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

2. 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

3. Figure 63-2 Joint changes in rheumatoid arthritis

4. 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

5. Degenerative Joint Disease
Figure 63-4 Joint changes in osteoarthritis

6. 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

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

8. 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.

9. 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

10. 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

11. 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

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

13. 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.

14. 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

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

16. 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

17. 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

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

19. 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.

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. End of Presentation