Connective Tissue Disorders Flashcards
Osteoarthritis risk factors
- Age
- Female
- *Obesity- most modifiable risk factor
- Prev injury/sport activity/muscle weakness
- Genetics/hx of inflammatory arthritis, joint/bone disorders
- Occupations with repetitive motions
Osteoarthritis clinical manifestations
- Progressive pain over time
- Decreased ROM
- Tenderness to touch around the joint
- Bony and soft tissue swelling, deformity, and instability
- *Crepitus (cracling or rubbing sound or feeling due to air or gas under the skin)
- *Pain with activity that improves with rest = differentiating factor from RA
Morning stiffness osteoarthritis
< 30 minutes
Osteoarthritis medical management
- Acetaminophen (mild-moderate pain): up to 4 grams daily, assess for liver disease
- NSAIDs (severe pain, Acetaminophen refractory)- associated to GI, Cardiac, and Kidney
- Intraarticular steroid injection (NSAID and Acetaminophen refractory)
- Opioids: significant side-effects and habit- forming
- Combination of Acetaminophen, NSAIDs, and Intraarticular injections
Osteoarthritis surgical management
Performed in the case of significant disability and severe pain
- Arthroscopic debridement (removes debris)
- Arthroscopic synovectomy (removes excess membrane)
- Surgical fusion
- Total joint replacement
Osteoarthritis complications
- Chronic pain
- Decreased function
- Toxic effects of medication (acetaminophen-liver, NSAIDS-look below)
- Can influence other comorbid conditions like DM and CAD – inability to exercise
Elderly & NSAIDs
- Polypharmacy (interactions)
- Multiple comorbidities
- Possible renal insufficiency (NSAIDs can exacerbate)
- Antiplatelets & anticoags: NSAIDs can cause more bleed
OA nursing assess
- VS, weight, skin integrity,
- Serum Cr
Joint deformities in hand:
- Bouchard’s nodes: proximal
- Herberden’s nodes: distal hand
OA nursing interventions
- Administer meds (analgesics, anti-inflammatory) as ordered
- Cold packs for painful joints
- Heat packs for painful muscles
- Encourage active ROM
- Encourage use of assistive devices for ADLs and mobility
OA pt teaching
- *Med adherence
- *Med risks
- Regular physical activity
- Role of PT and OT in patient care
- Home health aid if patient is alone and significantly disabled
NSAID OA pt medication teaching
- Myocardial infarction (chest pain)
- GI bleeding and ulcers (abdominal pain, blood in stool, or emesis)
- Renal insufficiency (edema, weight gain)
- Abnormal platelet function (bruising, abnormal bleed)
Rheumatoid arthritis
Autoimmune inflamm dz
- Unknown antigen triggers immune response –> produce collagenase, enzyme that breaks down collagen –> destruct of cartilage, erosion of bone
RA clinical manifestations - articular
WITHIN joint:
- Joint pain, swelling
- Erythema
- Morning stiffness
- Fatigue
- Rheumatoid nodules in SQ tissue over joints
RA diagnosis
- 3 factors: labs, x-ray or ultrasound, clinical manifestation
- Symmetrical joint pain
- Morning stiffness > 30 min
RA clinical manifestations
- *Symmetrical peripheral joint pain
- *Morning stiffness > 30 min
- Tenderness and synovitis by palpating joints individually
- Symptoms persist > 6 weeks
RA medical treatment (1st line)
- Analgesics (Acetaminophen or Opioids): pain relief
- NSAIDs: reduce inflammation, and
- Glucocorticoids (PO, IM, Joint, IV): reduce inflammation
RA medical treatment (2nd line)
- Disease-modifying Antirheumatic Medication Therapy (DMARDS)
- Methotrexate (1st line DMARD): Liver toxicity, oral ulcers, birth control (teratogen), assess for renal impairment
- Immune system-altering drugs that alter the inflammatory response `
- Assess TB status prior to therapy
RA medical treatment (3rd line)
- Biologics (Monoclonal antibodies): Act on specific targets in the inflammatory cascade → interrupts the immune response and decreases inflammation
- Rituximab, Infliximab, Etanercept → given IV
RA nursing assess
- VS (high temp = infection, tachy/tachypnea = pain)
- Pain assess
- Mobility assess (gait = decreased range of motion)
- Resp, cardiac, eyes: pleural effusions, pleurisy, pericarditis, scleritis, episcleritis
RA lab nursing assess
- CRP & ESR (inflamm)
- Monitor glucose (steroids)
- Hgb (RA or GI bleed from NSAIDS)
- Serum albumin (worsen dz)
- Platelet count (inflamm)
- Liver & renal function (meds)
RA nursing interventions
- Administer medications as ordered: analgesics, anti-inflammatory, glucocorticioids, DMARD therapy-methotrexate, biologics
- Nonpharmacological pain management
- Assist with ROM
- Maintain safety- fall precautions if unsteady gait
- Psychosocial support
RA pt teaching
- Med adherence
- Report S&S of infection, active infection = discontinuation of immunosupress meds
- Refer to PT/OT
- Atypical/chronic infection shud be addressed w infectious dz specialist
Systemic Lupus Erythematous triggers
- Pregnancy
- Sunlight exposure
- Illness
- Major surgery
- Silica dust
- Medication allergies
SLE clinical manifestations - mucocutaneous
- Malar rash (“butterfly rash”) over cheeks
- Erythematous plaques covered by scale appearing in sun-exposed areas
- Oral ulcers
- Urticaria (hives)
SLE clinical manifestations - musculoskeletal
- Joint paint w or w/o synovitis
