Transcript 09. Interv for Clients with Connective Tissue Disease

Interventions for
Clients with
Connective Tissue
Disease and Other
Types of Arthritis
Rheumatology
Connective tissue disease (CTD)
is a major focus of rheumatology.
Rheumatic disease is any disease
or condition involving the
musculoskeletal system.
Arthritis means inflammation of
one or more joints.
Osteoarthritis
Most common type of arthritis
Joint pain and loss of function
characterized by progressive
deterioration and loss of
cartilage in the joints
Osteophytes
Synovitis
Subluxation
Clinical Features
Age of Onset > 40 years
Commonly Affected Joints
– Cervical and lumbar spine
– First carpometacarpal
joint
– Proximal interphalangeal
joint
– Distal interphalangeal
joint
– Hip
– Knee
– Subtalar joint
– First metarsophalangeal
joint
Collaborative Management
History
Physical assessment and clinical
manifestations
– Joint involvement
– Heberden's nodes
– Bouchard’s nodes
– Joint effusions
– Atrophy of skeletal muscle
Joint Space Narrowing
OA typically asymmetrical
Paget’s disease
Subchondral Sclerosis
Increased bone density or thickening
in the subchondral layer
Osteophytes
Bone spurs
Subchondral Cysts
Fluid-filled sacs in subchondral bone
Assessments
Psychosocial
Laboratory assessment of
erythrocyte sedimentation rate
and C-reactive protein (may be
slightly elevated)
Radiographic assessment
Other diagnostic assessments
– MR imaging
– CT studies
Total Hip Arthroplasty
Preoperative care
Operative procedures
Postoperative care
– Prevention of dislocation, infection,
and thromboembolic complications
– Assessment of bleeding
– Management of anemia
Rheumatoid Arthritis
A most common connective tissue
disease and the most destructive to
the joints
Chronic, progressive, systemic
inflammatory autoimmune disease
primarily affecting the synovial joints
Autoantibodies (rheumatoid factors)
formed that attack healthy tissue
Affects synovial tissue of any organ
or body system
Joints changes with RA
Early Pannus
Granulation,
inflammation at
synovial
membrane,
invades joint,
softens and
destroys
cartilage
RA
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
Collaborative Management
Assessment
Physical assessment and clinical
manifestations
– Early disease manifestations
– Late disease manifestations
– Joint involvement
– Systemic complications
– Associated syndromes
Assessment RA
Deformities
that may
occur with
RA
Synotenovitis
Ulnar drift
Swan neck
deformity
Boutonniere
deformity
Mutlans deformity
(rapidly progressing
RA)
Hitch-hiker thumb
Genu valgus
Subcutaneous
nodules (disappear
and appear without
warning)
Hammer toes
Joint Protection: Do’s and Don’t’s
Nonpharmacologic Modalities
in the Treatment of RA
Plasmapheresis
Complementary and alternative
therapies
Promotion of self-care
Management of fatigue
Enhancement of body image
Health teaching
Lupus Erythematosus
Chronic, progressive,
inflammatory connective tissue
disorder can cause major body
organs and systems to fail.
Many clients with SLE have some
degree of kidney involvement.
Characteristic
butterfly rash
associated with
SLE, especially
discoid lupus
erythematous
Barry’s
lupus
Collaborative Management
Physical assessment and clinical
manifestations
– Skin involvement
– Musculoskeletal changes
– Systemic manifestations including
pleural effusions or pneumonia and
Raynaud’s phenomenon
Assessments for Lupus
Psychosocial results can be
devastating.
Laboratory
– Skin biopsy (only significant test to
confirm diagnosis)
– Anti-Ro (SSA) test
– Complete blood count
– Body system functions
Gout
Also called gouty arthritis, a
systemic disease in which urate
crystals deposit in the joints and
other body tissues, causing
inflammation
Primary gout
Secondary gout
Lyme Disease
Reportable systemic infectious
disease caused by the spirochete
Borrelia burgdorferi, resulting
from the bite of an infected deer
tick
Stages I and II
If not treated in early stages,
chronic complications such as
arthralgias, fatigue, memory and
thinking problems present in
Typical “hidebound” face of
person with
scleroderma
Tissue hardens;
claw-like
fingers; fibrosis
Ankylosing
Spondylitis
Insidious
onset
Morning
backache
Inflammation
of spine; later
spine
ossification
Oh my back hurts!