connective tissue disorders part 1 Flashcards by Diane M.

Osteoporosis, osteoarthritis, rheumatoid arthritis, gout, or scoliosis may have some

genetic basis

Autoimmune diseases, e.g., thyroid disorders

How well did you know this?

Not at all

Perfectly

is aproteinfound in the blood, the levels of which rise in response toinflammation

C-reactive protein(CRP)

i.e., C-reactive protein is an acute-phase protein

How well did you know this?

Not at all

Perfectly

is produced by the liver. The level ofrises when there is inflammation throughout the body

C-reactive protein

How well did you know this?

Not at all

Perfectly

Drug therapy

Anti-inflammatory drugs:

* * Glucocorticoids
* * Nonsteroidal anti-inflammatory drugs (NSAIDs)

How well did you know this?

Not at all

Perfectly

work like NSAIDs without the side effects of GI

distress, but may  risk of MI or CVA

Cyclooxygenase-2 (COX-2) inhibition

How well did you know this?

Not at all

Perfectly

Most common
  Non-inflammatory condition
  Primary cause– aging
  Secondary – trauma, infection
  Affects joints under pressure (knees, spine, hips)

Osteoarthritis

How well did you know this?

Not at all

Perfectly

Drug therapy

Osteoarthritis

Acetaminophen for pain

NSAIDs, DMARDs (disease-modifying anti-rheumaticdrugs), COX-2 inhibitors, or low dose of salicylates (aspirin)

How well did you know this?

Not at all

Perfectly

Surgery

Osteoarthritis

Arthroscopic

Arthroplasty

How well did you know this?

Not at all

Perfectly

Nursing Assessment

Osteoarthritis

Joint pain or tenderness
Examine joints for crepitus, enlargement, deformity, and decreased range of motion
Compare affected and unaffected joints to detect abnormalities
Determine how the disease affects the patient’s mobility and ability to perform activities of daily living
** 8 Critical Characteristics
Support joint during assessment

How well did you know this?

Not at all

Perfectly

Nursing Care following Total Joint Replacement Surgeries

Assessment

Vital signs, level of consciousness, intake and output, respiratory and neuro-vascular status, urinary function, bowel elimination, wound condition, dressing intact, and comfort
Circulation and sensation in the affected extremity

How well did you know this?

Not at all

Perfectly

Signs and symptoms

Rheumatoid Arthritis

Pain in affected joints aggravated by movement
Morning stiffness lasting more than 1 hour
Weakness, easy fatigability, anorexia, weight loss, muscle aches and tenderness
Warmth and swelling of the affected joints
Joint changes are usually symmetric
Rheumatoid nodules (subcutaneous, over bony prominences)
Any organ may be affected
Inflammation in tissues of heart, lungs, kidneys, eyes
blood vessels can be affected causing vasculitis
May develop a cluster of symptoms
Sjögren (show-gren): dryness of mouth, eyes and vagina
Felty: (less common) liver and speen enlargement, neutropenia
Caplan: rhuematoid nodules in the lungs

How well did you know this?

Not at all

Perfectly

Medical diagnosis

Rheumatoid Arthritis

Laboratory studies
RF (rheumatoid factor), ESR (erythrocyte sedimentation rate), and CRP (C-reactive protein)
MRI, bone scans, and DEXA scans (Dual-energy X-ray absorptiometry
Ulnar drift
Boutonniere deformity
swan neck deformity
rheumatoid deformity

How well did you know this?

Not at all

Perfectly

Drug therapy

Rheumatoid Arthritis

Aspirin and other NSAIDs for several months, with the addition of gold compounds, d-penicillamine, antimalarials, or sulfasalazine if needed

How well did you know this?

Not at all

Perfectly

Surgery

Rheumatoid Arthritis

Arthroplasty, synovectomy, tenosynovectomy (to release the tightened tendon sheath), and arthrodesis (joint fusion)

How well did you know this?

Not at all

Perfectly

Medical treatment

Rheumatoid Arthritis

Cortisone injections
Rest
Splinting joints
Orthotic devices

How well did you know this?

Not at all

Perfectly

Nursing Assessment

Rheumatoid Arthritis

Pain, joint swelling, tenderness
joint deformities and limitation of movement
fatigue and decreased ability to perform activities of daily living

How well did you know this?

Not at all

Perfectly

Bone is constantly formed and absorbed
Until adolescence, bone formation exceeds bone absorption so that bones grow and strengthen
Around age 30, bone absorption surpasses formation
Loss of trabecular bone, innermost layer, occurs first
Loss of cortical bone, hard outer shell, begins later
Begins earlier and progresses faster in women than in men
Result is loss of bone mass

Osteoporosis

How well did you know this?

Not at all

Perfectly

1° Osteoporosis =

aging w/o etiology; 2° Osteoporosis due to factors other than aging (e.g. long term steroid use)

How well did you know this?

