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Chapter 63: Caring for Clients w/ Orthopedic and Connective Tissue Disorders

front 1

general condition characterized by inflammation and degeneration of a joint

  • have the potential to interfere with mobility and ADLs

back 1

Arthritis

front 2

an autoimmune system inflammatory disease of connective tissues/joints characterized by chronicity, remissions, and exacerbations

  • can be caused by genetics, smoking, hormonal imbalances, menstrual history, and hormone replacement therapy
  • sudden!
  • can be detected using an x-ray, arthrocentesis, and a positive CRP test

back 2

Rheumatoid Arthritis (RA)

front 3

This client presents w/:

  • joint pain
  • swelling
  • warmth
  • erythema
  • mobility limitation and weakness (esp in the early mornings)
  • spongy tissue on joint palpation
  • fluid on joints
  • swan neck
  • boutonniere deformity
  • ulnar deviation
  • weight loss/anorexia
  • sleep/temp intolerance
  • fatigue

back 3

Rheumatoid Arthritis (RA)

front 4

Medical and surgical management for clients w/ RA?

back 4

  • can't be cured, but much can be done to minimize damage
  • omega-3 fatty acids found in fish (mackerel, herring, and salmon)
  • NSAIDs
  • Steroids
  • DMARDs: hydroxychloroquine or methotrexate
  • Immunosuppressants
  • TNF: end in -mab
  • rest
  • arthroplasty
  • synovectomy
  • Goals= minimize damage, decrease inflammation, relieve discomfort, preventing deformities, early tx leads to the best results

front 5

Nursing management for clients w/ RA?

back 5

  • teach clients about the disease and provide info about general health
  • instruct clients about medication regimen and effects
  • collaborate w/ OT to provide equipment
  • homecare planning
  • encourage clients to move affected parts gently
  • education about the disease is essential

front 6

Slow, steady progression of destructive changes in weight-bearing joints and those that are repeatedly used for work

  • aka osteoarthritis

back 6

Degenerative joint disease

front 7

This client presents w/:

  • brief joint stiffness and pain after a period of inactivity
  • pain increases w/ heavy use and is relieved by rest
  • joint undergoes enlargement and increased limitation of movement
  • can affect the hands causing Herberden nodes and Bouchard nodes
  • Crepitus
  • Limited ROM

back 7

Degenerative joint disease

front 8

Medical and surgical management for clients w/ DJD?

back 8

  • local rest of the affected joints, rather than total body rest
  • Heat applications
  • Weight loss
  • Ambulatory devices
  • Large does of acetaminophen. If that's not effective, NSAIDs.
  • Corticosteroids
  • Narcotics are avoided
  • Duloxetine
  • Diclofenac gel (Voltaren)

front 9

Nursing management for clients w/ DJD?

back 9

  • teach client about the purpose of drug therapy and possible s/e
  • advocate that client takes NSAIDs w/ food to prevent gastric bleeding
  • instruct client to maintain moderate activity
  • promote weight loss
  • remind client to assume good posture and to avoid unusual stress on a joint
  • ask about proton pump inhibitors (PPI) b/c both NSAIDs and salicylates can cause gastric distress

front 10

cluster of s/s localized near the jaw

  • include degenerative arthritis of the mandibular joint, malocclusion of the teeth, bruxism, dislocation of the jaw during endotracheal intubation, or other jaw injuries and trauma

back 10

Temporomandibular Disorder (TMD)

front 11

This client presents w/:

  • jaw pain
  • muscle spasm
  • tenderness of masseter and temporalis muscles
  • tinnitus
  • headache
  • ear pain
  • clicking of the jaw/locked jaw
  • difficulty chewing

back 11

Temporomandibular Disorder (TMD)

front 12

Medical and surgical management for clients w/ TMD?

back 12

  • refer to a dentist
  • analgesics/NSAIDs
  • custom mouth guard
  • TENS
  • muscle relaxants
  • oral irrigations w/ ice
  • amitriptyline
  • reconstructive surgery

front 13

Nursing management for clients w/ TMD?

back 13

  • monitor client's weight and ability to chew food
  • consult w/ dietician
  • soft diet
  • provide nutritional liquid supplements
  • assist client to acquire skills that control pain, such as a bite guard

front 14

inherited metabolic arthritic disorder that affects the feet, esp. the big toe; hands; elbows; ankles; and knees

  • marked by decrease renal excretion of uric acid (hyperuricemia)
  • increased ingestion of purines (organ meets, steak, shellfish, sardines)
  • dx'd by arthrocentesis or 24-hr urine collection

back 14

Gout

front 15

This client presents w/:

  • sudden onset of acute pain and tenderness in one joint
  • skin turns red and the joint swells, so it is warm and hypersensitive to touch
  • tophi (collection of urate crystals) is present
  • attack may last 1-2 weeks, but swelling and tenderness may persist
  • repeated episodes can deform joint

back 15

Gout

front 16

Medical/Surgical tx of Gout?

back 16

  • NSAIDs
  • Colchicine: given q 1-2 hours; if n/v, diarrhea or intestinal cramp start, temporarily stop admin of medication
  • Allopurinol
  • to prevent future attacks, drug therapy continues after acute attack subsides
  • If NSAIDs don't work, corticosteroids may be given
  • low-purine diet, but a high complex carb diet
  • weight loss
  • increased fluid intake
  • Prednisone

front 17

Nursing management for clients w/ Gout?

