Chapter 54 Flashcards
What are some problems caused by rheumatic diseases?
The problems include limitations in mobility and ADLs, systemic affect secondly organ failure and death or result in problems such as pain, fatigue, altered self image and sleep disturbance.
What are some common rheumatic diseases?
▪️ osteoarthritis
▪️ systemic lupus erythema
▪️ scleredema
What tissues do rheumatoid diseases primarily effect?
Skeletal muscles, bones, cartilage, ligaments, tendons and joints.
What part of the body is most commonly affected by rheumatoid diseases?
The joints.
What is the action of inflammation?
The antigen stimulus activates monocytes & T lymphocytes. Next immunoglobulin antibodies form immune complexes with antigens. Phagocytosis of the immune complexes causes inflammation.
What is the most common symptom of rheumatic diseases that causes people to seek medical treatment?
Pain.
What is involved in physical assessment for rheumatic diseases?
A combination of physical examination with functional examination.
What imaging studies are used with rheumatic diseases?
X-ray, CT scan, MRI and arthroscopy.
Why is it difficult to diagnose rheumatic diseases and elderly people?
Age and coexisting health problems.
What is medical management of rheumatoid arthritis?
Pharmacologic therapy including salicylates, NSAIDs and antirheumatic drugs. Short-term use of antidepressants may help with pain management and sleep. Heat application, braces, splints and assistive devices can help minimize stress on painful joints.
What is the importance of exercise and activity Intermatic diseases?
Maintain or improve joint mobility and functional status.
Why is sleep essential for patients with rheumatic diseases?
To cope with pain, minimize physical fatigue and deal with changes related to chronic disease.
What are examples of diffuse connective tissue diseases?
RA, SLE, scleroderma, polymyositis, and polymyalgia rheumatica.
How does RA effect joint health?
Enzymes cause collagen breakdown ultimately leading to pannus formation.
How does RA manifest?
Joint pain, swelling, warmth, erythema, and lack of function.
What are some ways RA may be diagnosed?
Rheumatoid nodules, joint inflammation and laboratory findings.
What is early treatment for RA?
Education, a balance of rest and exercise, and support agencies. Call management begins with NSAIDs and salicylates.
How is moderate, erosive RA treated?
PT and OT. And immunosuppressant may be prescribed such as the cyclosporine.
How is persistent, erosive RA treated?
Reconstructive surgery and low-dose steroids.
How is advanced, unremitting RA treated?
Immunosuppressive agents, short-term low-dose antidepressants, nutrition therapy- foods high in vitamins protein and iron.
How does a nurse manage RA?
Monitoring medication-induced complications, helping patient to maintain is much independence as possible, and encourage patients and their family to verbalize concerns and ask questions.
What is SLE?
Systemic lupus erythamatosis is the exaggerated production of autoantibodies.
How does SLE manifest?
Can affect any body system but it commonly affects the musculoskeletal system.
How is SLE diagnosed?
Complete history, physical examination and blood tests.
What medications are used to treat SLE?
Corticosteroids, anti-malarial medications, NSAIDs, and immunosuppressive agents.
What is scleroderma?
Is in undergoes fibrotic changes, leading to loss of elasticity and movement. Eventually tissue degenerates and becomes nonfunctional.
What are some clinical manifestations of scleroderma?
Raynaud’s phenomenon, swelling in the hands, increasingly hardened skin and subcutaneous tissues and the extremities stiffen and lose mobility.
What is CREST syndrome?
Symptoms of scleredema: C- calsinosis R- Raynaud's phenomenon E- esophageal hardening and dysfunction S- schleordactyly T- telangiectasia
What does the assessment focus on with scleroderma?
Sclerotic changes in fingers, contractures in fingers and color changes or lesions in the fingertips. Systemic assessment includes GI, renal, pulmonary and cardiac symptoms.
What is the medical management for scleroderma?
Counseling, support and moderate exercise to help prevent contractures.
Is there any medical treatment that is effective for scleroderma?
No but systemic symptoms may be treated.
What is polymyositis?
Idiopathic inflammatory myopathies.
What assessments are done with polymyositis?
A complete history and physical assessment to rule out other muscle-related disorders.
What is the medical management of polymyositis?
