Rheumatic

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Chapter 54

Assessment and Management of


Patients With Rheumatic
Disorders

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins


Question
Is the following statement True or False?

Diarthrodial is bleeding into a joint.

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins


Answer
False

Diarthrodial is a joint with two freely movable parts.


Hemarthrosis is bleeding into a joint.

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins


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

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins


Characteristic Degenerative Changes—
“Degradation”

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins


Clinical Manifestations

• Pain
• Joint swelling
• Limited movement
• Stiffness
• Weakness
• Fatigue

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins


Pathophysiology and Associated Physical
Signs of Rheumatoid Arthritis

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins


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
• X-rays, bone scans, CTs, and MRIs
• Tissue biopsy
• Blood studies

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins


Nursing Interventions

• Understanding of the underlying disease process guide;


the nurse’s critical thinking to provide interventions
• The extent of the disease process, and whether it is
localized or more systemic, will also affect nursing
activities

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins


Nursing Process: The Care of the Patient
with a Rheumatic Disease—Assessment

• 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

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins


Nursing Process: The Care of the Patient
with a Rheumatic Disease—Diagnoses

• Acute and chronic pain


• Fatigue
• Disturbed sleep pattern
• Impaired physical mobility
• Self-care deficits
• Disturbed body image
• Ineffective coping

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins


Collaborative Problems/Potential
Complications

• Adverse effects of medications

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins


Nursing Process: The Care of the Patient
with a Rheumatic Disease—Planning
• 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
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Diffuse Connective Tissue Diseases

• A group of chronic disorders characterized by diffuse


inflammation and degeneration in the connective tissue
• Cause is unknown but thought to have an immunologic
basis
• Characterized by a clinical course of exacerbations and
remissions
• Includes RA, SLE, scleroderma, polymyositis, and
polymyalgia rheumatica

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins


Systemic Effects: Extraarticular Features
• Fever
• Fatigue
• Anemia
• Lymph node enlargement
• Raynaud’s phenomenon and Sjögren’s syndrome
• Any organ system may be involved; arteritis, neuropathy
and other neurologic manifestations, scleritis,
pericarditis, pleural effusion, splenomegaly, renal
involvement
• Skin and mucosal manifestations
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Teaching Patients Self-Care

• Explain the disease and principles of disease


management
• Medication teaching
• Monitoring
• Sources of information
• Pain management
• Joint protection
• Self-care with assistive devices
• Exercise and relaxation

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins


Question
With which of these diagnoses should the nurse encourage
the patient to restrict consumption of foods high in
purine?
A.Fibromyalgia
B.Gout
C.Osteoarthritis
D.Rheumatoid arthritis

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins


Answer
B

The nurse encourage the patient to restrict consumption of


foods high in purine for gout.

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

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