E rationale: Heberden nodes are associated with osteoarthritis, not RA. These bony enlargements occur at the distal interphalangeal (DIP) joints and are not typically seen in RA.

Choice F rationale: Fatigue and fever are common systemic symptoms of RA. The chronic inflammation associated with RA can lead to generalized fatigue and occasional low-grade fevers.

Choice G rationale: Morning stiffness quickly resolves is not indicative of RA. In RA, morning stiffness typically lasts for more than an hour, whereas in other types of arthritis, it may resolve more quickly