1 Chapter 39 Assessment and Management of Patients With Rheumatic Disorders

2 Rheumatic Diseases “Arthritis”Affect primary the joints but also the muscles, bone, ligament, tendons, and cartilage Remission and exacerbation Classification Monoarticular or polyarticular Inflammatory or noninflammatory Marked by inflammation, autoimmunity, and degeneration

3 Question Is the following statement true or false? Diarthrodial is bleeding into a joint.

4 Answer False Diarthrodial is a joint with two freely movable parts. Hemarthrosis is bleeding into a joint.

5 Characteristic Degenerative Changes— “Degradation”

6 Clinical ManifestationsPain Joint swelling Limited movement Stiffness Weakness Fatigue

7 Pathophysiology and Associated Physical Signs of Rheumatoid Arthritis

8 Nursing Process: The Care of the Patient With a Rheumatic Disease—AssessmentHealth history: include onset of and evolution of symptoms, family history, past health history, and contributing factors Functional assessment Arthrocentesis Radiography, bone scans, CT, and MRI Tissue biopsy Blood studies

9 Nursing Process: The Care of the Patient With a Rheumatic Disease—DiagnosesAcute and chronic pain Fatigue Disturbed sleep pattern Impaired physical mobility Self-care deficits Disturbed body image Ineffective coping

10 Collaborative Problems and Potential ComplicationsAdverse effects of medications

11 Nursing Process: The Care of the Patient With a Rheumatic Disease—PlanningMajor goals may include Relief of pain and discomfort Relief of fatigue Promotion of restorative sleep Increased mobility Maintenance of self-care Improved body image Effective coping Absence of complications

12 Nursing Process: The Care of the Patient With a Rheumatic Disease—InterventionsAnti-inflammatory medications Heat to joints for pain management Splints, but maintain mobility Provide rest

13 Diffuse Connective Tissue DiseasesA group of chronic disorders characterized by diffuse inflammation and degeneration in the connective tissue Cause is unknown but thought to have an immunologic basis Characterized by a clinical course of exacerbations and remissions Includes RA, SLE, scleroderma, polymyositis, and polymyalgia rheumatica

14 Systemic Effects: Extraarticular FeaturesFever Fatigue Anemia Lymph node enlargement Raynaud’s phenomenon and Sjögren’s syndrome Any organ system may be involved; arteritis, neuropathy and other neurologic manifestations, scleritis, pericarditis, pleural effusion, splenomegaly, renal involvement Skin and mucosal manifestations

15 Teaching Patients Self-CareExplain the disease and principles of disease management Medication teaching Monitoring Sources of information Pain management Joint protection Self-care with assistive devices Exercise and relaxation

16 Question With which of these diagnoses should the nurse encourage the patient to restrict consumption of foods high in purine? Fibromyalgia Gout Osteoarthritis Rheumatoid arthritis

17 Answer Gout The nurse encourage the patient to restrict consumption of foods high in purine for gout.