Presentation is loading. Please wait.

Presentation is loading. Please wait.

1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 41 Connective Tissue Disorders.

Similar presentations


Presentation on theme: "1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 41 Connective Tissue Disorders."— Presentation transcript:

1 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 41 Connective Tissue Disorders

2 2Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Learning Objectives Define connective tissue. Describe the function of connective tissue. Describe the characteristics and prevalence of connective tissue diseases. Describe the diagnostic tests and procedures used for assessing connective tissue diseases. Discuss the drugs used to treat connective tissue diseases. Describe the pathophysiology and treatment of osteoarthritis (degenerative joint disease), rheumatoid arthritis, osteoporosis, gout, progressive systemic sclerosis, polymyositis, bursitis, carpal tunnel syndrome, ankylosing spondylitis, polymyalgia rheumatica, Reiters syndrome, Behçets syndrome, and Sjögrens syndrome. Identify the data to be collected in the nursing assessment of a patient with a connective tissue disorder. Assist in developing a nursing care plan for a patient whose life has been affected by a connective tissue disease.

3 3Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Anatomy and Physiology of Connective Tissues Bind structures together, providing support for individual organs and a framework for the body Store fat, transport substances, provide protection, and play a role in repair of damaged tissue

4 4Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Anatomy and Physiology of Connective Tissues Types of connective tissue Loose (areolar, adipose, reticular) Dense (tendons, fascia, dermis, gastrointestinal tract submucosa, fibrous joint capsules) Elastic (aortic walls, vocal cords, parts of trachea and bronchi, some ligaments) Hematopoietic (blood) Strong supportive (cartilage, bone, ligaments)

5 5Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Anatomy and Physiology of Connective Tissues Bone Hard tissue: makes up most of skeletal system Functions: support, protection, movement, storage of calcium and other ions, and manufacture of blood cells

6 6Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Anatomy and Physiology of Connective Tissues Cartilage Specialized fibrous connective tissue Provides firm but flexible support for the embryonic skeleton and part of the adult skeleton Cartilage cells are called chondrocytes

7 7Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Anatomy and Physiology of Connective Tissues Ligaments Strong and flexible fibrous bands of connective tissue that connect bones and cartilage and support muscles Yellow ligaments, located in the vertebral column, are elastic and allow for stretching White ligaments, found in the knee, do not stretch but provide stability

8 8Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Anatomy and Physiology of Connective Tissues Tendons Composed of very strong and dense fibrous connective tissue They are in the shape of heavy cords and anchor muscles firmly to bones

9 9Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Joint Structure and Function Connective tissue disorders: manifested as joint disorders since joint mobility depends on functional connective tissue Joint: site where two or more bones are joined; permit motion and flexibility of the rigid skeleton Classification Synarthroses (fixed joints) Amphiarthroses (slightly movable joints) Diarthroses (freely movable joints) Encased in a fibrous capsule made of strong cartilage and lined with synovial membrane

10 10Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Age-Related Changes Loss of bone mass and bone strength Osteoporosis common in women but affects men Put the older patient at risk for fractures Cartilage gradually loses elasticity; becomes soft and frayed Water content decreases, and cartilage may ulcerate, leaving bony joint surfaces unprotected and promoting growth of osteophytes (bony spurs) Result in pain and limited mobility

11 11Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Nursing Assessment of Connective Tissue Structures

12 12Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chief Complaint and History of Present Illness Complaints that suggest possible problems related to connective tissue disorders are aches, pain, joint swelling or stiffness, generalized weakness, a change in ability to work or to enjoy leisure activities, a change in appearance that is significant to the patient, and a change in ability to carry out activities of daily living

13 13Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Past Medical History Major childhood and adult illnesses, operations, and current medications and allergies History of tuberculosis, poliomyelitis, diabetes mellitus, gout, arthritis, rickets, infection of bones or joints, autoimmune diseases, and neuromuscular disabilities Accidents and injuries Current medications

