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RHEUMATIC
DISEASES
Objectives
• Identify connective tissue diseases
• Describe the nursing care for rheumatic diseases and
rheumatoid arthritis
• Identify the risks for rheumatoid arthritis
• Lists signs and symptoms for rheumatoid arthritis
• Describe the medical management for rheumatoid arthritis
• Describe the pathophysiology and symptoms of SLE
• Describe the medical management for SLE
Diffuse Connective Tissue Diseases
• A group of chronic disorders characterized by diffuse
inflammation and degeneration in the connective tissue
• Cause is unknown but thought to have an immunologic
basis
• Characterized by a clinical course of exacerbations and
remissions
• Includes RA, SLE, scleroderma, polymyositis, and
polymyalgia rheumatica
Systemic Effects: Extraarticular Features
• Exacerbations & remission
• Fever
• Fatigue
• Anemia
• Lymph node enlargement
• Any organ system may be
involved; arteritis, neuropathy and
other neurologic manifestations,
scleritis, pericarditis, pleural
effusion, splenomegaly, renal
involvement
• Skin and mucosal manifestations
Rheumatic Diseases
• “Arthritis”
• More than 100 different disorders
• Affect primary the joints, but also muscles, bone,
ligament, tendons, cartilage
• Classification
• Monoarticular or polyarticular
• Inflammatory or noninflammatory
• Characterized by inflammation of joints, systemic
manifestations
• Treatment
• Mild analgesics to
• Provide pain relief
• Reduce inflammation
• Corticosteroids to treat inflammation
• Radiation to suppress body’s abnormal
antigen–antibody responses
Rheumatoid Arthritis
Characteristic Degenerative Changes—
“Degradation”
Clinical Manifestations
• Pain
• Joint swelling
• Limited movement
• Stiffness
• Weakness
• Fatigue
Patient Assessment and Diagnostic
Findings
• Health history: include onset
of and evolution of symptoms,
family history, past health
history, and contributing
factors
• Raynauds’s Phenonmenon
• Functional assessment
• Arthrocentesis
• X-rays, bone scans, CTs, and
MRIs
• Tissue biopsy
• Blood studies
Nursing Interventions
• Understanding of the underlying disease process guide;
the nurse’s critical thinking to provide interventions
• The extent of the disease process, and whether it is
localized or more systemic, will also affect nursing
activities
Nursing Process: The Care of the Patient
with a Rheumatic Disease—Diagnoses
• Acute and chronic pain
• Fatigue
• Disturbed sleep pattern
• Impaired physical mobility
• Self-care deficits
• Disturbed body image
• Ineffective coping
Medical Management
• NSAIDs
• Cox-2 Enzyme blockers
• DMARDs
• Methotrexate
• Biologic therapies
• Corticosteroids
Nursing Process: The Care of the Patient
with a Rheumatic Disease—Planning
• Major goals may include:
• Relief of pain and discomfort
• Relief of fatigue
• Promotion of restorative sleep
• Increased mobility
• Maintenance of self-care
• Improved body image
• Effective coping
• Absence of complications
• Chronic systemic disorder
• Caused by development of antibodies that
fight body’s own tissues, cells
• Effects
• Damage to connective tissues, the hematologic
system, skin, kidneys, heart, brain
• Treatment
• Education in rest, stress management
• Use of anti-inflammatory agents and
corticosteroids
Systemic Lupus Erythematosus
Teaching Patients Self-Care
• Explain the disease and principles of disease management
• Medication teaching
• Monitoring
• Sources of information
• Pain management
• Joint protection
• Self-care with assistive devices
• Exercise and relaxation

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008 autoimmunesp14

  • 2. Objectives • Identify connective tissue diseases • Describe the nursing care for rheumatic diseases and rheumatoid arthritis • Identify the risks for rheumatoid arthritis • Lists signs and symptoms for rheumatoid arthritis • Describe the medical management for rheumatoid arthritis • Describe the pathophysiology and symptoms of SLE • Describe the medical management for SLE
  • 3. Diffuse Connective Tissue Diseases • A group of chronic disorders characterized by diffuse inflammation and degeneration in the connective tissue • Cause is unknown but thought to have an immunologic basis • Characterized by a clinical course of exacerbations and remissions • Includes RA, SLE, scleroderma, polymyositis, and polymyalgia rheumatica
  • 4. Systemic Effects: Extraarticular Features • Exacerbations & remission • Fever • Fatigue • Anemia • Lymph node enlargement • Any organ system may be involved; arteritis, neuropathy and other neurologic manifestations, scleritis, pericarditis, pleural effusion, splenomegaly, renal involvement • Skin and mucosal manifestations
  • 5. Rheumatic Diseases • “Arthritis” • More than 100 different disorders • Affect primary the joints, but also muscles, bone, ligament, tendons, cartilage • Classification • Monoarticular or polyarticular • Inflammatory or noninflammatory
  • 6. • Characterized by inflammation of joints, systemic manifestations • Treatment • Mild analgesics to • Provide pain relief • Reduce inflammation • Corticosteroids to treat inflammation • Radiation to suppress body’s abnormal antigen–antibody responses Rheumatoid Arthritis
  • 8. Clinical Manifestations • Pain • Joint swelling • Limited movement • Stiffness • Weakness • Fatigue
  • 9. Patient Assessment and Diagnostic Findings • Health history: include onset of and evolution of symptoms, family history, past health history, and contributing factors • Raynauds’s Phenonmenon • Functional assessment • Arthrocentesis • X-rays, bone scans, CTs, and MRIs • Tissue biopsy • Blood studies
  • 10. Nursing Interventions • Understanding of the underlying disease process guide; the nurse’s critical thinking to provide interventions • The extent of the disease process, and whether it is localized or more systemic, will also affect nursing activities
  • 11. Nursing Process: The Care of the Patient with a Rheumatic Disease—Diagnoses • Acute and chronic pain • Fatigue • Disturbed sleep pattern • Impaired physical mobility • Self-care deficits • Disturbed body image • Ineffective coping
  • 12. Medical Management • NSAIDs • Cox-2 Enzyme blockers • DMARDs • Methotrexate • Biologic therapies • Corticosteroids
  • 13. Nursing Process: The Care of the Patient with a Rheumatic Disease—Planning • Major goals may include: • Relief of pain and discomfort • Relief of fatigue • Promotion of restorative sleep • Increased mobility • Maintenance of self-care • Improved body image • Effective coping • Absence of complications
  • 14. • Chronic systemic disorder • Caused by development of antibodies that fight body’s own tissues, cells • Effects • Damage to connective tissues, the hematologic system, skin, kidneys, heart, brain • Treatment • Education in rest, stress management • Use of anti-inflammatory agents and corticosteroids Systemic Lupus Erythematosus
  • 15.
  • 16.
  • 17. Teaching Patients Self-Care • Explain the disease and principles of disease management • Medication teaching • Monitoring • Sources of information • Pain management • Joint protection • Self-care with assistive devices • Exercise and relaxation