connective tissue disorders part 1 Flashcards
Osteoporosis, osteoarthritis, rheumatoid arthritis, gout, or scoliosis may have some
genetic basis
Autoimmune diseases, e.g., thyroid disorders
is aproteinfound in the blood, the levels of which rise in response toinflammation
C-reactive protein(CRP)
i.e., C-reactive protein is an acute-phase protein
is produced by the liver. The level ofrises when there is inflammation throughout the body
C-reactive protein
Drug therapy
Anti-inflammatory drugs:
* * Glucocorticoids * * Nonsteroidal anti-inflammatory drugs (NSAIDs)
work like NSAIDs without the side effects of GI
distress, but may risk of MI or CVA
Cyclooxygenase-2 (COX-2) inhibition
Most common Non-inflammatory condition Primary cause– aging Secondary – trauma, infection Affects joints under pressure (knees, spine, hips)
Osteoarthritis
Drug therapy
Osteoarthritis
Acetaminophen for pain
NSAIDs, DMARDs (disease-modifying anti-rheumaticdrugs), COX-2 inhibitors, or low dose of salicylates (aspirin)
Surgery
Osteoarthritis
Arthroscopic
Arthroplasty
Nursing Assessment
Osteoarthritis
Joint pain or tenderness
Examine joints for crepitus, enlargement, deformity, and decreased range of motion
Compare affected and unaffected joints to detect abnormalities
Determine how the disease affects the patient’s mobility and ability to perform activities of daily living
** 8 Critical Characteristics
Support joint during assessment
Nursing Care following Total Joint Replacement Surgeries
Assessment
Vital signs, level of consciousness, intake and output, respiratory and neuro-vascular status, urinary function, bowel elimination, wound condition, dressing intact, and comfort
Circulation and sensation in the affected extremity
Signs and symptoms
Rheumatoid Arthritis
Pain in affected joints aggravated by movement
Morning stiffness lasting more than 1 hour
Weakness, easy fatigability, anorexia, weight loss, muscle aches and tenderness
Warmth and swelling of the affected joints
Joint changes are usually symmetric
Rheumatoid nodules (subcutaneous, over bony prominences)
Any organ may be affected
Inflammation in tissues of heart, lungs, kidneys, eyes
blood vessels can be affected causing vasculitis
May develop a cluster of symptoms
Sjögren (show-gren): dryness of mouth, eyes and vagina
Felty: (less common) liver and speen enlargement, neutropenia
Caplan: rhuematoid nodules in the lungs
Medical diagnosis
Rheumatoid Arthritis
Laboratory studies
RF (rheumatoid factor), ESR (erythrocyte sedimentation rate), and CRP (C-reactive protein)
MRI, bone scans, and DEXA scans (Dual-energy X-ray absorptiometry
Ulnar drift
Boutonniere deformity
swan neck deformity
rheumatoid deformity
Drug therapy
Rheumatoid Arthritis
Aspirin and other NSAIDs for several months, with the addition of gold compounds, d-penicillamine, antimalarials, or sulfasalazine if needed
Surgery
Rheumatoid Arthritis
Arthroplasty, synovectomy, tenosynovectomy (to release the tightened tendon sheath), and arthrodesis (joint fusion)
Medical treatment
Rheumatoid Arthritis
Cortisone injections
Rest
Splinting joints
Orthotic devices
Nursing Assessment
Rheumatoid Arthritis
Pain, joint swelling, tenderness
joint deformities and limitation of movement
fatigue and decreased ability to perform activities of daily living
Bone is constantly formed and absorbed
Until adolescence, bone formation exceeds bone absorption so that bones grow and strengthen
Around age 30, bone absorption surpasses formation
Loss of trabecular bone, innermost layer, occurs first
Loss of cortical bone, hard outer shell, begins later
Begins earlier and progresses faster in women than in men
Result is loss of bone mass
Osteoporosis
1° Osteoporosis =
aging w/o etiology; 2° Osteoporosis due to factors other than aging (e.g. long term steroid use)
Risk factors
Osteoporosis
Older women who have small frames, who are white or of
northern European heritage
Have fair skin and blond or red hair
Estrogen deficiency or have had bilateral oophorectomy
Physical inactivity or immobility
Low body weight, inadequate calcium, protein, or vitamin
D intake
Corticosteroid therapy over more than 6 months
Excessive use of cigarettes, caffeine, and alcohol
Signs and symptoms
Osteoporosis
Back pain, fractures, loss of height due to vertebral compression, and kyphosis
Bone deterioration in the jaw can cause dentures to fit poorly
Collapsed vertebrae can cause chronic pain
Medical treatment
