Rheumatic disorders Flashcards
Rheucmatic disorders affect what?
Affect joints, bones, skeletal muscles, and connective tissues
Rheumatic disorders: pain
Subtle - pain, weakness, fatigue, insomnia, disturbed body image, joint stiffness
Rheumatic disorders: general onset
acute or insideous with periods of remission
Rheumatic disorders: general treatment
aimed at localized relief
Rheumatic disorders: gerontological considerations
Rheumatic disorders are often consequences of aging
Many do not seek help thinking it’s a normal part of aging
Rheumatic disorders: gero considerations - support system
Need adequate support system
- Exercise
- Nutrition
- General health maintenance
- Pharmacotherapy
- Nonpharmacologic
Why might the gero population experience failure to follow treatment regimens for rheumatic disorders?
hearing
visual acuity
memory loss
depression
What serologic studies can be age related for rheumatic disorders?
ESR
ANA
What are anti-arthritic drugs
NSAIDs
Disease-modifying antirheumatic drugs (DMARDs)
Glucocorticoids
What are non-pharmacologic treatment regimens for arthritis
Heat or cold Weight reduction Joint rest and avoidance of join overuse Orthotic devices Exercise Regimen
How does the sed rate test work
Phlebotomist draws blood
Test measures how fast RBC fall to bottom of tube in an hour
Inflammation causes red blood cells to stick together and sink faster
Management Goals and strategies Rheumatic disorders: Suppress inflammation and the autoimmune response
Optimize pharmacologic therapy (anti-inflammatory and disease-modifying agents)
Management Goals and strategies for Rheumatic disorders: pain control
Project joints
Ease pain with splints, thermal modalities, relaxation techniques
Management Goals and strategies for Rheumatic disorders: maintain or improve joint mobility
Implement exercise programs for joint motion, muscle strengthening, weight loss as appropriate, and overall health
Management Goals and strategies for Rheumatic disorders: maintain or improve functional status
make use of adaptive devices and techniques
Management Goals and strategies for Rheumatic disorders: increase patient knowledge of disease process
provide and reinforce patient education
Management Goals and strategies for Rheumatic disorders: promote self management by patient adherence with the therapeutic regimen
Emphasize compatibility of therapeutic regiment and lifestyle
What is Osteoarthritis?
Degenerative joint disease
A chronic non-inflammatory progressive disorder
Erosion of articular cartilage combines with hypertrophy of bone at joint margins
Osteoarthritis risk factors
age and obesity
Osteoarthritis affects which joints (most of the time)
weight bearing joitns
Osteoarthritis s/s
pain, stiffness, and functional disability
Pain is worse with activity and alleviated by rest
Morning stiffness usually resolves after less than 10 minutes
May report limited ROM and patient report of limited ability to do daily activities.
Crepitus is heard or felt
Osteoarthritis: diagnostics
Xray is often used to diagnose, monitor and watch the progression of the disease
osteoarthritis: management
pharmacological and non-pharmacological
Osteoarthritis: education
Need education, reduce pain and inflammation, optimize physical function and attempt to prevent or slow progression
Osteoarthritis: non pharm tx
– rest and joint protection – heat with some cold, weight reduction and exercise
Osteoarthritis: pharm tx
NSAIDs
Corticosteroids
surgery - arthroplasty
Osteoarthritis: monitor
Check Liver, CBC – Tylenol – caution with alcohol and OTC products
gout
Most common of the inflammatory arthritides
Monosodium urate crystal deposits into joints & tissues
Increased serum uric acid levels
Gout risk factors
males
Gout s/s
– excruciating pain and inflammation in joints.
Trauma, alcohol ingestion, dieting, medications, surgical stress or illness = triggers
Abrupt onset occurs at night
Pain, redness,
Gout medications for tx
NSAIDs
Colchicine
Corticosteroids
Allopurinol
Gout: nursing considerations
Rest & elevate Ice – NOT heat Avoid alcohol, smoking Avoid foods high in purine Drink 2000mL daily
Gout education (diet)
Restrict consumption of foods high in purines, especially organ meats and shellfish; others believe that limiting protein foods such as red meats, lamb and pork or avoiding trigger foods are sufficient.
Gout: phase 1
asymptomatic hyperuricemia, is when the serum urate level is high, but gout manifested by arthritis or nephrolithiasis has not yet occurred. People can remain asymptomatic throughout their lifetimes. The subsequent development of gout is directly related to the duration and magnitude of the hyperuricemia. Therefore, the commitment to lifelong pharmacologic treatment of hyperuricemia is deferred until there is an initial attack of gout (phase 2)
Gout: early attacks
Early attacks tend to subside spontaneously over 3 to 10 days even without treatment. The attack is followed by a symptom-free period (the intercritical stage or phase 3) until the next attack, which may not come for months or years. However, with time, attacks tend to occur more frequently, to involve more joints, last longer, and lead to long-term sequelae (phase 4).
