250 connective tissue disorders

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250 connective tissue disorders
2013-09-29 13:08:49
250 connective tissue disorders

250 connective tissue disorders
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  1. osteoarthritis is
    a slowly progresive NONINFLAMMATORY disorder of the synovial joints
  2. what is important about osteoarthritis' location in the body
    • it is localized, only affects the joint
    • it is asymmetrical
  3. causes of osteoarthritis
    • age
    • obesity
    • injury or overuse
    • genetics
    • muscle weakness
  4. when does pain worsen in osteorthritis
    with use of the joint
  5. in early stages of OA does rest relieve pain
    yes but in later stages no
  6. when does joint stiffness occur in OA
    after periods of rest or static position
  7. early morning stiffness in OA usually resolves within
    30 minutes
  8. Heberden's and Bouchard's nodes are
    • red, swollen, and tender joints
    • visible disfigurement of joint
    • doesn't cause significant loss of function
  9. contrast Heberden's nodes to Bouchards
    • Heberden's = distal
    • Bouchards = proximal
  10. would inflammatory lab tests show an increase in OA
    NO osteoarthritis is a non inflammatory disease
  11. what happens to cartilage in OA
    it is worn away and bone rubs against bone
  12. some diagnostic tests for OA are
    • bone scan
    • CT scan
    • MRI
    • x-rays
    • synovial fluid analysis
  13. what is treatment of OA
    • NON-pharmacological
    • localized treatment of corticosteroids
    • care focuses on managing pain preventing disability, and maintaining and improving joint function
  14. what is hyaluronic acid
    • med that is put into joint of OA to cushion joint
    • works about 3 months
  15. osteoarthritis treatment includes
    • heat and cold
    • rest and joint protection
    • pain management
    • nutritional therapy and exercise
  16. for every one pound of weight loss what is the reduction in the knee
    4 lbs of weight load off the knees
  17. surgery for OA
    arthroscopic surgery
  18. teaching about OA
    • provide information about the disease
    • pain management
    • correct posture and body mechanics
    • correct use of assitive devices
    • principles of joint protection and energy conservation
    • nutritional choices
    • stress management
    • therapeutic exercise program
    • home management
    • sexual counseling
  19. what is RA
    • Rheumatoid arthritis
    • chronic systemic autoimmunne disease
    • inflammation of connective tissue synovial joints
  20. morning stiffness may last  how long in RA
    60 minutes to several hours
  21. what is unique about onset of RA
    • typically insidious (slow onset)
    • happens after a stressful life event
  22. signs and symptoms of RA
    • fatigue
    • anorexia
    • weight loss
    • joint deformity
    • extraarticular manifestations
  23. OA VS RA
    • OA = non-inflammatory, localized pain, asymmetrical, relief of stiffness after 30 min, non-drug therapy
    • RA = inflammatory, systemic disease, symmetrical, takes 60 minutes or more to relieve stiffness,drug therapy
  24. swans neck
    ulnar shift of fingers
  25. rheumatoid nodules are
    • subcu, firm, nontender, granuloma-type masses
    • usually located over extensor surfaces of joints
  26. Sjogrens syndrome
    • seen in 10 - 15% of RA cases with RA
    • dry eyes and dry mouth
  27. positive RF occurs in
    80% of patients with RA
  28. difference in synovial fluid color in RA and OA
    • RA = strawberry colored
    • OA = straw colored
  29. what is cornerstone of RA treatment
  30. DMARDS are
    • diseases modifying antirheumatic drugs
    • must be started when 1st year to prevent joint damage
  31. nursing management of RA
    • rest - sleep 8-10 hours at night  with naps
    • good body alignment
    • encourage joint extention and not flexion
  32. what is important in joint protection with RA
    • maintaining joint in neutral position to minimize deformity
    • use strongest joint
    • distribute weight evenly
    • change postions frequently
    • avoid repetitious movements
  33. when is cold therapy beneficial?
    during disease exacerbation
  34. how long should cold therapy be applied
    10 - 15 minutes
  35. when is heat therapy beneficial
    chronic stiffness
  36. how long should heat be applied
    20 minutes
  37. what can you tell a patient to decrease morning stiffness
    • warm shower or bath in the morning
    • pain relief before self care activities
  38. never use what with heating device to prevent burning
    heat producing cream
  39. exercise for RA
    • preserve joint function
    • range of motion exercises
    • balance rest and activity
  40. during peiord of remmision in RA you should encourage
    regular exercise

