Title: Chapter%2054%20Assessment%20and%20Management%20of%20Patients%20With%20Rheumatic%20Disorders
1Chapter 54Assessment and Management of Patients
With Rheumatic Disorders
2Rheumatic Diseases
- Arthritis
- More than 100 different disorders
- Affect primary the joints, but also muscles,
bone, ligament, tendons, cartilage - Classification
- Monoarticular or polyarticular
- Inflammatory or noninflammatory
3Characteristic Degenerative Changes Degradation
Joint space narrowing and osteophytes (bone
spurs) are characteristic of degenerative changes
in joints.
4Factors associated with degenerative joint changes
- Mechanical Stress (The articular plate
(subchondral bone) thins, and its ability to
absorb shock decreases) - Altered Lubrication
- Immobility
5Clinical Manifestations
- Pain
- Joint swelling
- Limited movement
- Stiffness
- Weakness
- Fatigue
- Warmth,
- Erythema
6- Joint involvement begins in the small joints of
the hands, wrists, and feet. As the disease
progresses, the knees, shoulders, hips, elbows,
ankles, and cervical spine joints are affected. - The onset of symptoms is usually acute. Symptoms
are usually bilateral and symmetric. In addition
to joint pain and swelling, another classic sign
of RA is joint stiffness, especially in the
morning, lasting at least 30 to 45 minutes
7Pathophysiology and Associated Physical Signs of
Rheumatoid Arthritis
8Patient Assessment and Diagnostic Findings
- Health history include onset of and evolution of
symptoms, family history, past health history,
and contributing factors - Functional assessment
- Arthrocentesis (to take fluid for sampling and to
relieve pain caused by pressure of increased
fluid volume. After procedure, observe the
patient for signs of infection and hemarthrosis) - X-rays, bone scans, CTs, and MRIs
- Tissue biopsy
- Blood studies
9Treatment
10Nursing Process The Care of the Patient with a
Rheumatic DiseaseAssessment
- Health history and physical assessment focus on
current and past symptoms, and also include the
patient's psychological and mental status, social
support systems, ability to participate in daily
activities, comply with treatment regimen, and
manage self-care
11Nursing Process The Care of the Patient with a
Rheumatic DiseaseDiagnoses
- Acute and chronic pain
- Fatigue
- Disturbed sleep pattern
- Impaired physical mobility
- Self-care deficits
- Disturbed body image
- Ineffective coping
12Collaborative Problems/Potential Complications
- Adverse effects of medications
13Nursing Process The Care of the Patient with a
Rheumatic DiseasePlanning
- Major goals may include
- Relief of pain and discomfort
- Relief of fatigue
- Promotion of restorative sleep
- Increased mobility
- Maintenance of self-care
- Improved body image
- Effective coping
- Absence of complications
14Systemic Lupus Erythematosus
- More common in women than men
- An autoimmune disease. The immunoregulatory
disturbance is brought about by some combination
of genetic factors, hormonal factors (as
evidenced by the usual onset during the
childbearing years), environmental factors (eg,
sunlight, thermal burns), and some medications
(hydralazine (Apresoline), isoniazid (INH),
chlorpromazine, and some antiseizure medications).
15Clinical Manifestations
- The onset of SLE may be insidious or acute. For
this reason, SLE may remain undiagnosed for many
years. - It can affect any body system (musculoskeletal
system, with arthralgias and arthritis
(synovitis), skin (butter fly rash), Oral ulcers,
Pericarditis, renal involvement (increased
creatinine) which leads to hypertension, CNS
(subtle changes in behavior patterns or cognitive
ability)
16Gout
- Is a heterogeneous group of conditions related to
a genetic defect of purine metabolism that
results in hyperuricemia. - Occur as a result of uversecretion of uric acid
or a renal defect to excrete uric acid, or a
combination of both. - Primary hyperuricemia may be caused by severe
dieting or starvation, excessive intake of foods
that are high in purines (shellfish, organ
meats), or heredity. - Secondary hyperuricemia is due to conditions in
which there is an increase in cell turnover
(leukemia, some types of anemias, psoriasis) and
an increase in cell breakdown.
17Pathophysiology
- With hyperuricemia, accumulations of sodium urate
crystals, called tophi, are deposited in
peripheral areas of the body, such as the great
toe, the hands, and the ear. - Renal urate lithiasis (kidney stones), with
chronic renal disease secondary to urate
deposition, may develop.
18Clinical Manifestations
- Acute gouty arthritis (recurrent attacks of
severe articular and periarticular inflammation),
tophi (crystalline deposits accumulating in
articular tissue, osseous tissue, soft tissue,
and cartilage) - The metatarsophalangeal joint of the big toe is
the most commonly affected joint (90). The ankle
or knee may also be affected. Less commonly, the
wrists, fingers, and elbows. - Severe pain, redness, swelling, warmth of the
affected joint - Gouty nephropathy (renal impairment), and uric
acid urinary calculi.
19Medical Management