Nursing Management: Arthritis and Connective Tissue Diseases Chapter 65 Overview Copyright © 2011,...

Nursing Management:Arthritis and Connective

Tissue Diseases

Chapter 65 Overview

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Arthritis

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 2

Osteoarthritis Etiology and

Pathophysiology


Osteoarthritis


Fig. 65-1. Pathologic changes in osteoarthritis. A, Normal synovial joint. B, Early change in osteoarthritis is destruction of articular cartilage and narrowing of the joint space. There is inflammation and thickening of the joint capsule and synovium.C, With time, there is thickening of subarticular bone caused by constant friction of the two bone surfaces. Osteophytes form around the periphery of the joint by irregular overgrowths of bone. D, In osteoarthritis of the hands, osteophytes on the distal interphalangeal joints of the fingers are termed Heberden’s nodes and appear as small nodules.

Osteoarthritis Clinical Manifestations

Systemic Joints


Osteoarthritis


Fig. 65-2. Joints most frequently involved in osteoarthritis.

Osteoarthritis Clinical Manifestations,

continued Deformity

Diagnostic Studies


Osteoarthritis Collaborative Care

Rest and joint protection Heat and cold applications Nutritional therapy and

exercise Complementary and

alternative therapies Drug therapy


Nursing Management: Osteoarthritis

Nursing Assessment Nursing Diagnoses Planning




Fig. 65-4. Typical deformities of rheumatoid arthritis. A, Ulnar drift. B, Boutonnière deformity. C, Hallux valgus. D, Swan neck deformity.


Nursing Implementation Health promotion Acute intervention Ambulatory and home care

Evaluation


Rheumatoid Arthritis Etiology and

Pathophysiology


Rheumatoid Arthritis


Fig. 65-3. Rheumatoid arthritis. A, Early pathologic change in rheumatoid arthritis is rheumatoid synovitis. The synovium is inflamed. There is a great increase in lymphocytes and plasma cells. B, With time, there is articular cartilage destruction; vascular granulation tissue grows across the surface of the cartilage (pannus) from the edges of the joint, and the articular surface shows loss of cartilage beneath the extending pannus, most marked at the joint margins. C, Inflammatory pannus causes focal destruction of bone. At the edges of the joint there is osteolytic destruction of bone, responsible for erosions seen on x-rays. This phase is associated with joint deformity. D, Characteristic deformity and soft tissue swelling associated with severe advanced rheumatoid disease of the hands.

Rheumatoid Arthritis Clinical Manifestations

Joints Extraarticular manifestations




Fig. 65-5. Extraarticular manifestations of rheumatoid arthritis.

Rheumatoid Arthritis Complications Diagnostic Studies




Table 65-7. American Rheumatism Association classification Criteria for Rheumatoid Arthritis

Rheumatoid Arthritis Collaborative Care

Drug therapy Nutritional therapy

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.18

Nursing Management:Rheumatoid Arthritis



Nursing Management:Rheumatoid Arthritis


Rest Joint protection Heat and cold therapy and

exercise Psychologic support


Gerontologic Considerations:Arthritis


Spondyloarthropathies


Ankylosing Spondylitis Etiology and

Pathophysiology Clinical Manifestations and

Complications


Ankylosing Spondylitis


Fig. 65-6. Advanced ankylosing spondylitis. Kyphotic posture causes many patients to havea protuberant abdomen secondary to pulmonary restriction.

Ankylosing Spondylitis Diagnostic Studies Collaborative Care


Nursing Management:Ankylosing Spondylitis


Psoriatic Arthritis


Septic Arthritis


Lyme Disease


Fig. 65-7. Erythema migrans of Lyme disease.

Gout Etiology and


Complications


Gout


Fig. 65-8. Tophaceous gout.

Gout Diagnostic Studies Collaborative Care

Drug therapy Nutritional therapy


Nursing Management: Gout


Systemic Lupus Erythematosus

Etiology and Pathophysiology

Clinical Manifestations and Complications




Fig. 65-9. Multisystem involvement in systemic lupus erythematosus.


Clinical Manifestations and Complications, continued Dermatologic manifestations




Fig. 65-10. Butterfly rash of systemic lupus erythematosus.


Clinical Manifestations and Complications, continued Musculoskeletal problems




Fig. 65-4. Typical deformities of rheumatoid arthritis. A, Ulnar drift. B, Boutonnière deformity. C, Hallux valgus. D, Swan neck deformity.


Clinical Manifestations and Complications, continued Cardiopulmonary problems Renal problems



Clinical Manifestations and Complications, continued Nervous system problems Hematologic problems Infection

Diagnostic Studies Collaborative Care

Drug therapy


Nursing Management:Systemic Lupus Erythematosus



Nursing Management:Systemic Lupus Erythematosus


Lupus and pregnancy Psychosocial issues

Evaluation


Systemic Sclerosis Etiology and

Pathophysiology


Systemic Sclerosis


Fig. 65-11. Skin changes in systemic sclerosis.

Systemic Sclerosis Clinical Manifestations

Raynaud’s phenomenon Skin and joint changes


Systemic Sclerosis


Fig. 65-12. Hand of a patient with systemic sclerosis showing sclerodactyly.

Systemic Sclerosis Clinical Manifestations,

continued Internal organ involvement

Diagnostic Studies Collaborative Care

Drug therapy


Nursing Management:Systemic Sclerosis


Polymyositis and Dermatomyositis

Etiology and Pathophysiology

Clinical Manifestations and Complications Muscular Dermal




Fig. 65-13. Dermatomyositis skin changes. Gottron’s papules.


Clinical Manifestations and Complications, continued Other manifestations

Diagnostic Studies


Nursing and Collaborative Management:



Mixed (Overlapping) Connective Tissue Disease


Sjögren's Syndrome


Soft Tissue Rheumatic Syndromes


Myofascial Pain Syndrome


Table 65-19. Comparison of Fibromyalgia and Myofascial Pain

Fibromyalgia Syndrome Etiology and


Complications


Fibromyalgia Syndrome


Fig. 65-14. Tender points in fibromyalgia syndrome.

Fibromyalgia Syndrome Diagnostic Studies Collaborative Care


Nursing Management:Fibromyalgia Syndrome


Chronic Fatigue Syndrome Etiology and

Pathophysiology Clinical Manifestations Diagnostic Studies


Nursing and Collaborative Management:

Chronic Fatigue Syndrome


Nursing Management: Arthritis and Connective Tissue Diseases Chapter 65 Overview Copyright © 2011,...

Documents

Transcript of Nursing Management: Arthritis and Connective Tissue Diseases Chapter 65 Overview Copyright © 2011,...