1. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 1 Mobility - Concept Care of Patients with Arthritis and Other Connective Tissue Diseases

2. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 2 Rheumatology  Connective tissue disease (CTD) major focus  Noninflammatory or inflammatory  Rheumatic disease = any disease/ condition involving musculoskeletal system  Arthritis = inflammation of one or more joints

3. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 3 Rheumatology (cont’d)  Noninflammatory localized arthritis (osteoarthritis) is not systemic, not an autoimmune disease  Inflammatory arthritis:  Rheumatoid arthritis  Systemic lupus erythematosus  Autoimmune disease

4. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 4 Osteoarthritis  Most common arthritis type  Progressive loss of cartilage  Joint pain, loss of function characterized by progressive deterioration  Osteophytes (bone spurs)  Cartilage disintegrates, bone and cartilage “float” into joint causing crepitus

5. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 5 Joint Changes in Degenerative Joint Disease

6. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 6 Collaborative Management  History  Usually older than 60 years  Physical assessment/clinical manifestations:  Joint pain and stiffness  Crepitus  Heberden's nodes  Bouchard’s nodes  Joint effusions  Atrophy of skeletal muscle

7. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 7 Heberden’s Nodes

8. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 8 Assessments  Psychosocial  Severe pain may cause depression/anxiety  Laboratory  ESR  nsCRP  Radiographic  Other diagnostic:  MRI  CT studies

9. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 9 Chronic Pain: Nonsurgical Management  Drug therapy  Rest, immobilization  Positioning  Thermal modalities  Weight control  Integrative therapies  Glucosamine, chondroitin

10. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 10 Chronic Pain: Surgical Management  Total joint arthroplasty (TJA)  Total joint replacement (TJR)  Arthroscopy  Osteotomy

11. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 11 Postoperative Care  Collaborate with patient/family to become safety partners to prevent complications  Hip dislocation  VTE  Infection  Anemia  Neurovascular compromise

12. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 12 Hip Flexion After Total Hip Replacement

13. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 13 Continuous Passive Motion Machine

14. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 14 Other Connective Tissue Diseases  Polymyositis (dermatomyositis)  Systemic necrotizing vasculitis  Polymyalgia rheumatica and temporal arteritis  Ankylosing spondylitis  Reiter’s syndrome  Marfan syndrome  Infectious arthritis

15. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 15 Psoriatic Arthritis  Skin condition characterized by scaly, itchy rash of elbows, knees, scalp  Joints stiff especially in morning  Treatment focus = managing pain

16. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 16 Fibromyalgia Syndrome  Chronic pain syndrome, not an inflammatory disease  Pain, stiffness, tenderness at certain areas of neck, upper chest, trunk, low back, extremities

17. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 17 Theoretic Pathophysiologic Model of Fibromyalgia

18. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 18 Chronic Fatigue Syndrome  Severe fatigue for 6 months or longer, usually following flu-like symptoms  Four or more criteria must be met for CFS diagnosis  Treatment is supportive

19. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 19 The patient is a 63-year-old woman admitted to the acute medical care unit. She is 5’4” and weighs 211 lb. Her medical history includes hypertension and GERD. On admission, she reports pain in her hands and joints that is unrelieved by OTC medications. What additional assessment data should you collect from the patient at this time?

20. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 20 While completing your admission assessment, you observe the patient’s hands appear as shown. 1. How would you document this finding? 2. What do you suspect the patient may be suffering from? (cont’d)

21. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 21 An hour later, the patient is crying because of severe joint pain in her hands. What are your priority actions at this time? (cont’d)

22. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 22 While the patient is in pain, her vital signs are taken and recorded. Are any of these vital signs a cause for concern? (cont’d)

23. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 23 Two hours later, laboratory values are drawn to investigate the patient’s symptoms. The results are: Sodium 136 mEq/LHCT 41.6% Potassium 4.6 mEq/LHGB 12.8 g/dL Calcium 8.9 mg/dLESR 28 mm/hr Are any of these results of concern? (cont’d)

24. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Audience Response System Questions 24

25. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 25 Question 1 Which population group is most likely to be diagnosed with fibromyalgia syndrome? A. Men between 30 and 50 years of age B. Women between 30 and 50 years of age C. Men between 50 and 70 years of age D. Women between 50 and 70 years of age

26. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 26 Question 2 The assessment of a patient status post total knee arthroplasty for which continuous femoral nerve blockade was utilized reveals that the patient is nervous and vital signs are BP 92/58, HR 62, RR 12, and SpO 2 89%. What should the nurse do next? A.Take vital signs every 10 minutes B.Notify the physician of the vital signs C.Anticipate administering IV fluids D.Notify the Rapid Response Team

27. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 27 Question 3 During a health history assessment of a patient with RA, chronic HTN, and a recent CVA, she states that she takes 2 fish oil capsules (5 g) daily as a supplement for her RA. What additional question should the nurse ask? A. “Have you found the fish oil to help your RA?” B. “Does your physician know you are taking the fish oil capsules to treat your RA?” C. “Are you taking any anticoagulant medications as well?” D. “How long have you been taking the fish oil capsules?”