High doses of steroids followed by gradual reduction over several months, immunosuppressants, and when there is no response to those two- plasmapheresis and lymphapheresis and total body irradiation.
What are some aspects of nursing management of polymyositis?
The use of assistive devices as well as PT and OT referrals.
It is polymyalgia rheumatica?
Severe proximal muscle discomfort with mild joint swelling. Severe aching in the neck shoulder and pelvic muscles common.
What assessments are done with polymyalgia rheumatica?
Assessments focused on musculoskeletal tenderness, weakness and loss of function.
What is the medical management of polymyalgia rheumatica?
Moderate doses of corticosteroids, NSAIDs and aspirin.
What is the nursing management for polymyalgia rheumatica?
Managing side effects of medications, encouraging dietary and lifestyle changes.
What is osteoarthritis?
A degenerative joint disease that can be debilitating.
What are some clinical manifestations of osteoarthritis?
Pain, stiffness and functional impairment.
How is osteoarthritis diagnosed?
X-ray showing narrowing of the joint space, with the presence of osteophytes.
What are complementary for osteoarthritis?
Special diets, herbal and dietary supplements, acupuncture, acupressure, magnets and tai chi.
Groovy what medications are used for osteoarthritis?
Medications for symptom management and pain control. These include acetaminophen, nonselective NSAIDs, COX-2 enzyme blockers, opioids, intra-articular corticosteroids, topical analgesia, methylsalicylate, glucosamine and chondroitin.
What are common surgeries done for osteoarthritis?
Osteotomy and arthroplasty.
What are major nursing goals with management of osteoarthritis?
Pain management and optimal functional ability.
What are the spondyloarthropathies?
Systemic inflammatory diseases of the skeleton- Ankylosing spondylitis, reactive arthritis, psoriatic arthritis.
What is most affected in ankylosing spondylitis?
Cartilaginous joints of the spine and surrounding areas. Back pain is the characteristic feature.
How is reactive arthritis characterized?
Is involved in Reiter’s syndrome and occurs after an infection.
What are several characteristics of psoriatic arthritis?
Synovitis, polyarthritis and spondylitis.
What is the focus of medical management for spondyloarthropathies?
Pain management and suppressing inflammation. NSAIDs and corticosteroids.
What is surgical management for spondyloarthropathies?
Total joint replacement.
What metabolic endocrine disorders are associated with rheumatic diseases?
Amyloidosis, scurvy, diabetes, and acromegaly.
What is gout?
A disorder related to the genetic defect in purine metabolism leading to hyperuricemia.
What can hyperuricemia cause?
Crystal urate deposits the precipitate an inflammatory attack.
How does gout manifest?
Acute gouty arthritis, tophi, gouty nephropathy, and uric acid urinary calculi.
I was gout treated?
Colchicine, NSAIDs and corticosteroids.
What is nursing management for gout?
Restricting high purine food such as organ meats and alcohol, maintenance of normal body weight and pain management during acute attacks.
What is fibromyalgia?
A chronic pain syndrome that involves chronic fatigue, generalized muscle aching, and stiffness.
How is fibromyalgia treated?
NSAIDs, tricyclic antidepressants, SSRIs, and individualized exercise programs.
How does a nurse assist with fibromyalgia?
Support and encouragement to make the necessary lifestyle changes.
What are some other types of arthritis?
Arthritis caused by bacterial infection or by viral infection. Bacterial arthritis is the most rapidly destructive form of infectious arthritis.
How is infectious arthritis characterized?
Acute onset of a warm swollen joint. A bacterial culture from the synovial fluid confirms diagnosis.
How is infectious arthritis treated?
Eliminating the causative organism.
What are some benign bone tumors?
Lipoma, hemangioma, fibroma, and tumor like lesions such as ganglion, bursitis and synovial cyst.
What are some malignant bone tumors?
Primary tumors such as synovial and bone sarcomas, and secondary tumors.
What are some methods of medical management of osteoarthritis?
Weight reduction, prevention of injuries, perinatal screening for congenital hip disease, and ergonomic modifications. Are conservative treatments include heat, joint rest and avoidance of joint overuse, isometric and postural exercises, and aerobic exercises.
