Week 3 Chapter 34 Rheumatic Disorders Flashcards
Encompass autoimmune, degenerative, inflammatory, and systemic conditions
Rheumatic Diseases
Affect the joints, muscles, and soft tissues of the body
More than 100 types of rheumatic diseases
Rheumatic Diseases
Problems caused by rheumatic diseases include:
-Limitations in mobility and activities of daily living
- Pain and fatigue
- Altered self-image
-Sleep disturbances
- Systemic effects that can lead to organ failure and death
How many different arthritis disorders are there?
More than 100
Rheumatic diseases affect the primary joints but also what?
Muscles, bone, ligament, tendons, and cartilage
Remission and exacerbation
Classification of Rheumatic diseases can be
Monoarticular or polyarticular
Inflammatory or noninflammatory
3 distinct characteristics of pathophysiology include
- Inflammation
- Autoimmunity
- Degeneration
Most commonly manifest the clinical features of arthritis (inflammation of a joint) and pain
Marked by periods of remission and exacerbation
Rheumatic Diseases
Classifications of Rheumatic diseases include
Monoarticular or polyarticular
Inflammatory or non inflammatory
What are the 3 distinct characteristics of rheumatologic diseases?
- Inflammation
- Autoimmunity
- Degeneration
What is the pathophysiology physical signs of RA?
-Presentation of antigen to T cells
- T and B cell proliferation in synovial lining
- Neutrophil accumulation in synovial fluid
Cell proliferation
No cartilage invasion
- Synovitis
Early pannus invasion
Chondrocyte activation
Degradation of cartilage by proteinase
–Subchondral bone erosion
Pannus invasion of cartilage
Chondrocyte proliferation
Laxity of ligaments
Name the common symptoms of Rheumatic Disease
Pain
Joint swelling
Limited movement
Stiffness
Weakness
Fatigue
Rheumatic Diseases onset may be what?
Acute or Insidious
Periods of remission or exacerbation
Tx of Rheumatic Diseases can be
Simple
Complex
Patho- Some degree of inflammation caused by immune system and degeneration -secondary process or both
Manifestations of RA
Symmetric joint pain and stiffness lasting for more than a hr
Disease progression of RA includes
Swelling
Warmth
Erythema
Lack of function
Palpated joint feels spongy or boggy
Fluid can be aspirated from inflamed joint
RA have deformities of ?
Hand - Ulnar deviation and swan neck deformity . Thumb boutonniere
Cause: misalignment, progressive joint destruction, subluxation
Differs from OA’s Heberden’s and Bouchard’s
Characteristic patterns of RA
Joint pain in
- Shoulders
- Elbows
- Hands/ wrists
- Hips
- Knee joints
- Foot pain on joints
INFLAMED SYNOVIUM
Manifestations of RA Systemic
Fever
Weight loss
Fatigue
Anemia
Lymph node enlargement
Raynaud’s phenomenon
Rheumatoid nodules
RA inflammation can be around
Lungs and heart low rbcs
Ray- cold and stress induced vasospasm causing digital blanching or cyanosis
Nursing Process The care of patient with Rheumatic Disease Assessment
Health History
- onset of evolution of symptoms
- family hx
- past health hx
- contributing factors
- previous tx and effectiveness
- pt support systems
Physical assessment includes -Physical exam and functional assessment
Dx of RA
Inspect and palpitation
LAB
-RA- 80%
- Antibodies to cyclic citrullinated peptide anti-CCP
-ESR
-CRP
-RBC and C4 complement decreased
-ANA
- Synovial fluid - cloudy, milky, or dark yellow
Nursing Process Care of Pt with Rheumatic Disease
- Health Hx: onset and evolution of symptoms, family hx, past health hx, and contributing factors
-Functional assessment
- Arthrocentesis
- Imaging studies: Xrays, arthrography, CT, MRI
Nursing Dx of RA includes
Acute and Chronic pain
Fatigue
Disturbed sleep pattern
Impaired physical mobility
Self care deficits
Disturbed body image
Ineffective coping
Planning and goals for the pt. with a Rheumatic Disorder major goals include
Relief of pain and discomfort
Relief of fatigue
Maintain optimal functional mobility
Performs self care and activities independently
Adapts to physical and psychosocial changes
Effective coping behaviors
Absence of complications
Nursing process interventions of pt with Rheumatic disease
Pain
- Anti-inflammatory/ analgesic medications
- Comfort measures(heat, positioning, etc)
Heat to joints for pain management
Fatigue
- Explain energy conserving techniques
- facilitate development activity/ rest schedule
Interventions for pt with Rheumatic Disorder includes
- Functional mobility
- Assess for need of PT/ OT
- Encourage independence in mobility
- Self- care
- Assist in self care deficits
- Provide assistive devices
- Consult with community agencies
Interventions to maintain functional ability
-ROM
- Isometric exercise
- Dynamic exercise
- Aerobic exercise
- Pool exercise
Interventions for pt with a Rheumatic Disorder
Physical and psychological changes
Absence of complications secondary to medications
Medications and Tx
- Salicylates and NSAIDs
- Topical analgesics
- DMARDs
- Immunomodulators
- Corticosteroids
- Reconstructive Surgery
First gen NSAIDs Cox 1 and Cox 2
ASA
Ibuprofen
Naproxen
Indomethacin
Diclofenac
Ketorolac
Meloxicam- COX 2
DMARDs I are
Major nonbiologic
ex: Leflunomide
Methotrexate
DMARD I-Immunomodulator
- Gold standard start first
Hydroxychloroquine
Antimalarial
DMARD I
Sulfasalazine
DMARD I
Antiinflammatory
DMARDs II
Major Biologic DMARD
TNFA meds include
Etanercept
Infliximab
Adalimumab
B Lymphocyte Depleting agent
Rituximab
Interleukin 1 receptor antagonist
Abatacept
DMARDs II target what?
Proinflamm mediators
Cost more
tended for most severe patients
Janus Kinase
New class drugs
- Binds to active JAK enzyme sites
- Inhibit cytokine production
- Used in combo with nonbiologic agents or as monotherapy
Prednisone
Prednisolone
Glucocorticoids
Diffuse connective tissue diseases
- Group of chronic disorders characterized by diffuse inflammation and degeneration in connective tissue
- Cause is unknow but thought to have an immunologic basis
- Characterized by a clinical course of exacerbations and remissions
- Includes RA, SLE, scleroderma, polymyositis, and polymyalgia rheumatica
Lupus is an autoimmune disease which means?
Mean’s the body’s natural defense system (immune system) attacks healthy tissues instead of attacking only things like bacteria and viruses. This causes inflammation
Systems affected by lupus includes
Nervous
Ophthalmologic
Oral
Derm
Cardiopulm
Renal
GI
Repro
Hemat
Musco
Name the systemic effects of SLE and the extraarticular features
-Fever
- Weight loss
- Fatigue
- Anemia
- Lymph node enlargement
- Raynaud’s and Sjorgens
- RA nodules
Other: arteritis, neuropathy, pericarditis, and splenomegaly
management of SLE
Pain management
Immunosuppression
Corticosteroids
Antimalarial
Home remedies
Mediterranean diet
Favor fish omega 3 fatty acids
Colorful produce
Whole grains
Olive Oil
How to teach pt self care of SLE
- Explain disease and principles of disease management
-Medication teaching - Monitoring
- Sources of info
- Pain management
- Joint protection
- Self care assitive devices -Exercise and relaxation
