Timby/Smith: Introductory Medical-Surgical Nursing, 10/e Chapter 63: Caring for Clients with Orthopedic and Connective Tissue Disorders

Inflammatory Disorders: Rheumatoid Arthritis Pathophysiology, Etiology: Synovial Tissue Assessment Findings: Signs and Symptoms Subcutaneous nodules; Muscles atrophy; Flexion contractures; Classic deformities Diagnostic Findings: Radiography; Serum protein electrophoresis; Arthrocentesis; CRP/ANA tests Medical, Surgical Management: Decreasing joint inflammation; Relieving discomfort; Preventing deformities; Restoring function Nursing Management

Figure 63-2 Joint changes in rheumatoid arthritis

Degenerative Joint Disease Pathophysiology, Etiology: Repeated trauma; Degenerative joint changes Assessment Findings: Signs and Symptoms Stiffness; Pain; Painless nodules; Heberden’s nodes, Bouchard’s nodes; Limited ROM; Crepitus Diagnostic Findings: Radiography Medical, Surgical Management: Rest; Exercise program; TENS unit; Drug therapy; Joint surgery Nursing Management

Degenerative Joint Disease Figure 63-4 Joint changes in osteoarthritis

Gout Pathophysiology, Etiology: Inherited; Painful metabolic disorder; Inflammatory reaction in joints; Affects men > women Assessment Findings: Sign and Symptoms – Edema; Recurring pain; Tenderness of one joint; Fever; Tophi may be palpated; Hyperuricemia Diagnostic Findings: Clinical signs; Urine test; Arthrocentesis; Radiography Medical, Surgical Management: Uricosuric drugs; Decreased ingestion of purine; NSAIDs; Colchicine; Phenylbutazone; Surgery Nursing Management

Question Is the following statement true or false? Gout affects more women than men.

Answer False. Gout is a very painful metabolic disorder, which causes inflammatory reactions in the joints, usually the feet, hands, elbows, ankles, and knees. Gout affects more men than women.

Fibromyalgia Pathophysiology, Etiology: Unknown Assessment Findings: Signs and Symptoms Chronic syndrome of pain, fatigue, sleep disturbances; Middle-aged women most common Diagnostic Findings: Diagnosis difficult; Rule out other conditions to diagnose Medical, Surgical Management: Analgesics; Nontraditional therapies Nursing Management

Bursitis Pathophysiology, Etiology: Trauma; Infection Assessment Findings: Painful movement of joint; Distinct lump Diagnostic Findings: Radiograph; Fluid aspiration Medical, Surgical Management: Rest; Salicylates, NSAIDs; Corticosteroids; Mild ROM exercises Nursing Management

Ankylosing Spondylitis Pathophysiology, Etiology: Chronic connective tissue disorder  progressive immobility, fixation Assessment Findings: Signs and Symptoms Low back pain; Flattened lumbar curve; Aortic regurgitation; Permanently flexed neck; Reduced lung sounds Diagnostic Findings: ESR; CT scan; Radiographs Medical, Surgical Management: Supportive treatment including medications; Back brace; Sleeping instructions; Prescribed exercise; Total hip replacement Nursing Management

Question Is the following statement true or false? There is no cure for ankylosing spondylitis.

Answer True. There is no cure for ankylosing spondylitis. The aim of supportive treatment is to maintain functional posture. Medications are prescribed to relieve inflammation and pain.

Systemic Lupus Erythematosus (SLE) Pathophysiology, Etiology: Unknown triggering mechanism; Destruction of diffuse connective tissues; Affects multiple body systems; Autoimmune; Great imitator Assessment Findings: Signs and Symptoms Clinical signs; Facial rash; Behavioral disturbances; Fluid retention; Proteinuria; Hematuria; Many others Diagnostic Findings: Presenting symptoms; Blood tests; Renal biopsy; Urinalysis

Systemic Lupus Erythematosus Medical Management: Producing remission; Prevent/Treat exacerbations; Medications Renal, Cardiac, GI, CNS symptomatic treatment Nursing Management

Infectious Disorders: Osteomyelitis Pathophysiology, Etiology: Pathogens; Complications Assessment Findings: Signs and Symptoms Sudden acute or chronic infection Diagnostic Findings: Elevated leukocyte count and ESR; Positive blood culture; Anemia; Radiographs; Bone scans, MRI: Definitive diagnoses Medical, Surgical Management: Immobilization; Surgical debridement; Closed saline irrigation; Antibiotic-impregnated bead application; Bone or muscle flap grafts Nursing Management

Lyme Disease Pathophysiology, Etiology: Ticks act as vectors to transmit bacteria Assessment Findings: Signs and Symptoms Stages of disease Diagnostic Findings: Serologic Studies Medical, Surgical Management: Antibiotics; Supportive measures; Prognosis Nursing Management

Question Is the following statement true or false? Lyme disease is spread via mosquito bites.

Answer False. Lyme disease is spread via deer tick bites. It is most common in the Northeast, mid-Atlantic, and other northern areas of the United States.

Structural Disorders: Osteoporosis Pathophysiology, Etiology: Loss of bone mass; Women > Men; Causes Assessment Findings: Signs and Symptoms Lumbosacral, thoracic back pain; Kyphosis Diagnostic Findings: Radiography; DEXA; QUS Medical, Surgical Management: Calcium; Vitamin D; Drug therapy; HRT (decreasing use); Exercise; Relieving pain; Preventing injury Nursing Management

Osteomalacia Pathophysiology, Etiology: Insufficient calcium absorption; Phosphate deficiency Assessment Findings: Bone pain; Deformities; Waddling gait Diagnostic Findings: Radiography; Serum levels Medical, Surgical Management: Adequate nutrition; Exposure to sunlight; Exercise; Braces or surgery Nursing Management

Paget’s Disease Pathophysiology, Etiology: Abnormal bone remodeling Assessment Findings: Bone pain; Tenderness; Skeletal deformity Diagnostic Findings: Radiography; Bone scans Medical, Surgical Management: Drug therapy; Surgery Nursing Management

Disorders of the Feet Pathophysiology, Etiology: Heredity; Arthritis; Improperly fitting shoes Bunions; Hammertoes Assessment Findings: Signs and Symptoms - Pain; Tenderness; Deformity; Corns and calluses Diagnostic Findings: Radiography Medical, Surgical Management: Well-fitted shoes; Exercises; Pads; Surgery Nursing Management

Benign Bone Tumors Pathophysiology, Etiology: Overgrown clusters of normal bone cells Assessment Findings: Signs and Symptoms - Pain; Deformity; Swelling Diagnostic Findings: Radiography; Bone scans; biopsy Medical, Surgical Management: Surgery; Curettage; Bone grafts; Splints or casts Nursing Management

Malignant Bone Tumors Pathophysiology, Etiology: Radiation, toxic chemical exposure; Heredity Assessment Findings: Signs and Symptoms - Primary tumors, location; Pathologic fracture; Difficulty in movement; Abnormal gait Diagnostic Findings: Radiography; MRI; Bone scan; Biopsy Medical, Surgical Management: Surgery; Radiation; Chemotherapy Nursing Management

End of Presentation