Week 3 Chapter 34 Rheumatic Disorders Flashcards by Steven Singh

Encompass autoimmune, degenerative, inflammatory, and systemic conditions

Rheumatic Diseases

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Affect the joints, muscles, and soft tissues of the body

More than 100 types of rheumatic diseases

Rheumatic Diseases

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Problems caused by rheumatic diseases include:

-Limitations in mobility and activities of daily living
- Pain and fatigue
- Altered self-image
-Sleep disturbances
- Systemic effects that can lead to organ failure and death

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How many different arthritis disorders are there?

More than 100

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Rheumatic diseases affect the primary joints but also what?

Muscles, bone, ligament, tendons, and cartilage

Remission and exacerbation

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Classification of Rheumatic diseases can be

Monoarticular or polyarticular

Inflammatory or noninflammatory

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3 distinct characteristics of pathophysiology include

Inflammation
Autoimmunity
Degeneration

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Most commonly manifest the clinical features of arthritis (inflammation of a joint) and pain

Marked by periods of remission and exacerbation

Rheumatic Diseases

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Classifications of Rheumatic diseases include

Monoarticular or polyarticular

Inflammatory or non inflammatory

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What are the 3 distinct characteristics of rheumatologic diseases?

Inflammation
Autoimmunity
Degeneration

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What is the pathophysiology physical signs of RA?

-Presentation of antigen to T cells
- T and B cell proliferation in synovial lining
- Neutrophil accumulation in synovial fluid
Cell proliferation
No cartilage invasion
- Synovitis
Early pannus invasion
Chondrocyte activation
Degradation of cartilage by proteinase
–Subchondral bone erosion
Pannus invasion of cartilage
Chondrocyte proliferation
Laxity of ligaments

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Name the common symptoms of Rheumatic Disease

Pain
Joint swelling
Limited movement
Stiffness
Weakness
Fatigue

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Rheumatic Diseases onset may be what?

Acute or Insidious

Periods of remission or exacerbation

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Tx of Rheumatic Diseases can be

Simple
Complex

Patho- Some degree of inflammation caused by immune system and degeneration -secondary process or both

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Manifestations of RA

Symmetric joint pain and stiffness lasting for more than a hr

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Disease progression of RA includes

Swelling
Warmth
Erythema
Lack of function
Palpated joint feels spongy or boggy
Fluid can be aspirated from inflamed joint

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RA have deformities of ?

Hand - Ulnar deviation and swan neck deformity . Thumb boutonniere

Cause: misalignment, progressive joint destruction, subluxation

Differs from OA’s Heberden’s and Bouchard’s

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Characteristic patterns of RA

Joint pain in
- Shoulders
- Elbows
- Hands/ wrists
- Hips
- Knee joints
- Foot pain on joints

INFLAMED SYNOVIUM

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Manifestations of RA Systemic

Fever
Weight loss
Fatigue
Anemia
Lymph node enlargement
Raynaud’s phenomenon
Rheumatoid nodules

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RA inflammation can be around

Lungs and heart low rbcs

Ray- cold and stress induced vasospasm causing digital blanching or cyanosis

Nursing Process The care of patient with Rheumatic Disease Assessment

Health History
- onset of evolution of symptoms
- family hx
- past health hx
- contributing factors
- previous tx and effectiveness
- pt support systems

Physical assessment includes -Physical exam and functional assessment

Dx of RA

Inspect and palpitation
LAB
-RA- 80%
- Antibodies to cyclic citrullinated peptide anti-CCP
-ESR
-CRP
-RBC and C4 complement decreased
-ANA
- Synovial fluid - cloudy, milky, or dark yellow

Nursing Process Care of Pt with Rheumatic Disease

Health Hx: onset and evolution of symptoms, family hx, past health hx, and contributing factors

-Functional assessment
- Arthrocentesis
- Imaging studies: Xrays, arthrography, CT, MRI

Nursing Dx of RA includes

Acute and Chronic pain
Fatigue
Disturbed sleep pattern
Impaired physical mobility
Self care deficits
Disturbed body image
Ineffective coping

Planning and goals for the pt. with a Rheumatic Disorder major goals include

Relief of pain and discomfort Relief of fatigue Maintain optimal functional mobility Performs self care and activities independently Adapts to physical and psychosocial changes Effective coping behaviors Absence of complications

Nursing process interventions of pt with Rheumatic disease

Pain - Anti-inflammatory/ analgesic medications - Comfort measures(heat, positioning, etc) Heat to joints for pain management Fatigue - Explain energy conserving techniques - facilitate development activity/ rest schedule

Interventions for pt with Rheumatic Disorder includes

- Functional mobility - Assess for need of PT/ OT - Encourage independence in mobility - Self- care - Assist in self care deficits - Provide assistive devices - Consult with community agencies

Interventions to maintain functional ability

-ROM - Isometric exercise - Dynamic exercise - Aerobic exercise - Pool exercise

Interventions for pt with a Rheumatic Disorder

Physical and psychological changes Absence of complications secondary to medications

Medications and Tx

- Salicylates and NSAIDs - Topical analgesics - DMARDs - Immunomodulators - Corticosteroids - Reconstructive Surgery

First gen NSAIDs Cox 1 and Cox 2

ASA Ibuprofen Naproxen Indomethacin Diclofenac Ketorolac Meloxicam- COX 2

DMARDs I are

Major nonbiologic ex: Leflunomide

Methotrexate

DMARD I-Immunomodulator - Gold standard start first

Hydroxychloroquine

Antimalarial DMARD I

Sulfasalazine

DMARD I Antiinflammatory

DMARDs II

Major Biologic DMARD

TNFA meds include

Etanercept Infliximab Adalimumab

B Lymphocyte Depleting agent

Rituximab

Interleukin 1 receptor antagonist

Abatacept

DMARDs II target what?

Proinflamm mediators Cost more tended for most severe patients

Janus Kinase

New class drugs - Binds to active JAK enzyme sites - Inhibit cytokine production - Used in combo with nonbiologic agents or as monotherapy

Prednisone Prednisolone

Glucocorticoids

Diffuse connective tissue diseases

1. Group of chronic disorders characterized by diffuse inflammation and degeneration in connective tissue 2. Cause is unknow but thought to have an immunologic basis 3. Characterized by a clinical course of exacerbations and remissions 4. Includes RA, SLE, scleroderma, polymyositis, and polymyalgia rheumatica

Lupus is an autoimmune disease which means?

Mean's the body's natural defense system (immune system) attacks healthy tissues instead of attacking only things like bacteria and viruses. This causes inflammation

Systems affected by lupus includes

Nervous Ophthalmologic Oral Derm Cardiopulm Renal GI Repro Hemat Musco

Name the systemic effects of SLE and the extraarticular features

-Fever - Weight loss - Fatigue - Anemia - Lymph node enlargement - Raynaud's and Sjorgens - RA nodules Other: arteritis, neuropathy, pericarditis, and splenomegaly

management of SLE

Pain management Immunosuppression Corticosteroids Antimalarial

Home remedies

Mediterranean diet Favor fish omega 3 fatty acids Colorful produce Whole grains Olive Oil

How to teach pt self care of SLE

- Explain disease and principles of disease management -Medication teaching - Monitoring - Sources of info - Pain management - Joint protection - Self care assitive devices -Exercise and relaxation