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RHEUMATIC DISORDERS
RHEUMATIC
DISEASES
PATHOPHYSIOLOGY
CLINICAL MANIFESTATIONS
Pain – most common
Joint swelling
Limited movement
Stiffness
Weakness
Fatigue
DIAGNOSTIC PROCEDURES
1. Erythrocyte Sedimentation Rate (ESR)– reflects inflammatory activity and,
indirectly, the progression or remission of the disease
N⁰ = M: up to 15 mm/hr
F: up to 20 mm/hr
2. Arthrocentesis – needle aspiration of synovial fluid
Purposes:
✓ sample for analysis (crystals=gout; bacteria=infectious arthritis
✓ relieve pain caused
Site: knee or shoulder
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RHEUMATIC DISORDERS
ARTHROCENTESIS
6. Blood Tests
ESR
Serum Creatinine M: 0.6-1.2mg/dL F: 0.5-1.1mg/dL
HCT M: 42-52% F: 37-47%
RBC 4.9 – 6.1 M/cu mm
WBC 5,000-10,000 cu mm
Uric Acid M:2.5-8.5mg/dL F: 2.7 – 7.3 mg/dL
Anti-nuclear Antibody (ANA): Negative at 1:40 dilution
C-reactive Protein Test (CRP) <1.0mg/dL
Rheumatoid Factor: Negative (Normal) <60 units/Ml
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RHEUMATIC DISORDERS
MEDICAL MANAGEMENT
PHARMACOLOGIC THERAPY – to manage symptoms, to control inflammation,
and, in some instances, to modify the disease
Salicylates – eg. Aspirin; anti-inflammatory, analgesic
NSAIDs – eg. diclofenac (Voltaren), COX 2 inhibitors; anti-inflammatory,
analgesic and platelet aggregation inhibitor
DMARDs (Disease-modifying Antirheumatic Drugs) – gold containing
compounds which inhibit T- and B- cell activity, suppress synovitis during
active stage of RD;
Penicillamine (Cuprimine, Depen) which inhibits T-cell function,
impairs antigen presentation, and an anti-inflammatory
Immunosuppressives like methotrexate (Rheumatrex) for immune
suppression.
Immunomodulators – eg. Pyrimidine synthesis inhibitor; Interleukin-1
receptor antagonist; Had anti-inflammatory and anti-proliferative effects.
Corticosteroids – eg. prednisone, hydrocortisone; Has anti-inflammatory
effects
Topical Analgesics – eg. capsaicin (Zostrix); Analgesic
SURGICAL MANAGEMENT
Joint damage and deformity can be repaired by knee replacement
surgery, which can also reduce pain and restore function.
○ The knee cap is removed and the damaged portion (head) of
the femur and tibia are shaved off or resurfaced. The two-
part prosthesis (usually metal) is implanted.
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RHEUMATIC DISORDERS
NURSING PROCESS
ASSESSMENT
Assess patient’s perception of the disorder and situation, actions taken to
relieve symptoms, plans for treatment, and expectations.
Assess current and past symptoms like fatigue, weakness, pain, stiffness,
fever, or anorexia and the effects of theses symptoms on the patient’s
lifestyle and self-image.
Review history and physical assessment focusing on areas commonly
affected including the musculoskeletal system.
Assess ability to comply with treatment regimen, and manage self-care.
DISGNOSIS
Acute and Chronic Pain related to inflammation and increased disease
activity, tissue damage, fatigue, or lowered tolerance level
Impaired Physical Mobility related to decreased range of motion, muscle
weakness, pain on movement, limited endurance
Disturbed sleep pattern related to pain, depression, and medications
Self-care Deficits related to contractures, fatigue, or loss of motion
Ineffective coping related to actual or perceived lifestyle or role changes
INTERVENTIONS
Relieving Pain and Discomfort
Decreasing Fatigue
Promoting restorative Sleep
Increasing Mobility
Facilitating Self-care
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RHEUMATIC DISORDERS
EVALUATION
The client:
Experiences relief of pain or improved comfort level
Experiences reduction in level of fatigue
Improves sleep pattern
Increases or maintains level of mobility
Maintains self-care activities
Experiences improved body image and coping
Experiences absence of complications
RHEUMATOID ARTHRITIS
used as the prototype for inflammatory arthritis
affects 0.5% to 1% of the general population worldwide, with a female-male
ratio between 2:1 and 4:1
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RHEUMATIC DISORDERS
CLINICAL MANIFESTATIONS
(may vary, usually reflecting the stage and severity of the disease)
Classic symptoms include:
Joint Pain
Swelling
Warmth
Erythema
Lack of function
Joint stiffness
Deformities of the hands and feet
DIAGNOSTIC FINDINGS
ESR: Significantly elevated
RBC and C4 complement component: Decreased
C4 N⁰ = 20 – 50 mg/dL or 0.20 – 0.50 g/L
C-reactive protein and antinuclear antibody (ANA) may be positive
Arthrocentesis shows synovial fluid that is cloudy, milky or dark yellow and
contains numerous inflammatory components such as leukocytes and
complement.
X-ray – helps diagnose and monitor the progression of the disease, show
characteristic bony erosions and narrowed joint spaces occurring later in
the disease.
MEDICAL MANAGEMENT
Pharmacologic treatment mentioned in Rheumatic diseases is indicated
but varies according to the progress of the disease.
NURSING MANAGEMENT
Nursing care follows the basic plan of care presented earlier in RD
Assess and intervene in patient concerns and issues that occur with the
diagnosis of a chronic illness such as RA and its resulting disability