RHEUMATICDISEASES

Objectives

• Identify connective tissue diseases• Describe the nursing care for rheumatic diseases and

rheumatoid arthritis• Identify the risks for rheumatoid arthritis• Lists signs and symptoms for rheumatoid arthritis• Describe the medical management for rheumatoid arthritis• Describe the pathophysiology and symptoms of SLE• Describe the medical management for SLE

Diffuse Connective Tissue Diseases

• A group of chronic disorders characterized by diffuse inflammation and degeneration in the connective tissue

• Cause is unknown but thought to have an immunologic basis

• Characterized by a clinical course of exacerbations and remissions

• Includes RA, SLE, scleroderma, polymyositis, and polymyalgia rheumatica

Systemic Effects: Extraarticular Features

• Exacerbations & remission• Fever• Fatigue• Anemia• Lymph node enlargement• Any organ system may be

involved; arteritis, neuropathy and other neurologic manifestations, scleritis, pericarditis, pleural effusion, splenomegaly, renal involvement

• Skin and mucosal manifestations

Rheumatic Diseases

• “Arthritis” • More than 100 different disorders• Affect primary the joints, but also muscles, bone,

ligament, tendons, cartilage• Classification

• Monoarticular or polyarticular• Inflammatory or noninflammatory

• Characterized by inflammation of joints, systemic manifestations

• Treatment• Mild analgesics to

• Provide pain relief• Reduce inflammation

• Corticosteroids to treat inflammation• Radiation to suppress body’s abnormal

antigen–antibody responses

Rheumatoid Arthritis

Characteristic Degenerative Changes— “Degradation”

Clinical Manifestations

• Pain• Joint swelling• Limited movement• Stiffness• Weakness• Fatigue

Patient Assessment and Diagnostic Findings

• Health history: include onset of and evolution of symptoms, family history, past health history, and contributing factors

• Raynauds’s Phenonmenon• Functional assessment• Arthrocentesis• X-rays, bone scans, CTs, and

MRIs• Tissue biopsy• Blood studies

Nursing Interventions

• Understanding of the underlying disease process guide; the nurse’s critical thinking to provide interventions

• The extent of the disease process, and whether it is localized or more systemic, will also affect nursing activities

Nursing Process: The Care of the Patient with a Rheumatic Disease—Diagnoses

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

Medical Management• NSAIDs• Cox-2 Enzyme blockers• DMARDs• Methotrexate• Biologic therapies• Corticosteroids

Nursing Process: The Care of the Patient with a Rheumatic Disease—Planning

• Major goals may include: • Relief of pain and discomfort• Relief of fatigue • Promotion of restorative sleep • Increased mobility • Maintenance of self-care • Improved body image • Effective coping• Absence of complications

• Chronic systemic disorder• Caused by development of antibodies that

fight body’s own tissues, cells• Effects

• Damage to connective tissues, the hematologic system, skin, kidneys, heart, brain

• Treatment• Education in rest, stress management • Use of anti-inflammatory agents and

corticosteroids

Systemic Lupus Erythematosus

Teaching Patients Self-Care

• Explain the disease and principles of disease management• Medication teaching• Monitoring• Sources of information• Pain management• Joint protection • Self-care with assistive devices• Exercise and relaxation