Med Surg Nursing I Chapter 69

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Med Surg Nursing IChapter 69

• Caring for Clients with Orthopedic Connective
  Tissue Disorders

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Rheumatoid Arthritis

• An chronic, autoimmune disorder with periods of
  remissions excerbations
• usually starts in 20-50 yrs olds in small
  joints progresses into the larger joints

• S/S acute onset of joint pain with bilateral,
  symmetic swelling, warmth, erythema, limited
  mobility, spongy feeling to the joints
• Fig 69-3 swan neck deformity, boutonniere
  deformity ulnar deviation of both hands

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RA (cont)

• Treatment
• no cure
• prevention of complications
• application of heat or cold
• drug therapy table 69-1
• arthroplasty

• Nursing mgmt
• teaching
• pain relief
• reduce stress
• decrease inflammation
• preserve joint mobility
• work with OT, PT
• maintain optimal nutrition

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Degenerative Joint Disease (DJD)

• Also known as osteoarthritis, wear tear
  disease most common type of arthritis
• Slow onset
• Progressive deterioration of the wt bearing
  joints such as the knees, hips, spine
• S/S brief joint stiffness pain following brief
  period of inactivity
• Relieved by rest

• Medical Surgical treatment
• starts with large doses of Aceteminophen
• ASA, NSAIDS follow if no relief
• Steroid injection to joints
• Local rest, heat, wt loss
• Surgery joint replacements
• Nursing care meds, pain relief, activity levels

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GOUT

• An inflammatory reaction within the joints
• Usually affects the feet (especially the great
  toe), hands, elbows, ankles, knees
• accumulation of uric acid in the blood

• S/S sudden onset of pain tenderness in one
  joint, redness edema, hypersensitivity to touch
• Treatment
• prevent recurrences of attacks by
• medications , table 69-2
• decrease dietary purine intake, increase
  fluids, restrict alcohol
• Use of bed cradle

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Lupus Erythematosus

• SLE most common type affects multiple body
  systems
• DLE affects only the skin
• Autoimmune disease
• Familial tendency
• Box 69-2 S/S red butterfly rash fig 69-6,
  fever, wt loss, joint pain, malaise, muscle pain,
  extreme fatigue, behavioral disturbances, etc

• No specific treatment
• Mgmt aimed at producing remissions
  prevention/treat acute exacerbations by use of
  high doses of steroids
• Nursing mgmt support medical interventions see
  nursing care plan
• Client family teaching 69-1

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Osteomyelitis

• An infection of the bone
• Common causes are staph strep infection from
  trauma, surgical contamination
• S/S high fever, chills, rapid pulse, tenderness
  or pain over affected area, redness swelling.
  May become chronic.

• Treatment
• immobilization
• warms soaks
• ID cause treat
• debridement
• irrigation
• bone grafts muscle flaps
• Nursing Care
• gentle care due to pain
• skin care
• medication administration
• emotional support

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Lyme Disease

• Caused by the transmission of a spirochetal
  bacterium via a tick bite resulting in a chronic,
  inflammatory process multisystem disease
• S/S
• early red macule or papule at site of bite
  with characteristic bulls-eye rash which may not
  occur until 20-30 days after bite

• midstage neurological cardiac involvement,
• later arthritic other musculoskeletal
  problems
• Treatment early best, antibiotics, supportive
• See box 69-3 - tips for avoiding Lyme Disease

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Osteoporosis

• A loss of bone density, that occurs mostly in
  postmenopausal women
• Risk factors small framed, thin white women
• Causes aging, Cushings syndrome, high doses of
  corticosteroids prolonged periods of immobility
• S/S lumbosacral or thoracic pain, loss of
  height, figure 69-7
• Prevention diet rich in calcium vitamin D

• Treatment
• slow the rate of bone reabsorption by use of
  meds such as Fosamax, pain meds, calcium
  supplements, HRT, rest, wt bearing exercise like
  walking
• Nursing dietary counseling, prevention

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PAGETS DISEASE

• Chronic bone disorder with abnormal bone
  remodeling
• Usually involves long bones, spine, pelvis
  skull
• Causes unknown, runs in families
• Complications pathologic fractures, paralysis
  from spinal cord compression, cranial nerve damage

• S/S mild skeletal deformities, marked
  deformities with enlargement of the skull, bowing
  of long bones kyphosis, pain
• Treatment analgesics, calcitonin, Didronel
• Nursing med teaching monitoring side effects

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Disorders of the FeetFig 69-8

• Hallux Valgus bunion
• deformity of the great toe associated with
  heredity, arthritis or improperly fitting shoes
• Hammer toe
• results from wearing improperly fitting shoes
• s/s pain, obvious foot deformity,
• Treatment none unless pain becomes severe wear
  low-heeled properly fitted shoes, pads to protect
  joints possibly surgery to correct defect