Gout diagnostics
clinically relevant to use the biologic value of 6.8 mg/dL or 408 μmol/L, a level of serum uric acid above the saturation point for crystal formation
Fibromyalgia:
Chronic pain, exxagerated tenderness at 18 specified tender points
Fibromyalgia: s/s
– sleep disturbances, fatigue, morning stiffness, muscle weakness, paresthesia, cognitive dysfunction, chronic headaches, mood disturbances, irritable bowel syndrome
Fibromyalgia: treatment
Based on s/s
- NSAIDs
- Tramadol
- Pregabalin
- SNRI (Duloxetine)
- nonpharm.
Fibromyalgia: nursing considerations
holistic approach
Safety
What is a hallmark of fibromyalgia
that individuals display diffuse hyperalgesia (increased pain to normally painful stimuli) and/or allodynia (pain to normally nonpainful stimuli). This suggests that these individuals have a fundamental problem with central dysfunction (pain processing mechanisms) that results in central pain sensitization.
What is rheumatoid arthritis
Autoimmune disease occurring in synovial joint
Rheumatoid arthritis affects joint linings, causing painful swelling. Over long periods of time, the inflammation associated with rheumatoid arthritis can cause bone erosion and joint deformity.
What are risk factors to rheumatoid arthritis?
pollution
smoking
family history
bacterial and viral diseases
rheumatoid arthritis: lab values
Rheumatoid Factor (RF) Anticitrullinated peptide antibody (ACPA) Erythrocyte sedimentation rate (ESR) C-reactive protein (CRP) CBC TB Hepatitis B & C Liver & Kidney Functions X-ray Ultrasound Arthrocentesis
Rheumatoid arthritis: clinical manifestations
Symmetric joint pain Morning joint stiffness lasting longer than 1 hour Swelling Warmth Erythema Lack of function Joints feel spongy Fluid can be aspirated Bilaterally and symmetric
RA is a systemic disease with multiple extra-articular features, such as
Fever weight loss fatigue anemia lymph node enlargement Raynaud's disease
What is raynaud’s disease?
cold- and stress-induced vasospasm causing episodes of digital blanching or cyanosis
What is the goal of treatment with RA
decrease joint pain and swelling
achieve clinical remission
decrease the likelihood of joint deformity
minimize disability
RA: early medical management medications
medication
Methotrexate
Hydroxychloroquine
NSAIDS
What is medical management for someone with moderate RA?
OT/PT
Cyclosporine
RA medical management for someone with persistent RA
Reconstructive surgery
Corticosteroids
RA: nutrition therapy
Anorexia
Weight loss
Anemia
Food high in vitamins, protein, and iron
RA potential complication
Cardiovascular disease Elevated lipid values Chronic inflammation Dysfunction of the endothelium Abnormal homocysteine levels
What is systemic lupus erythematous?
Inflammatory, autoimmune disorder
Body’s immune system inaccurately recognizes the cell’s nucleus as foreign
SLE triggers?
Cigarette smoke UV rays Medications Viral Infections Emotional Stress Stress on the body Dust exposure
SLE s/s
Systemic Symptoms Fever Malaise Weight loss Anorexia Joint pain
SLE: cutaneous s/s
Butterfly-shaped erythematous rash bride of nose and cheeks
Rashes
SLE: assessment
Cardiovascular
Joint Swelling
Neurologic
Kidney
it can impact any organ in the body
SLE labs
ANA
Anti-DNA
CBC
the labs and what they mean are on this ppt
go look if you ned
SLE: pharm therapy – monoclonal antibodies
Example: Belimumab
education: No live vaccines
SLE: corticosteroids
education about the complications that can arise such as osteoporosis and fractions
SLE: example of antimalarial agents for tx
Hydroxychloroquine
SLE treatment: NSAIDS
just know this is a treatment options
SLE pharm therapy: examples of immunosuppressive agents
Cyclophosphamide
Azathioprine
SLE medical and nursing management
Interventions are directed at controlling exacerbations
Body image
Skin integrity
medication education
What is Sjogren’s syndrome
progressively affects the lacrimal and salivary glands
Sjogren’s syndrome s/s
dry eyes dry mouth lesions trigeminal neuralgia sensory neuropathy
Sjogren’s syndrome: diagnostics
Histopathy of salivary glands
Sjogren’s syndrome: medical management
No cure
Treat symptoms
Cholinergic agents
What is scleroderma
begins with changes in the skin
cause is unknown
What are the 3 cardinal features of scleroderma
Vascular injury and damage
Activation of innate and adaptive arms of the immune system autoimmunity
Generalized interstitial and vascular fibrosis
Scleroderma: management
depends on the clinical manifestations
The limited symptoms of scleroderma are referred to as CREST
Calcinosis: calcium deposits in skin
Raynaud’s phenomenon
Esophageal dysfunction: acid reflux and decrease in motility of esophagus
Sclerodactyly: thickening and tightening of the skin on the fingers and hands
Telanglectasis: dilation of capillaries causing red marks on surfaces of the skin