  41. Parameter



    Age of onset

    Young to middle age

    Usually > age 40


    More females than males

    Before age 50, more men after age 50 more females


    Lost or maintained

    Often overweight




    Affected Joints

    Small joints first: bilateral, symmetric

    Weight bearing, asymmetric

    Pain characteristics

    Stiffness lasts 1 hr. to all day, variable

    Stiffness subsides in 30 min., worsens with use, relieved with rest






    Heberdens’s and Bouchard’s

    Synovial fluid

    WBC > 20,000

    WBC < 2000


    Joint space narrowing

    Joint space narrowing, osteophytes


    +RF, CRP-inflammation

    --RF, transient ↑ in ESR
  42. difference in age of onset between RA and OA
    • RA = young to middle age 
    • OA = usually > age 40
  43. SLE =
    • systemic LUPUS erythematosus
    • chronic multisystem inflammatory autoimmune disease
  44. LUPUS is more common in who
    • women 90%
    • people of color
    • genetic factors
  45. what is fever in LUPUS
    > 100
  46. common clinical manifestations in lupus
    • fever> 100
    • butterfly rash
    • anemia
    • hair loss
    • memory problems
    • sun or light sensitivity
  47. FLARES are
    • sudden outbreaks of SLE and may be triggered by
    • fatigue, stress, sunlight, infection, pregnancy
  48. what is butterfly rash
    common rash across face and bridge of nose in LUPUS
  49. signs of upcoming flare in LUPUS
    • overtires and overstressed
    • frequent fever and higher than normal
    • muscle aches and pains
    • swollen joints
  50. can a test confirm SLE
    • no
    • ANA
    • ESR
    • LE prepe
  51. Plaquenil
  52. antimalarial-hydroxychloroquine
    • common treatment in LUPUS
    • ***patient must have regular eye exams because it can cause issues with retina (6-12 Months)***
  53. drug treatment in LUPUS
    • NSAIDS
    • Plaquenil
    • corticosteriods
    • immunosuppressives
  54. things that can cause flares
    • fatigue
    • sun exposure
    • emotional upset
    • infection
    • drugs
    • surgery
  55. patient education in LUPUS =
    • Disease process
    • Drugs
    • Pain management
    • Rest/exercise/quit smoking
    • Avoidance of physical and emotional stress
    • Avoidance of people with infections
    • Avoidance of drying soaps, powders, & household chemicals that come into contact with the skin
    • Use of sunscreen and minimal sun exposure from 11am-3pm.
    • Regular medical checkups
    • Pregnancy counseling as needed
    • Community resources
  56. GOUT =
    systemic disease in which urate crystals deposit in the joints and other body tissues, causing inflammation
  57. GOUT may be due to
    overproduction or under excretion of uric acid
  58. primmary disease =
    • don't know why someone has something
    • ie primary HTN, primary gout
  59. intake of foods high in what can cause gout
  60. what causes primary gout
    don't know (majority of cases)
  61. secondary gout can be casued by
    • obesity
    • HTN
    • Diuretic use
    • alcohol consumption
    • diet high in purines
  62. foods high in purines =
    • shellfish
    • spinach, lentils, asparagus
    • beef chicken and pork
  63. TOPHI =
    joint, cartilage, soft tissue  deposit in someone with gout
  64. diagnostic tests with GOUt
    • presece of sodium urate crystals  in synovial fluid
    • elevated serun uric acid levels
  65. Colchicine =
    • med given in gout
    • must be given with NSAID because it doesn't have pain relieving agent

    Often DR give this to diagnose pt with gout because the inflammation goes away quickly
  66. management of gout
    • increased fluids and joint rest
    • drug therapy
    • nutrition
  67. nursing management of gout
    • ¢Avoid all forms of aspirin and diuretics because they may precipitate an attack.
    • ¢Excessive physical or emotional stress can exacerbate the disease (surgery)
    • ¢Increase fluids
    • ¢Low purine diets
    • ¢Avoidance of alcohol
    • ¢Prompt treatment of acute gout