Rheumatoid Diseases.ppt

1、Rheumatoid Diseases,Osteoarthritis Rheumatoid Arthritis Systemic Lupus Erythematosis Scleroderma,Osteoarthritis,Definition: *wear and tear, progressive, non-systemic, Degenerative Joint Disease (DJD) Pathophysiology,Identify which joints are primarily affected with osteoarthritis. What factors contr

2、ibute to the development of osteoarthritis?,Note top slide only,Structural changes with Osteoarthritis Early Cartilage softens, pits, frays Progressive Cartilage thinner, bone ends hypertrophy, bone spurs develop and fissures form Advanced Secondary inflammation of synovial membrane; tissue and cart

3、ilage destruction; late ankylosis,Normal Knee structure,Moderately advanced osteoarthritis,Advanced osteoarthritis,What signs and symptoms does the person with osteoarthritis experience?,Assessment,Onset of pain is insidious, individual is healthy! Pain is aching in nature; relieved by rest!. Local

4、signs and symptoms: swelling, crepitation of joint and joint instability, asymmetrical joint involvement,Deformities with Osteoarthritis,Genuvarus,Herberdens nodes,Carpometacarpocarpal joint of thumb with subluxation of the first MCP,Osteoarthritis,Diagnostic Tests None specific Late joint changes,

5、boney sclerosis, spur formation Synovial fluid inc., minimal inflammation Gait analysis,Nursing diagnosis Interventions determined by complications Supportive devices Medications (no systemic treatment with steroids) Dietary to dec. wt. Surgical Intervention (joint replacement) Teaching,Rheumatoid A

6、rthritis,Chronic systemic, inflammatory disease characterized by recurrent inflammation of diarthroidal joints and related structures.,Comparison of RA and OA,RA Cause unknown Remissions *Body parts affected, systemic, small joints, symmetrical Females, age 20-30; 3-1 ratio OA Cause “wear and tear”,

7、 weight Non-systemic, weight bearing joints Middle-aged and elderly, males 2-1 affected,Manifestations of RA,Systemically ill Hematologic Pulmonary/CV Neurologic Ocular (Sjorgens) Skin MS, deformity, pain,Pain!,Pain!,Pain,Assessment,Fatigue, weakness, pain Joint deformity Rheumatic nodules,Pathophys

8、iology IgG/RF (HLA)= antigen-antibody complex Precipitates in synovial fluid Inflammatory response,Joints changes with RA,Early Pannus Granulation, inflammation at synovial membrane, invades joint, softens and destroys cartilage,Diagnostic Tests,ESR elevated + RA, RA titer Dec. serum complement Syno

9、vial fluid inflammation Joint and bone swelling,inflammation,Mod advanced Pannus joint cartilage disappears, underlying bone destroyed, joint surfaces collapse Fibrous Ankylosis Fibrous connective tissue replaces pannus; loss of joint otion Bony Ankylosis Eventual tissue and joint calcification,Join

10、t Changes,Bilateral, symmetrical, PIPs, MCPs Thumb instability Swan neck, boutonniere deformity Tensynovitis Multans deformity,Subcutaneous nodules Genu valgum Pes plano valgus Prominent metatarsal heads Hammer toes,Assessment,Deformities that may occur with RA,Synotenovitis Ulnar drift Swan neck de

11、formity Boutonniere deformity,Mutlans deformity (rapidly progressing RA) Hitch-hiker thumb Genu valgus,Hammer toes Subcutaneous nodules (disappear and appear without warning),Interventions,Nursing Diagnosis Comfort Physical mobility Self image Goals Team Approach,Pain management Exercise Surgery Tea

12、ching,Medications,ASA *cornerstone NAISD Steroids (burst therapy) Remitting agents antimalarial (plaquinal) *eye effects Penicillamine gold *dermatitis, blood dyscrasia Immunosuppressive agents,Joint Protection: Dos and Donts,Case Presentation,Comparison to usual course Diagnostic tests Nursing diag

13、nosis Therapies Medications used Exercise Joint Protection,Systemic Lupus Erythematous (SLE),Chronic multisystem disease involving vascular and connective tissue,Lupus help,Characteristics of SLE,Types: Discoid, SLE Incidence Periods remission and exacerbation Stress factor,Assessment Low grade feve

14、r Discoid erythema MS involvement Pericarditis Raynaulds RENAL CNS Digestive,anemia,Characteristic butterfly rash associated with SLE, especially discoid lupus erythematous,Barrys lupus,SLE characterized by periods of remission and exacerbation. Stimulated by sunlight, stress, pregnancy, infections

15、like strep and some drugs. Some drugs like apresoline, pronestyl, dilantin, tetracycline, phenobard may cause a lupus-like reaction which disappears when drug is stopped.,Diagnostic Tests,LE cell ANA, titer Anti-DNA Complement fixation ESR Other,Criteria to Dx. malar, discoid rash photosensitivity a

16、rthritis renal disorder immunological disorder DNA, ANA,Management SLE,Nursing diagnosis Goal to control inflammation Emotional support Life Planning,Medications Avoid UV Reduce stress Monitor/manage to prevent complications,Scleroderma,Definition: progressive sclerosis of skin and connective tissue

17、; fibrous and vascular changes in skin, blood vessels, muscles, synovium, internal organs. become “hide bound” CREST syndrome: benign variant of disease,Typical “hide-bound” face of person with scleroderma Tissue hardens; claw-like fingers; fibrosis,Assessment of Scleroderma,Female 4:1 Pain, stiffne

18、ss, polyartheritis Nausea, vomiting Cough Hypertension Raynaulds syndrome,Scleroderma cont.,Esophageal hypomotility leads to frequent reflux GI complaints Lung-pleural thickening and pulmonary fibrosis Renal disease.leading cause of death!,CREST Syndrome,Calcinosis Raynauds phenomena Esophageal hypo

19、motility Sclerodactyl (skin changes of fingers) Telangiectasia (macula-like angioma of skin),More on CREST,Diagnosis/Treatment Scleroderma,R/O autoimmune disease Radiological: pulmonary fibrosis, bone resorption, subcutaneous calcification, distal esophageal hypomotility,What are the KEY components

20、of care for the individual with Scleroderma?,Scleroderma: Patient Care,Dos Avoid cold Provide small, frequent feedings Protect fingers Sit upright post meals No fingersticks Daily oral hygiene,Ankylosing Spondylitis,Definitions; polyarteritis of spine Affects mostly men Associated with HLA positive antigen,Signs and symptoms Morning backache, flexion of spine, decreased chest expansion Diagnosis Nursing Diagnosis,Ankylosing Spondylitis Insidious onset Morning backache Inflammation of spine; la