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Nursing Care & Interventions for the Client with Connective Tissue Disorders

Nursing Care & Interventions for the Client with Connective Tissue Disorders. Keith Rischer RN, MA, CEN. Today’s Objectives…. Review pathophysiology of the inflammatory response. Compare and contrast pathophysiology & manifestations of RA, lupas, gout, lyme’s disease & fibromyalgia.

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Nursing Care & Interventions for the Client with Connective Tissue Disorders

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  1. Nursing Care & Interventions for the Client with Connective Tissue Disorders Keith Rischer RN, MA, CEN

  2. Today’s Objectives… • Review pathophysiology of the inflammatory response. • Compare and contrast pathophysiology & manifestations of RA, lupas, gout, lyme’s disease & fibromyalgia. • Identify the diagnostic tests, nursing priorities, and client education with RA, lupas, gout, lyme’s disease & fibromyalgia. • Discuss medical and pharmocologic management for clients with RA, lupas, gout, lyme’s disease & fibromyalgia. • Describe the mechanism of action, side effects and nursing responsibilities with pharmacologic management of connective tissue disorders.

  3. Antigen-Antibody Interactions • Exposure • Antigen recognition • Lymphocyte recognition • Anti-body production & release • Anti-body/binding actions • Agglutination • Lysis

  4. Autoimmunity • Recognizes self antigens as foreign • Produces antibodies against own tissue • Examples • Lupus • Rheumatoid Arthritis

  5. Rheumatoid Arthritis • Patho • Inflammation • Auto-immune disease • Cartilage damage • Exacerbations • Vasculitis • Causes • Unknown • Possible combo environment/genetic factors • Women>men

  6. Rheumatoid Arthritis: Assessment • Early disease manifestations • Joint stiffness/swelling/pain • Fatigue, weakness, fever • Late disease manifestations • Joint deformities/effusions • Osteoporosis • Systemic complications • Anemia • Vasculitis • Renal disease • Sjogrens syndrome

  7. Rheumatoid Arthritis: Diagnostic • Rheumatoid factor • Erythrocyte sedimentation rate • Serum immunoglobulins • IgG elevated

  8. RA: Pharmocologic Management Mild disease • Nonsteroidal anti-inflammatory drugs (NSAIDs) • Celecoxib (cox-2 inhibiting properties) • ASA Moderate to severe disease • Methotrexate • SE:N&V, anorexia, liver toxicity • Prednisone

  9. RA: Nursing Diagnostic Priorities • Impaired physical mobility r/t… • ROM, physical therapy…assistive devices • Encourage ambulation • Chronic pain r/t… • Analgesics per schedule…Assess effectiveness • Non-pharmacologic • Fatigue r/t… • Monitor nutritional intake • Alternate rest/activity…avoid over exertion

  10. Systemic Lupus Erythematosus (SLE) • Patho • Auto-immune • Exacerbations • Vasculitis • Kidneys • Causes • Unknown • Women 15-40 yrs • 10x more than men

  11. SLE: Assessment • Skin involvement • Butterfly rash • Musculoskeletal changes • Joint inflammation • Systemic • Fever • Fatigue • Anorexia • Pleural effusions • Raynaud’s • Pericarditis

  12. Lupus: Management • Same as RA • Sed rate • Complete blood count • r/o pancytopenia • Immunologic testing • Drug management • Prednisone • Oral • Topical

  13. Lupas: Education Priorities • Skin care • Avoid prolong exposure to sun • Mild soap • Stress reduction • Fatigue • Signs of exacerbation • fever

  14. Gout • Patho • Primary gout • Most common • Excess uric acid • Secondary gout • Excess uric acid • Renal insufficiency • Diuretics • Oncology dx

  15. Gout: Assessment-Treatment • Pain-inflammation small joints • Renal calculi • Labs • Sed rate elevated • WBC elevated • Drugs • Indocin (NSAID) • Colchicine • Allopurinol

  16. Lyme Disease • Patho • Deer tick bite • Spirochete

  17. Lyme Disease: Assessment/Treatment • Stage 1 (early) • Flu-like sx • Bull’s eye rash • Joint pain/stiffness • Stage 2 (2-12 weeks) • Dizziness/palpatations • CNS changes • meningitis • Stage 3 • Arthritis • Fatigue • Memory/cognitive deficits • Drugs • Doxycycline po • Ceftriaxone IV

  18. Fibromyalgia Syndrome • Patho • Cronic pain syndrome • Mental health overlay • Women 30-50 yrs • Assessment • Muscle pain at trigger points • Fatigue • Insomnia • Abd/pelvic pain • Treatment • Increase sleep time • NSAIDS • Muscle relaxants • Physical therapy/exercise

  19. Case Study #2 • Marge, a 35 year old female, presents to the ER with complaints of abdominal pain and blood in her urine • Marge also appears to have an inflamed, red rash on her face. She states she is extremely fatigued and all her muscles ache. Her appetite is poor and she states she has lost several pounds over the past few weeks • Marge’s BP is 146/90, P is 114, RR 28, sats 92%, temp is 101. The nurse notes that Marge has swollen lymph nodes in her neck and groin areas

  20. Case Study #2 • According to the above assessment data, what disease is Marge probably suffering from? What data points to this? • What labs/diagnostic procedures will the provider most likely order? • Knowing that this disease affects highly vascular tissues and organs such as the kidney, what should the nurse teach Marge to monitor? • What broad classifications of drugs can the nurse expect the provider to order for Marge? • What will the nurse teach Marge about exposure to sunlight? • What other hygiene measures are important for the nurse to teach Marge about?

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