Chapter 39 Assessment and Management of Patients With Rheumatic Disorders

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

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

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

Characteristic Degenerative Changes— “Degradation”

Clinical Manifestations Pain Joint swelling Limited movement Stiffness Weakness Fatigue

Pathophysiology and Associated Physical Signs of Rheumatoid Arthritis

Nursing Process: The Care of the Patient With a Rheumatic Disease—Assessment Health 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

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

Collaborative Problems and Potential Complications Adverse effects of medications

Nursing Process: The Care of the Patient With a Rheumatic Disease—Planning Major 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

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

Diffuse Connective Tissue Diseases A 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

Systemic Effects: Extraarticular Features Fever 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

Teaching Patients Self-Care Explain 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

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

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