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37 Cards in this Set

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Definition
*1. Autoimmune (body attacks itself)
*2. Connective tissue disorder - collagen
*3. Rheumatoid Arthritis: chronic, systemic disease characterized by recurrent inflammation of the diarthroidal(movable) joints and related structures
Pathophysiology
*Cause unknown
*Several theories:
1. Infection (virus)
2. Autoimmune Process
3. Genetic Factors (HLA-DR4) marker 65% of patients
4. Other factors
Pathogenesis of RA: Four Stages-See handout
*First: unknown factor causes joint inflammation & production of excess synovial fluid
*Second: Pannus is formed
*Third: Tough fibrous connective tissue replaces the pannus
*Fourth: Fibrous tissue calcifies, bony ankylosis may lead to joint immobilization
System specific assessments: Clinical Manifesttations
*Arthritic complaints: pain, stiffness, inflammation, usually bilaterally
*Usually starts w/ fingers, hands, wrists, knees, feet
*Prolonged MORNING stiffness lasting from 60 minutes to several hours
Clinical Manifestations
*Joints tender and painful to touch
*Eventually can lead to deformity and disability
*Can lead to subluxation (partial dislocation)
Extra-articular manifestations
*25-50% develop nodules (are removable but they reoccur
*See handout for pictures
*Small-vessel vasculitis (peripheral neuropathy)
*Vasculitis (inflammation of blood vessels
Non-specific Manifestations
*Fatigue
*Anorexia
*Wt. Loss
*Generalized stiffness
*Low grade fever
*Flu-like symptoms
*Depression
*Anxiety
Complications of disease & treatment
*Physical disability
*Adverse effects from drugs
*Decreases life span (3-10 years)
*Infection
*Osteoporosis
*Amyloidosis
Complications (continued)
*Spinal cord compression
*Sjogren's syndrome 10-15% RA
-Keratoconjunctivitis (extremely dry eyes, need drops)
-Xerostomia (dry mouth)
*Vasculitis
*Pericardial effusion 30% pts
*Pericarditis (inflammtion, chest pain, fever, abnormal heart rate)
*Pulmonary Fibrosis (formation of scar tissue of parenchyma of lung)
Treatment
*Needs to be a collaborative approach
*Which members of the health care team should be involved? (nursing, dietary, PT, OT, Family members)
Treatment/Medical
*Joint protection: (handout) PT, OT, splints, work modification, use assistive devices
*Rest/Activity: need to conserve energy
*Pharmacological: next slide and handout
*Basic Human Needs: family, OT, home care, self help groups
Pharmacological Management
*1. NSAIDS: ASA, Ibuprofen, Celebrex
*2. Corticosteroids: prednisone, solumedrol
*3. DMARDS: Rheumatrex, Plaquenil, Azulfidine
Pharmacological Management
*4. Other DMARDS: Gold therapy, Imuran, Cytoxan, Neoral, Arava, and Remicade
*5. Biologic response modifiers: Enbrel, Remicade, Humira, Kineret
Surgical Management
*TREND: prevention and early treatment
*Indicated for someone with uncontrolled pain or loss of function
*Synovectomy - remove synovial membrane
*Joint Replacement: arthroplasty
*Joint fusion
*Tendon repair
*Osteotomy
Nutritional Therapy
*No specific diet for RA, but balanced nutrition important
*Occupational therapy
*Meals on Wheels
*Excessive wt. = increased stress on joints
*Limit NA+ intake
*Need to look at S/E of meds
NSAIDS take with food or milk
Assessment: (Physiological Integrity)
RISK FACTORS
*Higher prevalence in certain Native Americans, lower in rural Asia
*Women more than men
*Smoking
*Age 40-60 most common
Assessment (basic care and comfort)
*Alternative therapies
*Assistive devices
*Mobility
*Non-pharmacological comfort
*Nutritional considerations
*Comfort care
*Rest
Assessment (Pharmacological therapies)
*Medications taken at home
*Adverse effects
*Pharmacological interactions
*Medication administration
Diagnostic Studies/Labs
*ESR (sed. rate) elevated in 85% of pts.
