Connective Tissue Disorders PDF

COORDINATING CARE FOR PATIENTS WITH CONNECTIVE TISSUE DISORDERS DYANA GALLANT, BSN, RN, CMSRN NUR 136 JANUARY 27, 2025 HOFFMAN PAGES 397-425  OBJECTIVES 01 02 03...

COORDINATING CARE FOR PATIENTS WITH CONNECTIVE TISSUE DISORDERS DYANA GALLANT, BSN, RN, CMSRN NUR 136 JANUARY 27, 2025 HOFFMAN PAGES 397-425  OBJECTIVES 01 02 03 04 Explore the clinical Explain the diagnostic Examine the medical Highlight important manifestations findings utilized to and nursing approaches teaching aspects for associated with verify the presence of in managing individuals patients affected by various connective connective tissue diagnosed with connective tissue tissue disorders. disorders. connective tissue disorders. disorders.  Cover, support, and protect Most abundant tissue in body structures and organs CONNECTIVE Functions: Aid in movement TISSUE Disease: Inflammation or Bone, cartilage, tendons, Immune system dysfunction ligaments, lymphatic tissue, damages and destroys bone marrow connective tissue OSTEOARTHRITIS (OA) Most common form of arthritis Leading cause of disability in US More prevalent in women Affects weight-bearing joints, cervical spine and joints in hands  OA PATHO Cartilage loss Unprotected bone Deterioration of joint function Synovial membrane thickens Restriction of joint movement Muscle atrophy  6 OA: RISK Female FACTORS Age 80% >55 yeas old Obesity Occupations Sports Previous injuries Muscle weakness Genetics Bone & joint disorders  OA SYMPTOMS Morning stiffness Progressive pain Decreased ROM Swelling < 30 mins Pain with Deformity Instability Crepitus activity, decrease with rest  8 OA TREATMENT Weight Aerobic Heat/Cold PT, OT Tylenol loss exercise Steroid Surgery if NSAIDs Opioids injections severe COMMON JOINTS AFFECTED BY OA  MEDICAL MANAGEMENT OF OA History Diagnosis Laboratory testing Radiographs Decrease pain and maintain mobility Treatment Nonpharmacological therapy Diabetes Complications Heart failure  Medications Acetaminophen NSAIDs (aspirin, ibuprofen) Corticosteroid injections OA MEDICAL (methylprednisolone) AND Opioids ( SURGICAL Surgical Management MANAGEMENT Arthroscopic irrigation and/or debridement Synovectomy Surgical fusion  OA NURSING MANAGEMENT— ASSESSMENT & ANALYSIS Elevated Unsteady gait Swelling Fatigue Painful ROM serum creatinine Elevated liver Monitor skin Constipation Vital signs Weight enzymes integrity Pain Encourage Patient management PT/OT Education OA NURSING INTERVENTIONS Administer analgesic and anti-inflammatory medications Cold packs for joints Heat pad for muscles  OA: TEACHING & EVALUATING OUTCOMES Take medications as prescribed Report chest pain, abdominal pain, abnormal bleeding Participate in regular physical activity Occupational and physical therapy Orthopedic surgery Home health referral Goal Maintain normal function Pain control Unrestricted movement  RHEUMATOID ARTHRITIS (RA) Epidemiology Risk factors Chronic, systemic & Cigarette smoke autoimmune Less prevalent than Bacteria osteoarthritis (1%) Viruses More prevalent in women Symmetrical joint distribution Can affect other organs For those patients who do not enter remission, about 60% will be disabled within 10 years  RHEUMATOID ARTHRITIS Pathophysiology Clinical Manifestations Antigen triggers Joint pain and swelling, immune response erythema Synovial tissue damage Morning stiffness Increase in synovial Fatigue fluid > impaired Irreversible joint movement > pain damage and disability Thickened synovial membrane > joint destruction COMMON JOINTS AFFECTED BY RA RHEUMATOID ARTHRITIS Signs/Symptoms Diagnosis Joint pain Sx 6 weeks or longer Joint stiffness Palpation of synovitis Morning stiffness > 30 mins Ultrasound Fatigue Labs inconclusive - antibodies may or may Osteopenia – decrease bone density not be present, the rheumatoid factor can also Muscle weakness be present in other autoimmune diseases, and Episcleritis – between conjunctica/sclera elevated CRP or ESR are indicators of inflammation and aren’t specific to RA. Pleuritis – Outside lining of lungs X-rays – erosions/narrowing Pleural effusion Pericarditis MRI if xray inconclusive  RHEUMATOID ARTHRITIS