Exam 3: Chapter 38 - Assessment and Management of Patietns with Rheumatic Disorders Flashcards
What is a Rheumatic Disease?
Numerous disorders afecting skeletal muscles, bones, cartilage, ligaments, tendons, and jointsH
Rheumatic Disease most commonly manifest the clinical features of
arthritis (inflammation of a joint) and pain
Rheumatic Diseases encompass
autoimmune, degenerative, inflammatory, and systemic conditions
How many types of Rheumatic Diseases are there?
Over 100 types
Problems caused by rheumatic diseases?
Limitations in mobility and ADL Pain Fatigue Altered Self-Image Sleep Disturbances
How can Rheumatic Diseases be classified?
Monoarticular (Affecting a Single Joint) / Polyarticular (Affecting Multiple Joints)
Inflammatory / NonInflammatory
Common symptoms of Rheumatic Disease
Pain Joint Swelling Limited Movement Stiffness WEakness Fatigue
Three distinct characteristics of pathophysiology include
inflammation, autoimmunity, and degeneration
Phagocytosis produces chemicals such as
leukortrienes and prostaglandins
Leukotrienes contribute to the inflammatory process by
attracting other white blood cells to the area
Prostaglandins act as
modifiers to inflammation
Instead of resolution of swelling and joint pain once the trigger has subsided,
Pannus (prolifieration of newly formed synovial tissue infiltrated with inflammatory cells) formation occurs. Destruction of the joints cartilage and erosion of bone soon follow
Joints become swollen because
T and B Cell Proliferation
What is Autoimmunity?
The body mistakenly recognizes its own tissue as a foreignn antigen
Autoimmunity leads to
the destruction of tissue via the same inflammatory seen with inflammation.
What may be affected by autoimmunity?
Blood Vessels, Lungs, Heart, and Kdineys may be affected
What occurs in Degeneration?
Inflammation also occurs but as a secondary process. Cartilage has been broken down and increased mechanical stress on bone ends causes stiffening of bone tissue
What happens with Neutrophil accumulation in synovial fluid?
Warmth, swelling, Effusions, Pain and Decreased Motion with Possible Rheumatoid Nodules
Increasein severity of physical signs and symptoms due to
synovitis, early pannus invasion, chrondrocyte activcation, and degradation of cartilage by protteinase
Health History Assessment includes
Onset and Evolution of Symptoms
Family History
Past Health History
Contributing Factors
Functional Assessment includes
Combination of History and Observation
Gait, Posture, General Musculoskeletal Size and Structure
Gross Deformities and Abnormalities in movement
Symmetry, size, and contour of other connective tissues such as the skin and adipose tissue
Imaging studies commonly used for patients with rheumatic diseases include
X Rays
CT
MRI
Arthrography
Nursing Process: The Care of a Patient With a Rheumatic Disease Diagnosis
Acute and Chronic Pain Fatigue Imparied Physical Mobility Self-Care Deficity Distrubed Body Image Ineffective Coping Complications SEcondary to Effects of Medications
Medications used with Rheumatic diseases include
Salicylates
NSAIDs
Biologic and Nonbiologic Disease-Modifying Antirheumatic drugs (DMARDs)
DMARDs have the ability to
suppress the autoimmune response, alter disease progression, and stop or decrease durther tissue damage on the joints
DMARDs have been found to
hallt the progresion of bone loss and destruction and can induce remission.
Nonbiologic DMARDs are thought to reduce
proin-inflammatory cytokines and increase anti-inflammatory cytokines
Nonpharmacologic PAin Management Examples
Heat helpful in relieving pin, stiffness, and muscle spasms. Maximum is 20 minnutes.
Nursing Process: Planning : Goals may include
Suppress inflammation adn the autoimmune response
Control Pain Maintain or improve joint mobility Maintain or improve functional status Increase patietns knowledge Promote self-management by patient adherence
Lisas Major Goals
Relief o f Pain or Discomofrt Relief of Fatigue Increasd Mobility Maintanence of Self CAre Improved Body Image Effective coping Absence of Complications
Two types of Salicytates?
Acetylated and Nonacetylated
What falls under a Acetylated Salicylate?
Aspirin
What falls under a Nonacetylated Salicylate?
Choline Trilisalicylate (Arrthropan, TRilisate)
Salsalate (Disalcid)
Sodium Salicylate
Action of Salicyates?
Anti inflammatory, Analgesic, Antipyretic
Accetylated Salicylate are
platelet aggregation inhibitors
You should administer Salicylates with
meals to prevent gastric irritation
Salicylates: Assess for
tinnitus, gastric intolerance, GI bleeding , purpura
Salicylates: Monitor for possible
confusion in older adult
Rheumatoid ARthritis is a
autoimmune disease of unknown irign that affects 1% of population worldwide.
Risk factors for development of RA include
environmental factors such as pollution, smoking, family hisotry, and illnesses
What has a specificty of 95% at detecting RA?
Antibodies to cyclic citrullinated peptide (Anti-CCP)
Nursing Process Intervention: Pain
Provide comfort measures
Administer Anti-Inflammatory Analgesic
Nursing Process Intervention: Fatigue
Explain energy convserving techniques
Facilitate development of activity / rest schedule
Combat fatigue by exercising
Nursing Process Intervention: Imparied Physical Mobility
Assess for need of PT/OT
Encourage independence
Nursing Process Intervention: Self-Care Deficit
Assist in identifying self-care deficits
Provide assistive devices (This can include wheel chair, reaching device, shoe horns)
Consult with community agencies
Nursing Process Intervention: Distrubed Body Image
Assist to identify elements of control over disease
Encourage verbalization of feelings
Nursing Process Intervention: Ineffective Coping
Identify ares of life affected by disease
Develop plan for managing symptoms and enlisting support of family and friends to promote daily function
Nursing Process Intervention: Complciations secondayr to medications
Perform periodic clinical assesment and laboratory evaulation
Provide education about correct self-administration, potential side effects, importance of monitoring
Counsel regarding methods to reduce side effects
Administer medication in modified doses
Normal range for RBC?
4.7-6.1 for Men
Women: 4.2 - 5.4
Children: 4.0 - 5.5
Clinical Manifesations: Stiffness takes
an hour or more to go away when they first wake up
What is the goal of giving someone DMARD?
Preventing inflammation and joint damage
Biologic DMARDs have been specifially engineered to target
a certain cell or molecule within the immune system to otreat the specific theumatologic condition
Downside to DMARDs?
Can decrease your immune system, which can lead to infection