*RhF: Serum Rheumatoid factor (positive in 70-80% of pts.
*ANA and lupus cell tests may also be present (normal = negative)
*Synovial fluid shows increased volume & turbidity but decreased viscosity of fluid
Diagnostic Studies/Labs
*C-reactive proten (non-specific)
*WBC of synovial fluid high
*Inflammtory changes in synovium noted on tissue biopsy
**basic x-ray may show bone demineralization**
Diagnostic Studies
*X-ray: may show bone demineralization and soft-tissue swelling early in disease
*LATER narrowing of joint spact, destruct. of cartilage, erosion, subluxation & deformity
*Malalignment & ankylosis=ADVANCED
*American Rheumatism Association: Diagnostic Criteria for Rheumatoid Arthritis (see handout)
Physiological Adaptation
*Alterations in body systems
*Illness management
*Unexpected response to therapies
Management of care
*Case management
*Collaboration with multidisciplinary teaching
*Consultation: PT, OT
*Referrals: VNA, HHA, meals on wheels, local support groups
Safe, effective care environment: Safety and infection control
*Accident prevention
*Home safety
*Injury prevention
*Safe use of equipment (nursing's responsibility)
Assessment: Psychosocial Integrity
*Coping mechanisms
*Family Dynamics
*Grief and Loss
*Sensory/Perceptual Alterations
*Situational Role Changes
*Support Systems
*Unexpected Body Image Changes
Assessment: Promotion of wellness/HP/Maintenance
*Aging Process
*Expected body image changes
*Health and wellness
*Self-care (ADL's)
Analysis/Diagnosis (Actual)
*Impaired Physical MOBILITY related to pain and restricted joint movement
*Chronic PAIN r/t swollen, inflammed joints and restricted movement
*FATIGUE r/t chronic inflammatory process
*BODY image disturbance r/t
*Self CARE deficit r/t
page 1730 care plan READ IT!
Diagnosis (Risk & PC)
*Risk for ineffective management of therapeutic regimen r/t insufficient knowledge of condition, pharmacological therapy, exercise program, rest vs. activity, myths, and community resource
*PC: Pericarditis
*PC: Pulmonary fibrosis
*PC: Vasculitis
Implementation: Physiological Integrity
BASIC CARE AND COMFORT
*Alternative therapies
*Assistive devices
*Mobility
*Non-pharmacological interventions
*Nutrition
*Provide comfort care
*Provide rest
Pharmacological Therapies
TEACH THE CLIENT AND FAMILY ABOUT
1. Medication plan
2. Adverse effects vs. expected effects
3. Expected effects
4. Complications of RA
5. Complications of treatments
Ex: weight gain is normal on Prednisone
Heat no more than 20 minutes
Physiological Adaptation
*Maintain body systems
*Illness management
1. Joint protection (handout)
2. Rest
Implementation
*Safe, effective care environment: ambulation, activity
*PT: maintain muscle strength and motion
*OT: develop UE function & encourage joint protection with splinting & assist. Devices
Implementation: Psychosocial Integrity
*Coping mechanisms
*Family Dynamics
*Grief and Loss
*Sensory/Perceptual Alterations
*Situational Role Changes
*Support Systems
*Body Image Changes
Implementation
*HEALTH MAINTENANCE/PROMOTION:
*Discharge planning: need for home care, OT, PT & Nursing
*Educate the client & family to monitor for signs of complications
*Educate the client & family about medications, exercises, techniques for compensation in physiologic integrity
*Provide information about local community resources
Evaluate Expected Outcomes & Interventions
*Client will have satisfactory PAIN RELIEF
*Client will participate in therapeutic regiment
*Client will maintain positive self image
*Client will perform self-care as much as possible
Summary
*No cure for RA
*Prevention is NOT possible at this time
*Early detection, diagnosis and treatment are the key elements
Current Trends/Research
*Article
*www.arthritis.com
*www.rheumatology.org
*3/07