- Muscle pain and weakness
SLE clinical manifestation - renal
- Lupus nephritis (glomerulonephritis)
SLE diagnosis
- Positive ANA
- Must have 4/17 (at least 1 clinical and 1 immunological) criteria to support a diagnosis of SLE
SLE medical management
Plaquenil, NSAIDS, Glucocorticoids, Immunosuppressants (Methotrexate)
SLE non-pharmacological management
- Avoid prolonged sun exposure – use sunscreen daily (SPF >50)
- Well-balanced diet
- Frequent rest periods, regular sleep
- Regular exercise to improve strength and maintain ROM
SLE complications
- Renal failure from lupus nephritis
- Premature heart disease
- Interstitial lung disease
- Hypercoagulation
- Stroke
- Avascular necrosis of joints
- Increased risk for infection
- Complication from pharmacological therapy
SLE nursing assess
- VS (temp = infection, HTN = renal/cardiac dz)
- Past health hx & head-toe assess
- Labs: CRP & ESR, BUN/Cr, Urinalysis, Coag studies
Plaquenil
- Med for SLE
- Block immune complex –> reduce constitutional symptoms
- Prevent dz flares and organ dz
- SE: abd pain & nausea
- *Baseline eye exam & biannual/annual eye exams d/t renal toxicity
SLE nursing intervention
- Administer medications as ordered: NSAIDs, Analgesics, Glucocorticoids, Plaquenil, Biologics
- Psychosocial Support
- Daily weights, intake, and output, sodium restriction, of Lupus nephritis
SLE pt teaching
- *Dz process education
- *Avoid live vaccines (immunosuppression) + vaccines up-to-date
- *Avoid oral contraceptives in patients with raynaud’s phenomenon & hx of phlebitis (oral contraceptions could cause a hypercoaguable states)
- Daily sunscreen use
- Energy conservation and activity prioritization
Gout risk factors
- *Eating large amounts of meat and seafood (purine- rich foods increase uric acid production)
- *Consuming large amounts of alcohol (purine-rich)
- Obesity
- HTN
- Thiazide diuretics increase urate reabsorption (which increases serum uric acid levels)
Gout clinical manifestations
-*Usually affects a lower extremity joint - typically the first metatarsophalangeal (MTP) joint called Podagra Last 12-24 hours
- Acute gout: involves one join, acute onset of pain, redness, and swelling
- Intercortical gout: asymptomatic between gout attacks
- Chronic tophaceous gout: repeated attacks over years leading to tophi (uric acid deposit in the joint) and joint destruction
Gout kidney stones
High UA leads to kidney stones
Acute gout meds
Pain relief and reducing inflammation
- NSAIDs, (indomethacin and colchicine reduce uric acid crystals from building up in the joint)
- Glucocorticoids reduce inflammation and pain relief
- Never treated with uric acid lowering agents (Allopurinol) as it could worsen gout attacks
Chronic gout meds
- Uric-acid lowering agents
- Allopurinol or Febuxostat reduces serum uric acid by inhibiting its production
Gout nursing assess
- Monitor uric acid levels
- Tophi (bumps, hard masses) under the skin or around joints
- Red and painful joints indicative of a gout flare
- Pain levels
- Urinary symptoms or flank pain
Gout nursing intervention
Administer medications as ordered in the appropriate situations:
- Analgesics
- Anti-inflammatory agents
- Uric acid lowering agents (chronic gout)
- Glucocorticoids
Gout pt teaching
- Avoid purine-rich food and alcohol
- Medication adherence for UA lowering agents
- Report gout flares immediately as prompt treatment decreases flare severity and pain
- Weight reduction through exercise and diet modification
Osteoarthritis
Degenerative dz of joints
RA clinical manifestations - extra-articular
- Osteopenia
- Muscle weakness
- Episcleritis
- Scleritis
- Pleuritis
- Pleural effusion
- Pericarditis
- Enlarged spleen
- Anemia
Amputation nurse assess
- VS for infection
- Pulses, temp, color, movement of affected extremity
- Pain: phantom pain
- Wound incision site
- Hgb and Hct for hemorrhage
Amputation nursing intervention
- Insert large bore IV: IV blood & fluid resuscitate
- Transfusions as ordered
- Analgesic meds as ordered
- Alternative pain management technqiue: CAM
- No pillow under portion of lower extremity d/t flexion contraction
- Apply ice
- Nutrition, ROM, application of rigid splint
Amputation pt teaching
- Meds, nutrition & hydration
- Wrap limb w compression dressing: figure 8 technique
- Wound care
- S&S of infection
- ROM exercise
- Community support
Phantom limb pain
- Numbness, tingling, and sharp burning are perceived in the removed limb or distal remaining limb
- Exacerbated by weather changes, stress, nervousness, exhaustion
Neuroma
Regeneration of clumps of nerve axons in the distal end of the residual limb after amputation (inevitable)
- *Mostly in UE but can be in any limb
- Cause problems with prosthesis fitting
Amputation complications
Neuromas, phantom limb pain
Medical intervention before elective amputation
- Hyperbaric therapy: 100% O2 under pressure in a hyperbaric chamber
- Percutaneous transluminal angioplasty: to open the artery and restore blood flow
- Anticoagulant therapy
- Resection of the tumor and bone grafting (neoplasms)
Immediate concerns in traumatic amputation
- Achieving hemostasis (stop bleed)
- Fluid resuscitation (blood prods, IV fluids to correct hypovolemia)