Surgical Complications Treatment management Decreased function PT/OT Joint replacement Permanent joint ROM Bone fusion deformity Aerobic exercises Infection Healthy nutrition Cancer Tylenol, NSAIDs, Steroids DMARDs such as Methotrexate Surgery  RHEUMATOID ARTHRITIS Nursing interventions— Nursing interventions— Nursing management— Assessments Actions Assessment & Analysis Joint pain and mobility Administer analgesics and Manifestations Temperature anti-inflammatories as related to Laboratory testing – ordered Pain CRP, ESR, HGB, Administer glucocorticoids Decreased function Albumin, PLT, Liver and as ordered Side effects of Renal panels Administer DMARD Assess for pleural effusion, therapy as ordered pharmacological (methotrexate) therapy pericarditis, pleuritic, scleritis, episcleritis, and Administer biologics as osteopenia. ordered (adalimumab (Humira))  RHEUMATOID ARTHRITIS Nursing interventions— Nursing management— Teaching Importance of adherence to treatment Few to no tender Evaluating care outcomes swollen joints plan Minimal morning stiffness Report signs and symptoms of infection No adverse effects from Immunosuppressive therapy pharmacological therapy Assist with referrals Infectious disease specialist Physical and occupational therapy Keep current with vaccinations  SCLERODERMA Epidemiology Pathophysiology 9-19 cases per 1,000,000 people per year Affects skin and internal organs Onset 30-50 years old Tissue damage More women than men Excess insoluble collagen formation More common in African Americans Loss of elasticity and movement Tissue degenerates and becomes Risk factors nonfunctional Environmental exposure Infectious agents Clinical manifestations Occupational toxins Localized Systemic  23 LOCALIZED VS SYSTEMIC Localized Scleroderma Systemic Scleroderma Morphea (hardened patches of skin) Raynaud’s phenomenon (Not Linear Scleroderma Primary Raynaud’s) Scleroderma en coup de saber Scleroderma renal crisis Pulmonary artery hypertension  SYSTEMIC SCLERODERMA Limited Diffuse Gradual onset Rapid onset Skin of extremities distal to elbows Skin of extremities and trunk and knees Raynaud’s occurs concurrently or Raynaud’s can precede disease by after disease years Likely to affect internal organs within 2 years If internal organs involved, late Difficult to treat onset Shortened life span more likely SCLERODERMA DIAGNOSIS & TREATMENT Signs/Symptoms There is no single treatment to manage Antibody testing scleroderma. Treatment is focused on X-rays specific organ involvement and clinical manifestations. PFTs Steroids - prednisone Echocardiograms Immunosuppressants - methotrexate Heart catheterizations Antihistamines - loratadine Kidney biopsies Vasodilators - amlodipine Topical ointments  SCLERODERMA Nursing interventions—Assessments Nursing interventions—Teaching Vital signs – High BP may = renal crisis, High Scleroderma disease process HR/arrhythmias may = heart failure, High RR may = lung disease/pulm htn Protect skin from trauma Auscultate – interstitial lung disease Assess skin integrity Nursing management—Evaluating care Bowel sounds for GI involvement outcomes Serum BUN and creatinine Maintained skin integrity Nursing interventions—Actions Maintained pulmonary, cardiac, GI, and Administer medications as ordered renal functions Perform range-of-motion exercises Assist in referrals Pulmonologist, gastroenterologist, plastic surgeon, physical therapist Referral to counseling  SYSTEMIC LUPUS Chronic inflammatory disease ERYTHEMATOSUS Can affect any organ Does not follow a pattern More prevalent in women Genetic predisposition Flares occur No specific diagnostic test: Laboratory findings are used to support or confirm the diagnosis when combined with patient history and physical examination findings.  