Calcium supplementation (1500mg/day postmenopausal w/o estrogen replacement) with Vitamin D Calcium supplementation (1000mg/day postmenopausal with estrogen replacement) with Vitamin D Bisphosphonates and selective estrogen receptor modulators (Fosamax or Actonel) Regular exercise Percutaneous vertebroplasty (cement injected to vertebrae)
Nursing Assessment
Diet, calcium intake, and exercise plan
Note whether the patient is menopausal or has had an oophorectomy
Compare height with previous measurements
Posture; note the presence and degree of deformity, pain level
Characterized by hyperuricemia
Related to excessive uric acid production or decreased uric acid excretion by the kidneys
Gout
Four stages
Gout
Asymptomatic hyperuricemia
Acute gouty arthritis
Asymptomatic intercritical period
Chronic tophaceous gout
Signs and symptoms
Asymptomatic hyperuricemia
Gout
Blood uric acid level is elevated, but no other symptoms
Many people with asymptomatic hyperuricemia never progress to the next stage
Signs and symptoms
Acute gouty arthritis
Gout
Onset is abrupt, usually occurs at night
The patient is suddenly afflicted with severe, crushing pain and cannot bear even the light touch of bed sheets on the affected joint
Joint commonly affected is the great toe
Symptoms usually disappear within a few days
Signs and symptoms
Asymptomatic inter-critical period
Gout
No symptoms
Chronic tophaceous gout
Advanced gout
Tophi: deposits of sodium urate crystals that are visible as small white nodules under the skin
Medical treatment
gout
Asymptomatic hyperuricemia requires no medical treatment
NSAID alone or with colchicine for acute gouty arthritis (give q hour until pain eases or N/V starts)
For subsequent attacks: indomethacin (an NSAID), corticosteroids, and corticotrophin
Prednisone may be injected into single joint
Avoid foods high in purines
Allopurinol to inhibit uric acid synthesis
Nursing Assessment
gout
Pain and joint swelling P/A tophi, uric acid stones Fever History of trauma, injury, or surgery When taking colchicine, monitor labs for abnomalities in blood cell counts…. Fatal blood dyscrasia have occured
Multi-system autoimmune disease of unknown origin, thought to be the result of 1° vessel injury or dysfunction of immune system
Term came from symptom of hardening of skin
Other organs affected include: Primary vessel, GI tract, lungs, heart and kidneys
Progressive manifestations: from inflammation to degeneration of tissues, that results in decreased elasticity, stenosis, and occlusion of vessels
onset between age 30-50
Progressive Systemic Sclerosisalso called Scleroderma
Term Scleroderma came from symptom of hardening of skin
– thickening of skin and systemic effects
Progressively fatal sclerosis
calcium deposit in tissues
CREST Syndrome:
Calcinosis:
vascular spasms
CREST Syndrome:
Raynaud’s phenomenon:
scleroderma of the digits
CREST Syndrome:
Sclerodactyly:
dilated superficial blood vessels
CREST Syndrome:
Telangiectasis:
Progressive Systemic
Sclerosis
Signs and symptoms
Raynaud’s phenomenon Symmetric painless swelling or thickening of the skin Taut and shiny skin Morning stiffness Frequent reflux of gastric acid Difficulty swallowing, Weight loss, Dyspnea, Pericarditis Renal insufficiency
Medical treatment
Progressive Systemic Sclerosis
No cure
High doses of steroids or other immunosuppressants may bring about remission
Physical therapy
Antihypertensives; d-Penicillamine (chelator drug: the process of removing a heavy metal from the bloodstream by means of a chelate as in treating lead or mercury poisoning)
Assessment
Progressive Systemic Sclerosis
Pain and stiffness in the fingers; intolerance for cold
Signs and symptoms suggestive of cardiovascular, respiratory, renal, and gastrointestinal problems
Skin rash, loss of wrinkles on the face, limitations of joint range of motion, muscle weakness, and dry mucous membranes
Examine the hands for contractures of the fingers and for color changes or lesions on the fingertips
Palpate the fingers to determine warmth
chronic disorder of spine and surrounding cartilaginous joints
Ankylosing Spondylitis
multi-system antibody destructive disorder
Systemic Lupus Erythematosus:
inflammation of the bursa sac
Bursitis:
chronic syndrome of muscle pain
Fibromyalgia:
: infection of the bone
Osteomyelitis:
bacterial tick bite
Lyme Disease
: loss of bone density
Osteoporosis:
metabolic disease (softening re low Vit. D)
Osteomalacia:
deformity of the great toe
Bunions (Hallux Valgus):