Not at all

Perfectly

Risk factors

Osteoporosis

Older women who have small frames, who are white or of
northern European heritage

Have fair skin and blond or red hair
Estrogen deficiency or have had bilateral oophorectomy
Physical inactivity or immobility
Low body weight, inadequate calcium, protein, or vitamin
D intake
Corticosteroid therapy over more than 6 months
Excessive use of cigarettes, caffeine, and alcohol

How well did you know this?

Not at all

Perfectly

Signs and symptoms

Osteoporosis

Back pain, fractures, loss of height due to vertebral compression, and kyphosis
Bone deterioration in the jaw can cause dentures to fit poorly
Collapsed vertebrae can cause chronic pain

Medical treatment

Calcium supplementation (1500mg/day postmenopausal w/o estrogen replacement) with Vitamin D
Calcium supplementation (1000mg/day postmenopausal with estrogen replacement) with Vitamin D
Bisphosphonates and selective estrogen receptor modulators (Fosamax or Actonel) 
Regular exercise 
Percutaneous vertebroplasty (cement injected to vertebrae)

Nursing Assessment

Diet, calcium intake, and exercise plan
Note whether the patient is menopausal or has had an oophorectomy
Compare height with previous measurements
Posture; note the presence and degree of deformity, pain level

Characterized by hyperuricemia

Related to excessive uric acid production or decreased uric acid excretion by the kidneys

Gout

Four stages

Gout

Asymptomatic hyperuricemia
Acute gouty arthritis
Asymptomatic intercritical period
Chronic tophaceous gout

Signs and symptoms Asymptomatic hyperuricemia Gout

Blood uric acid level is elevated, but no other symptoms | Many people with asymptomatic hyperuricemia never progress to the next stage

Signs and symptoms Acute gouty arthritis Gout

Onset is abrupt, usually occurs at night The patient is suddenly afflicted with severe, crushing pain and cannot bear even the light touch of bed sheets on the affected joint Joint commonly affected is the great toe Symptoms usually disappear within a few days

Signs and symptoms Asymptomatic inter-critical period Gout

No symptoms

Chronic tophaceous gout

Advanced gout | Tophi: deposits of sodium urate crystals that are visible as small white nodules under the skin

Medical treatment | gout

Asymptomatic hyperuricemia requires no medical treatment NSAID alone or with colchicine for acute gouty arthritis (give q hour until pain eases or N/V starts) For subsequent attacks: indomethacin (an NSAID), corticosteroids, and corticotrophin Prednisone may be injected into single joint Avoid foods high in purines Allopurinol to inhibit uric acid synthesis

Nursing Assessment | gout

``` Pain and joint swelling P/A tophi, uric acid stones Fever History of trauma, injury, or surgery When taking colchicine, monitor labs for abnomalities in blood cell counts…. Fatal blood dyscrasia have occured ```

Multi-system autoimmune disease of unknown origin, thought to be the result of 1° vessel injury or dysfunction of immune system Term came from symptom of hardening of skin Other organs affected include: Primary vessel, GI tract, lungs, heart and kidneys Progressive manifestations: from inflammation to degeneration of tissues, that results in decreased elasticity, stenosis, and occlusion of vessels onset between age 30-50

Progressive Systemic Sclerosisalso called Scleroderma | Term Scleroderma came from symptom of hardening of skin

– thickening of skin and systemic effects

Progressively fatal sclerosis

calcium deposit in tissues | CREST Syndrome:

Calcinosis:

vascular spasms | CREST Syndrome:

Raynaud’s phenomenon:

scleroderma of the digits | CREST Syndrome:

Sclerodactyly:

dilated superficial blood vessels | CREST Syndrome:

Telangiectasis:

Progressive Systemic Sclerosis Signs and symptoms

``` Raynaud’s phenomenon Symmetric painless swelling or thickening of the skin Taut and shiny skin Morning stiffness Frequent reflux of gastric acid Difficulty swallowing, Weight loss, Dyspnea, Pericarditis Renal insufficiency ```

Medical treatment | Progressive Systemic Sclerosis

No cure High doses of steroids or other immunosuppressants may bring about remission Physical therapy Antihypertensives; d-Penicillamine (chelator drug: the process of removing a heavy metal from the bloodstream by means of a chelate as in treating lead or mercury poisoning)

Assessment | Progressive Systemic Sclerosis

Pain and stiffness in the fingers; intolerance for cold Signs and symptoms suggestive of cardiovascular, respiratory, renal, and gastrointestinal problems Skin rash, loss of wrinkles on the face, limitations of joint range of motion, muscle weakness, and dry mucous membranes Examine the hands for contractures of the fingers and for color changes or lesions on the fingertips Palpate the fingers to determine warmth

chronic disorder of spine and surrounding cartilaginous joints

Ankylosing Spondylitis

multi-system antibody destructive disorder

Systemic Lupus Erythematosus:

inflammation of the bursa sac

Bursitis:

chronic syndrome of muscle pain

Fibromyalgia:

: infection of the bone

Osteomyelitis:

bacterial tick bite

Lyme Disease

: loss of bone density

Osteoporosis:

metabolic disease (softening re low Vit. D)

Osteomalacia:

deformity of the great toe

Bunions (Hallux Valgus):