LUPUS ERYTHEMATOSUS Pathophysiology Chronic inflammatory disease Triggers include Pregnancy Exposure to sunlight Illness Major surgery Silica dust Medication allergies COMMON SIGNS & SYMPTOMS Malar “butterfly rash” Fatigue Itchy skin Joint & muscle pain Alopecia Depression, anxiety Stroke Peri/Endocarditis Retinal lesions Not present in all patients, making it difficulty to diagnose  LUPUS ERYTHEMATOSUS Treatment Complications Avoiding the sun and applying sunscreen >SPF 50, daily Renal failure Proper nutrition Premature heart disease Sleep schedule Regular exercise Lung disease Hydroxychloroquine *routine eye exams Hypercoagulation NSAIDs – aches/pains Stroke Glucocorticoids – suppress the immune response Avascular necrosis of joints Belimumab - immunosuppressivem * significant drug interactions exist. Nurses and patients should make sure that Increased risk of infection drug lists are up to date, including OTC medications.  Vital signs Head to toe assessment Monitor labs LUPUS: Medication administration NURSING MANAGEMENT Pain management Education Collaboration with referred disciplines  GOUT Build up of uric acid in joints, bone & tissues Results in inflammation to affected joint Can resolve or evolve into destructive arthritis 80% of first gout attacks affect lower extremity joint “Podagra” gout in the great toe At risk for kidney stones  33 RISK FACTORS Obesity Hypertension Diet high in meat and seafood Thiazide diuretics Consuming large quantities of alcohol  GOUT Clinical manifestations Acute Acute onset of pain, redness, swelling Intercortical Asymptomatic period between gout attacks Chronic Repeated attacks of many years, leading to the production of tophi (uric acid deposits or nodules in the joint) and joint destruction  DIAGNOSTICS Objective: Redness, warmth, tenderness & swelling Subjective: “I think my toe or knee is swollen. It’s hot and red.” Labs: Elevated serum uric acid levels Microscopic view of crystals from synovial fluid or tophi X-rays reveal joint erosions or nodules  Weight loss Avoiding beer and other alcoholic beverages Splinting joint Colchicine & Indomethacin decrease crystal build up TREATMENT Glucocorticoids Allopurinol decreases uric acid in CHRONIC gout Avoid aspirin – can increase uric acid levels NURSING MANAGEMENT OF GOUT Monitor lab values Skin assessment Pain assessment Medication administration Proper patient teaching FIBROMYALGIA Chronic pain disorder of soft connective tissue More prevalent in women Etiology and pathophysiology unclear  TREATMENT & NURSING MANAGEMENT PT/OT, strength training and aerobic Vital signs exercises Pain management Cognitive therapy to assist with pt’s Assess patient affect response to pain Heat application for pain Coping skills to minimize stress Encouragement of healthy lifestyle Regular sleeping patterns Avoid opioids Medications to block overactivity of nerve cells FIBROMYALGIA Epidemiology Medical management—Diagnosis 4% of US population History Greater prevalence in women Physical assessment Laboratory tests to rule out other causes Risk factors Rheumatoid arthritis Medical management—Treatment Physical therapy Lupus Strength training Sjogren’s syndrome Aerobic exercise Pathophysiology Cognitive behavioral therapy Unclear etiology; theories include Education Abnormal processing of stimuli by Self-management skills central nervous system Medical management—Medications Clinical manifestations Serotonin Widespread pain Norepinephrine Insomnia Sleep aids Fatigue Non-opioid analgesics Stiffness Cognitive dysfunction  FIBROMYALGIA Nursing management—Assessment and analysis Vital signs – Pain may alter vital signs (increased Enhanced pain perception heart rate and blood pressure). Stress Affect – Depression may be an associated symptom Nursing management—Nursing because of chronic pain. diagnoses Chronic pain Pain – Fibromyalgia causes chronic pain. Increased Ineffective coping levels indicate ineffective treatment strategies, whereas decreased pain levels indicate effective Depressed mood treatment and self-management. Ineffective sleep pattern Nursing interventions—Actions Nursing interventions—Assessments Administer medications as ordered Vital signs Provide heating pad Affect and mood Pain  FIBROMYALGIA Nursing management— Nursing interventions—Teaching Evaluating care outcomes Take medications only as prescribed Decreased pain Participate in regular physical activity Decreased fatigue Effective coping skills Healthy sleep patterns Sleep study Improved strength and Mental health function Physical and occupational therapy