Chapter%2054%20Assessment%20and%20Management%20of%20Patients%20With%20Rheumatic%20Disorders - PowerPoint PPT Presentation

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Title: Chapter%2054%20Assessment%20and%20Management%20of%20Patients%20With%20Rheumatic%20Disorders


1
Chapter 54Assessment and Management of Patients
With Rheumatic Disorders
2
Rheumatic 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

3
Characteristic Degenerative Changes Degradation
Joint space narrowing and osteophytes (bone
spurs) are characteristic of degenerative changes
in joints.
4
Factors associated with degenerative joint changes
  • Mechanical Stress (The articular plate
    (subchondral bone) thins, and its ability to
    absorb shock decreases)
  • Altered Lubrication
  • Immobility

5
Clinical 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

7
Pathophysiology and Associated Physical Signs of
Rheumatoid Arthritis
8
Patient 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

9
Treatment
10
Nursing 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

11
Nursing 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

12
Collaborative Problems/Potential Complications
  • Adverse effects of medications

13
Nursing 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

14
Systemic 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).

15
Clinical 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)

16
Gout
  • 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.

17
Pathophysiology
  • 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.

18
Clinical 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.

19
Medical Management
  • Pharmacology
  • Diet
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