back 17

  • place a bed cradle over affect joint to protect it from pressure from the bed linen
  • explain hourly administration of colchicine; instruct client to report any side effects
  • measure intake/output

front 18

inflammation of the bursa

  • commonly seen in elbow, knee, and shoulder
  • caused by repetitive motion or positioning, stress, infection, trauma, or secondary effects of gout

back 18

Bursitis

front 19

This client presents w/:

  • painful movement of shoulder or elbow
  • distinct lump
  • dx'd by x-ray, MRI, aspiration of fluid

back 19

Bursitis

  • if it ruptures, tissue in area may become edematous, warm, and tender

front 20

Medical and surgical management for clients w/ Bursitis?

back 20

  • joint rest
  • NSAIDs
  • Corticosteroids
  • mild ROM exercises
  • if infection is the cause, antibiotics will be ordered

front 21

Nursing management for clients w/ Bursitis?

back 21

  • review prescribed medication and exercise regimens
  • advise client not to traumatize or overuse the recovering joint but to use it normally

front 22

autoimmune disorder that affects multiple body systems

  • can be caused by genetics, hormones, sunlight, stress, viruses, cigarette smoke, previous infection w/ Epstein-Barr virus (mononucleosis)
  • dx'd based on blood tests and presenting s/s

back 22

Systemic Lupus Erythematosus (SLE)

front 23

This client presents w/:

  • red, butterfly shaped rash/"Malar Rash"
  • fever
  • pericardial friction rub
  • enlargement of spleen and lymph nodes
  • weight loss
  • arthralgia
  • muscle pain
  • Raynaud phenomenon
  • easy bruising
  • renal impairment: elevated creatinine level

back 23

Systemic Lupus Erythematosus (SLE)

front 24

Medical tx for clients w/ SLE?

back 24

  • high doses of corticosteroids
  • cytotoxic drugs (azathioprine)
  • aspirin or NSAIDs
  • topical corticosteroids
  • Antimalarials: hydroxychloroquine
  • dialysis or kidney transplantation due to renal impairment

front 25

REVIEW NURSING PROCESS FOR THE CLIENT WITH SLE ON PG 1168

back 25

REVIEW NURSING PROCESS FOR THE CLIENT WITH SLE ON PG 1168

front 26

REVIEW CLIENT AND FAMILY TEACHING 63-1: SLE

back 26

REVIEW CLIENT AND FAMILY TEACHING 63-1: SLE

front 27

infection of the bone, resulting in limited blood supply to the bone, inflammation of and pressure on the tissue, bone necrosis, and formation f new bone around the devitalized bone tissue

  • results from bacteria reaching the bone through the bloodstream

back 27

Osteomyelitis

front 28

This client presents w/:

  • high fever
  • chills
  • rapid pulse
  • tenderness or pain over the affected area
  • redness
  • swelling
  • persistent draining pus

back 28

Osteomyelitis

front 29

Medical/Surgical Management for clients w/ Osteomyelitis?

back 29

  • surgically removing the diseased portion of the bone
  • antibiotics
  • clients need close follow-up to assure that the infection is eradicated and that the bone is healed

front 30

Nursing management for clients w/ Osteomyelitis?

back 30

  • handle affected arm or leg or related areas gently to prevent injury or pain
  • protect area from injury
  • elevate area and bear weight only as indicated
  • protect skin from breakdown
  • administer antibiotics and pain meds
  • extensive emotional support

front 31

disease caused by a tick bite

s/s:

  • red macule/papule at the site of tick bit
  • bull's eye rash
  • headache
  • neck stiffness
  • pain
  • pruritic lesions
  • fever, chills, malaise

back 31

Lyme disease

front 32

Medical/Nursing Management of Lyme Disease?

back 32

  • antibiotics
  • supportive measures
  • teach client how to avoid Lyme disease
  • REVIEW CLIENT AND FAMILY TEACHING 63-2: TIPS FOR AVOIDING LYME DISEASE

front 33

A loss of bone density due to the decrease in:

  • calcitonin
  • estrogen

and increase in:

  • parathyroid hormone

back 33

Osteoporosis

front 34

This client presents w/:

  • lumbosacral pain
  • thoracic back pain
  • progressive kyphosis (loss of height)

back 34

Osteoporosis

front 35

Medical/Nursing Tx for clients w/ osteoporosis?

back 35

  • a diet rich in calcium and vitamin D can prevent osteoporosis (3 glasses of milk daily)
  • mild analgesics (aspirin)
  • calcium preparations (1000-1500 mg of calcium gluconate)
  • calcitonin
  • alendronate
  • raloxifene
  • tamoxifen

front 36

Foods rich in Vitamin D

back 36

  • milk
  • yogurt
  • orange juice
  • margarine
  • cereals

front 37

softening of bones caused by Vitamin D deficiency

back 37

Osteomalacia

front 38

This client presents w/:

  • tenderness of bone on palpation
  • kyphosis
  • bowing of the legs
  • bone pain
  • waddling gait

back 38

Osteomalacia

front 39

Management of Osteomalacia

back 39

  • Vitamin D supplements
  • Calcium
  • Phosphorus
  • Sunlight exposure
  • Progressive exercise

front 40

abnormal bone remodeling

dx'd by x-ray: bone reveals a mosaic appearance

back 40

Paget's disease

front 41

This client presents w/:

  • skull deformities/skull enlargement
  • bowing of long bones
  • bone pain/tenderness
  • kyphosis

back 41

Paget's disease

front 42

Management of Paget's disease

back 42

  • calcitonin
  • alendronate
  • etidronate sodium
  • ambulatory aids