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37 Cards in this Set
- Front
- Back
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Definition
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*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 |
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Pathophysiology
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*Cause unknown
*Several theories: 1. Infection (virus) 2. Autoimmune Process 3. Genetic Factors (HLA-DR4) marker 65% of patients 4. Other factors |
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Pathogenesis of RA: Four Stages-See handout
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*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 |
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System specific assessments: Clinical Manifesttations
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*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 |
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Clinical Manifestations
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*Joints tender and painful to touch
*Eventually can lead to deformity and disability *Can lead to subluxation (partial dislocation) |
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Extra-articular manifestations
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*25-50% develop nodules (are removable but they reoccur
*See handout for pictures *Small-vessel vasculitis (peripheral neuropathy) *Vasculitis (inflammation of blood vessels |
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Non-specific Manifestations
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*Fatigue
*Anorexia *Wt. Loss *Generalized stiffness *Low grade fever *Flu-like symptoms *Depression *Anxiety |
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Complications of disease & treatment
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*Physical disability
*Adverse effects from drugs *Decreases life span (3-10 years) *Infection *Osteoporosis *Amyloidosis |
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Complications (continued)
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*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) |
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Treatment
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*Needs to be a collaborative approach
*Which members of the health care team should be involved? (nursing, dietary, PT, OT, Family members) |
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Treatment/Medical
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*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 |
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Pharmacological Management
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*1. NSAIDS: ASA, Ibuprofen, Celebrex
*2. Corticosteroids: prednisone, solumedrol *3. DMARDS: Rheumatrex, Plaquenil, Azulfidine |
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Pharmacological Management
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*4. Other DMARDS: Gold therapy, Imuran, Cytoxan, Neoral, Arava, and Remicade
*5. Biologic response modifiers: Enbrel, Remicade, Humira, Kineret |
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Surgical Management
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*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 |
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Nutritional Therapy
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*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 |
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Assessment: (Physiological Integrity)
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RISK FACTORS
*Higher prevalence in certain Native Americans, lower in rural Asia *Women more than men *Smoking *Age 40-60 most common |
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Assessment (basic care and comfort)
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*Alternative therapies
*Assistive devices *Mobility *Non-pharmacological comfort *Nutritional considerations *Comfort care *Rest |
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Assessment (Pharmacological therapies)
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*Medications taken at home
*Adverse effects *Pharmacological interactions *Medication administration |
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Diagnostic Studies/Labs
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*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 |
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Diagnostic Studies/Labs
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*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** |
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Diagnostic Studies
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*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) |
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Physiological Adaptation
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*Alterations in body systems
*Illness management *Unexpected response to therapies |
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Management of care
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*Case management
*Collaboration with multidisciplinary teaching *Consultation: PT, OT *Referrals: VNA, HHA, meals on wheels, local support groups |
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Safe, effective care environment: Safety and infection control
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*Accident prevention
*Home safety *Injury prevention *Safe use of equipment (nursing's responsibility) |
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Assessment: Psychosocial Integrity
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*Coping mechanisms
*Family Dynamics *Grief and Loss *Sensory/Perceptual Alterations *Situational Role Changes *Support Systems *Unexpected Body Image Changes |
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Assessment: Promotion of wellness/HP/Maintenance
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*Aging Process
*Expected body image changes *Health and wellness *Self-care (ADL's) |
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Analysis/Diagnosis (Actual)
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*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! |
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Diagnosis (Risk & PC)
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*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 |
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Implementation: Physiological Integrity
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BASIC CARE AND COMFORT
*Alternative therapies *Assistive devices *Mobility *Non-pharmacological interventions *Nutrition *Provide comfort care *Provide rest |
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Pharmacological Therapies
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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 |
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Physiological Adaptation
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*Maintain body systems
*Illness management 1. Joint protection (handout) 2. Rest |
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Implementation
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*Safe, effective care environment: ambulation, activity
*PT: maintain muscle strength and motion *OT: develop UE function & encourage joint protection with splinting & assist. Devices |
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Implementation: Psychosocial Integrity
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*Coping mechanisms
*Family Dynamics *Grief and Loss *Sensory/Perceptual Alterations *Situational Role Changes *Support Systems *Body Image Changes |
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Implementation
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*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 |
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Evaluate Expected Outcomes & Interventions
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*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 |
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Summary
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*No cure for RA
*Prevention is NOT possible at this time *Early detection, diagnosis and treatment are the key elements |
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Current Trends/Research
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*Article
*www.arthritis.com *www.rheumatology.org *3/07 |
