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Download 09. Interv for Clients with Connective Tissue Disease
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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!
