Inflammation of the joint
Arthritis
The symptom that most commonly causes a person to seek medical attention for rheumatic diseases
pain
what are the most prevalent types of arthritis
osteoarthritis
Rheumatoid
Gout
disease that involves the joints, bones and muscles
Rheumatic disease
which clinical manifestations are shared by rheumatoid arthritis (RA) and Osteoarthritis (OA)
joint swelling
pain
stiffness
which characteristic of rheumatoid arthritis (RA) differentiate it from other forms of inflammatory arthritis?
Pannus formation
it has a destructive effect on the adjacent cartilage and bone
Raynaud’s phenomenon
cold and stress induced vasospasm causing episodes of digital blanching or cyanosis
what are the classic symptoms of RA
joint pain swelling warmth erythema (redness) lack of function
onset is usually acute
bilateral and symmetric
what is the cardinal sign of inflammatory arthritis that an appear even before pain?
morning stiffness
lasting at least 30 to 45 minutes
name some extra-articular features of RA
fever weight loss fatigue anemia lymph node enlargement Raynaud's phenomenon (cold and stress induced vasospasm causing episodes of digital blanching or cyanosis) arteritis neuropath scleritis pericarditis
splenomegaly
Sjögren’s syndrome (dry eyes and dry mucous membranes)
Sjögren’s syndrome
dry eyes
dry mucous membranes
Rheumatic disorders with diffuse inflammation and degeneration in connective tissues are referred to as
connective tissue diseases
what are some common connective tissue diseases
RA
systemic lupus erythematosus (SLE)
scleroderma
The connective tissue disease that is a result of disturbed immune regulation that causes an exaggerated production of autoantibodies and antigens.
Systemic Lupus Erythematosus (SLE)
what is the first choice in the treatment of RA
The use of traditional NSAIDs
what are the primary goals in managing RA
decrease inflammation
manage pain
maintain join function
prevent or correct join deformity
heat and cold therapy for RA
help relieve pain, stiffness, and muscle spasm
Ice is beneficial during periods of disease exacerbation
Ice application should not exceed 10 to 15 minutes at one time.
Tx options for RA
drug therapy rest joint protection heat and cold application exercise patient and family teaching
Medical management of RA
NSAIDs and salicylates inhibit the production of prostaglandins and provide anti-inflammatory effects and analgesia. COX-2 inhibit inflammatory processes patient at risk for GI cimmpplications DMARDS Methotrexate (Rheumatrex, Trexall) hydroxychloroquine (plaquenil) -antimalarial biologic agents (immunomodulators) small-molecule agents
The major end produce to purine catabolism?
uric acid.
primarily excreted by the kidneys
Increase cause GOUT
what is the most common initial problem of Gout?
inflammation of the great toe (podagra)
other affect joints are midtarsal area of the foot, ankle, knee and writs.
when does the onset of symptoms typically occurs in Gout?
at night with sudden swelling and excruciating pain peaking within several house.
low-grade fever
what are some foods high in purine content which patient with Gout need to avoid?
anchovies liver wine beer red and organ meats shellfish
what will be prescribed for patient with acute Gout attack
antiinflammatory such as Colchincine
NSAID for pain management
corticosteroids
Adrenocorticotropic hormone (ACTH)
future attacks of Gout are prevented by maintenance does of what?
Allopurinol (Zyloprim, Alloprim)
uricosuric such as probenecid (Benemid)
when may systemic corticosteroid be used for Gout?
only if routine therapies are contraindicated or ineffective.
Defect of purine metabolism will result in
hyperuricemia = GOUT
crystalline deposits accumulating in articular tissue, osseous tissue, soft tissue and cartilage.
Tophi seen in patient with chronic Gout
what will be the serum uric acid levels that will indicate gout?
6.8 mg/dL
Nursing management for patient with gout
pain control joint rested and application of ice self care measures avoidance of aspirin medication compliance restricting foods high in purines such as organ meats and shell fish. limit protein foods, alcohol. avoid starvation diets increase fluids 2,000 ml/day maintain normal body weight decrease Na, fat and cholesterol
A patient with gout is taking Colchicine what should the RN teach the patient about this medication
causes diarrhea
Probenecid (Benemid)
Risk of uric acid deposition in kidney
Allopurinol (Zyloprim)
vomiting
abdominal pain
