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37 Cards in this Set

  • Front
  • Back
*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
*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
*Wt. Loss
*Generalized stiffness
*Low grade fever
*Flu-like symptoms
Complications of disease & treatment
*Physical disability
*Adverse effects from drugs
*Decreases life span (3-10 years)
Complications (continued)
*Spinal cord compression
*Sjogren's syndrome 10-15% RA
-Keratoconjunctivitis (extremely dry eyes, need drops)
-Xerostomia (dry mouth)
*Pericardial effusion 30% pts
*Pericarditis (inflammtion, chest pain, fever, abnormal heart rate)
*Pulmonary Fibrosis (formation of scar tissue of parenchyma of lung)
*Needs to be a collaborative approach
*Which members of the health care team should be involved? (nursing, dietary, PT, OT, Family members)
*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
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)
*Higher prevalence in certain Native Americans, lower in rural Asia
*Women more than men
*Age 40-60 most common
Assessment (basic care and comfort)
*Alternative therapies
*Assistive devices
*Non-pharmacological comfort
*Nutritional considerations
*Comfort care
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
*Alternative therapies
*Assistive devices
*Non-pharmacological interventions
*Provide comfort care
*Provide rest
Pharmacological Therapies
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
*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
*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
*No cure for RA
*Prevention is NOT possible at this time
*Early detection, diagnosis and treatment are the key elements
Current Trends/Research