14 14Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Family History Osteoporosis, osteoarthritis, rheumatoid arthritis, gout, or scoliosis may have some genetic basis Autoimmune diseases, e.g., thyroid disorders Review of systems General health status; determines patients perception of well-being Fatigue, malaise, anorexia, weight loss, pain, stiffness, dysphagia, or dyspnea

15 15Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Physical Examination Vital signs, height, and weight Skin color, rashes, lesions, scars, or any signs of injuries Palpate skin for warmth, edema, and moisture Palpate lymph nodes for enlargement and tenderness Inspect joints for swelling and deformity, and palpate for warmth, swelling, and tenderness Joint pain and range of motion Measure limb length and muscle strength

16 16Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Diagnostic Tests and Procedures Blood studies Complete blood cell count, erythrocyte sedimentation rate (ESR), and C-reactive protein determination Venereal Disease Research Laboratory (VDRL), rheumatoid factor (RF), creatinine, and antinuclear antibody (ANA) tests Urine studies Creatinine and uric acid levels

17 17Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Diagnostic Tests and Procedures Radiologic imaging studies Radiography, ultrasonography, arthrography, nuclear scintigraphy, magnetic resonance imaging, diskography, tomography, and computed tomography

18 18Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Therapeutic Measures Physical and occupational therapy Physical therapy: exercise and positioning to help preserve functional capability and minimize disability Occupational therapy helps patient gain maximal function in work and personal life Education and support Education: how treatment plan will benefit the patient Patients and their families need information about community support groups that can offer encouragement, information, and resources

19 19Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Therapeutic Measures Drug therapy Glucocorticoids Nonsteroidal anti-inflammatory drugs (NSAIDs) Biologic response modifiers (BRMs) Disease-modifying antirheumatic drugs (DMARDs) Cyclooxygenase-2 (COX-2) inhibitors Surgical treatment Indicated in some musculoskeletal disorders, such as degenerative joint disease and arthritis Continuous passive motion (CPM) machine

20 20Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Disorders of Connective Tissue Structures

21 21Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Osteoarthritis Pathophysiology Degeneration of articular cartilage with hypertrophy of the underlying and adjacent bone Normally, articular cartilage provides a smooth surface for one bone to glide over another Cartilage transfers the weight of one bone to another so the bones do not shatter Osteoarthritis: shock-absorbing protection lost New bone growth is stimulated by exposed bone surfaces, causing bone spurs

22 22Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 41-1

23 23Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Osteoarthritis Signs and symptoms Pain in affected joint, stiffness, limitation of movement, mild tenderness, swelling, and deformity or enlargement of the joint Heberden nodes and Bouchard nodes Medical diagnosis Health history and radiographic studies Arthroscopy and MRI Synovial fluid aspiration

24 24Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 41-2

25 25Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Osteoarthritis Medical treatment Drug therapy Acetaminophen, NSAIDs, DMARDs, COX-2 inhibitors, or low dose of salicylates (aspirin) Surgery Arthroscopic surgery and arthroplasty Physical therapy Improve range of motion; maintain muscle mass and strength Education

26 26Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 41-3

27 27Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Osteoarthritis Assessment Joint pain or tenderness Examine joints for crepitus, enlargement, deformity, and decreased range of motion Compare affected and unaffected joints to detect abnormalities Determine how the disease affects the patients mobility and ability to perform activities of daily living

28 28Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Osteoarthritis Interventions Chronic Pain Impaired Physical Mobility Ineffective Coping Ineffective Therapeutic Regimen Management

29 29Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Osteoarthritis Care following total joint replacement Assessment Vital signs, level of consciousness, intake and output, respiratory and neurovascular status, urinary function, bowel elimination, wound condition, and comfort Circulation and sensation in the affected extremity

30 30Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Osteoarthritis Interventions Acute Pain Risk for Injury Impaired Physical Mobility Impaired Tissue Perfusion Risk for Infection Anxiety or Fear Deficient Knowledge

31 31Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 41-4

32 32Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Rheumatoid Arthritis Pathophysiology Chronic, progressive inflammatory disease Inflammation of the synovial tissue Synovium thickens; fluid accumulates in joint space Vascular granulation tissue (pannus) forms in the joint capsule and breaks down cartilage and bone Fibrous tissue invades pannus, converting it first to rigid scar tissue and finally to bony tissue These changes result in ankylosis

33 33Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 41-6

34 34Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Rheumatoid Arthritis Signs and symptoms Pain in affected joints aggravated by movement Morning stiffness lasting more than 1 hour Weakness, easy fatigability, anorexia, weight loss, muscle aches and tenderness, and warmth and swelling of the affected joints Joint changes are usually symmetric Rheumatoid nodules (subcutaneous, over bony prominences) Any organ may be affected Inflammation in tissues of heart, lungs, kidneys, eyes Clusters of symptoms Sjögrens, Feltys, or Caplans syndromes

35 35Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 41-7

36 36Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Rheumatoid Arthritis Medical diagnosis Health history and physical examination Laboratory studies RF (rheumatoid factor), ESR (erythrocyte sedimentation rate), and CRP (C-reactive protein) MRI, bone scans, and DEXA scans

37 37Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Rheumatoid Arthritis Medical treatment Drug therapy Aspirin and other NSAIDs for several months, with the addition of gold compounds, d-penicillamine, antimalarials, or sulfasalazine if needed Physical and occupational therapy Surgery Arthroplasty, synovectomy, tenosynovectomy, and arthrodesis

38 38Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 41-5

39 39Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Rheumatoid Arthritis Assessment Pain, joint swelling, tenderness, joint deformities and limitation of movement, fatigue, and decreased ability to perform activities of daily living Interventions Chronic Pain Activity Intolerance Ineffective Coping Social Isolation Ineffective Therapeutic Regimen Management

40 40Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Osteoporosis Pathophysiology Bone constantly formed and absorbed Until adolescence, bone formation exceeds bone absorption so that bones grow and strengthen Around age 30, bone absorption surpasses formation Loss of trabecular bone, innermost layer, occurs first Loss of cortical bone, hard outer shell, begins later Begins earlier and progresses faster in women than in men Result is loss of bone mass

41 41Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Osteoporosis Risk factors Older women who have small frames, who are white or of northern European heritage, and who have fair skin and blond or red hair Estrogen deficiency; physical inactivity; low body weight; inadequate calcium, protein, or vitamin D intake; corticosteroid therapy over more than 6 months; and excessive use of cigarettes, caffeine, and alcohol

42 42Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Osteoporosis Signs and symptoms Back pain, fractures, loss of height due to vertebral compression, and kyphosis Bone deterioration in the jaw can cause dentures to fit poorly Collapsed vertebrae can cause chronic pain

43 43Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Osteoporosis Medical diagnosis Absorptiometry Radiographs Bone specimen Medical treatment Calcium supplementation and estrogen replacement Bisphosphonates and selective estrogen receptor modulators (SERMs) Regular exercise Percutaneous vertebroplasty

44 44Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Osteoporosis Assessment Diet, calcium intake, and exercise plan Note whether the patient is menopausal or has had an oophorectomy Compare height with previous measurements Posture; note the presence and degree of deformity Interventions Risk for Trauma Chronic Pain Ineffective Therapeutic Regimen Management

45 45Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Gout Pathophysiology Characterized by hyperuricemia Related to excessive uric acid production or decreased uric acid excretion by the kidneys Four stages Asymptomatic hyperuricemia Acute gouty arthritis Asymptomatic intercritical period Chronic tophaceous gout

46 46Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Gout Signs and symptoms Asymptomatic hyperuricemia Blood uric acid level is elevated, but no other symptoms Many people with asymptomatic hyperuricemia never progress to the next stage

47 47Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Gout Signs and symptoms Acute gouty arthritis Onset is abrupt, usually occurs at night The patient is suddenly afflicted with severe, crushing pain and cannot bear even the light touch of bed sheets on the affected joint Joint commonly affected is the great toe Symptoms usually disappear within a few days

48 48Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Gout Signs and symptoms Asymptomatic intercritical period No symptoms Chronic tophaceous gout Advanced gout Tophi: deposits of sodium urate crystals that are visible as small white nodules under the skin

49 49Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 41-8

50 50Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Gout Medical diagnosis History and physical examination Urate crystals in synovial fluid Urinary uric acid Blood uric acid

51 51Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Gout Medical treatment Asymptomatic hyperuricemia requires no medical treatment NSAID alone or with colchicine for acute gouty arthritis For subsequent attacks: indomethacin, corticosteroids, and corticotrophin Avoid foods high in purines

52 52Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Gout Assessment Pain, joint swelling, tophi, uric acid stones, fever, and a history of trauma, injury, or surgery Interventions Acute Pain Impaired Physical Mobility Altered Urinary Elimination Ineffective Therapeutic Regimen Management

53 53Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Progressive Systemic Sclerosis Pathophysiology Primary vessel injury/dysfunction of immune system Manifestations: from inflammation to degeneration of tissues, that results in decreased elasticity, stenosis, and occlusion of vessels Signs and symptoms Raynauds phenomenon, symmetric painless swelling or thickening of the skin, taut and shiny skin, morning stiffness, frequent reflux of gastric acid, difficulty swallowing, weight loss, dyspnea, pericarditis, and renal insufficiency

54 54Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Figure 41-9

55 55Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Progressive Systemic Sclerosis Medical diagnosis History and physical examination may lead the physician to suspect fibrotic changes typical of PSS in the skin, lungs, heart, or esophagus Positive ANA assay result, elevated ESR, and increased serum muscle enzyme levels

56 56Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Progressive Systemic Sclerosis Medical treatment No cure High doses of steroids or other immunosuppressants may bring about remission Physical therapy d-Penicillamine; antihypertensives

57 57Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Progressive Systemic Sclerosis Assessment Pain and stiffness in the fingers; intolerance for cold Signs and symptoms suggestive of cardiovascular, respiratory, renal, and gastrointestinal problems Skin rash, loss of wrinkles on the face, limitations of joint range of motion, muscle weakness, and dry mucous membranes Examine the hands for contractures of the fingers and for color changes or lesions on the fingertips Palpate the fingers to determine warmth

58 58Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Progressive Systemic Sclerosis Interventions Impaired Skin Integrity Self-Care Deficit Chronic Pain Social Isolation Imbalanced Nutrition: Less Than Body Requirements Ineffective Therapeutic Regimen Management

59 59Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Dermatomyositis/Polymyositis Pathophysiology Polymyositis: infiltration of inflammatory cells, causing destruction of muscle fibers Inflammation of tissues surrounding blood vessels is an outstanding pathologic feature of the disease Condition is sometimes associated with malignancy Signs and symptoms Polymyositis: muscle weakness, Raynauds phenomenon, and joint pain and inflammation Dermatomyositis: periorbital edema as well

60 60Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Dermatomyositis/Polymyositis Medical diagnosis Proximal muscle weakness, a muscle biopsy positive for muscle degeneration, elevated muscle enzymes, and myopathic electromyographic changes Medical treatment Drug therapy High-dose glucocorticoids, such as prednisone, and chemotherapeutic agents, such as methotrexate Supportive treatment: balancing rest and exercise to prevent contractures

61 61Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Other Connective Tissue Disorders Bursitis Carpal tunnel syndrome Ankylosing spondylitis Polymyalgia rheumatica Reiters syndrome Behçets syndrome Sjögrens syndrome Periarteritis nodosa


Download ppt "1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 41 Connective Tissue Disorders."

Similar presentations


Ads by Google