1. Nursing Management: Arthritis and Connective Tissue Diseases
Chapter 65 Overview
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2. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Arthritis
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3. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Osteoarthritis
Etiology and Pathophysiology
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Osteoarthritis
Fig Pathologic changes in osteoarthritis. A, Normal synovial joint. B, Early change in osteoarthritis is destruction of
articular cartilage and narrowing of the joint space. There is inflammation and thickening of the joint capsule and synovium.
C, With time, there is thickening of subarticular bone caused by constant friction of the two bone surfaces. Osteophytes form
around the periphery of the joint by irregular overgrowths of bone. D, In osteoarthritis of the hands, osteophytes on the distal
interphalangeal joints of the fingers are termed Heberden’s nodes and appear as small nodules.
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Osteoarthritis
Clinical Manifestations
Systemic
Joints
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Osteoarthritis
Fig Joints most frequently involved in osteoarthritis.
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Osteoarthritis
Clinical Manifestations, continued
Deformity
Diagnostic Studies
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Osteoarthritis
Collaborative Care
Rest and joint protection
Heat and cold applications
Nutritional therapy and exercise
Complementary and alternative therapies
Drug therapy
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9. Nursing Management: Osteoarthritis
Nursing Assessment
Nursing Diagnoses
Planning
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10. Nursing Management: Osteoarthritis
Fig Typical deformities of rheumatoid arthritis. A, Ulnar drift. B, Boutonnière deformity.
C, Hallux valgus. D, Swan neck deformity.
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11. Nursing Management: Osteoarthritis
Nursing Implementation
Health promotion
Acute intervention
Ambulatory and home care
Evaluation
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12. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Rheumatoid Arthritis
Etiology and Pathophysiology
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Rheumatoid Arthritis
Fig Rheumatoid arthritis. A, Early pathologic change in rheumatoid arthritis is rheumatoid synovitis. The
synovium is inflamed. There is a great increase in lymphocytes and plasma cells. B, With time, there is articular
cartilage destruction; vascular granulation tissue grows across the surface of the cartilage (pannus) from the edges
of the joint, and the articular surface shows loss of cartilage beneath the extending pannus, most marked at the
joint margins. C, Inflammatory pannus causes focal destruction of bone. At the edges of the joint there is osteolytic
destruction of bone, responsible for erosions seen on x-rays. This phase is associated with joint deformity.
D, Characteristic deformity and soft tissue swelling associated with severe advanced rheumatoid disease of the hands.
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Rheumatoid Arthritis
Clinical Manifestations
Joints
Extraarticular manifestations
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Rheumatoid Arthritis
Fig Extraarticular manifestations of rheumatoid arthritis.
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Rheumatoid Arthritis
Complications
Diagnostic Studies
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Rheumatoid Arthritis
Table American Rheumatism Association classification Criteria for Rheumatoid Arthritis
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Rheumatoid Arthritis
Collaborative Care
Drug therapy
Nutritional therapy 18
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19. Nursing Management: Rheumatoid Arthritis
Nursing Assessment
Nursing Diagnoses
Planning
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20. Nursing Management: Rheumatoid Arthritis
Nursing Implementation
Health promotion
Acute intervention
Ambulatory and home care
Rest
Joint protection
Heat and cold therapy and exercise
Psychologic support
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21. Gerontologic Considerations: Arthritis
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22. Spondyloarthropathies
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23. Ankylosing Spondylitis
Etiology and Pathophysiology
Clinical Manifestations and Complications
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24. Ankylosing Spondylitis
Fig Advanced ankylosing spondylitis. Kyphotic posture causes many patients to have
a protuberant abdomen secondary to pulmonary restriction.
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25. Ankylosing Spondylitis
Diagnostic Studies
Collaborative Care
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26. Nursing Management: Ankylosing Spondylitis
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Psoriatic Arthritis
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Septic Arthritis
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Lyme Disease
Fig Erythema migrans of Lyme disease.
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Gout
Etiology and Pathophysiology
Clinical Manifestations and Complications
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Gout
Fig Tophaceous gout.
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Gout
Diagnostic Studies
Collaborative Care
Drug therapy
Nutritional therapy
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33. Nursing Management: Gout
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34. Systemic Lupus Erythematosus
Etiology and Pathophysiology
Clinical Manifestations and Complications
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35. Systemic Lupus Erythematosus
Fig Multisystem involvement in systemic lupus erythematosus.
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36. Systemic Lupus Erythematosus
Clinical Manifestations and Complications, continued
Dermatologic manifestations
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37. Systemic Lupus Erythematosus
Fig Butterfly rash of systemic lupus erythematosus.
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38. Systemic Lupus Erythematosus
Clinical Manifestations and Complications, continued
Musculoskeletal problems
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39. Systemic Lupus Erythematosus
Fig Typical deformities of rheumatoid arthritis. A, Ulnar drift. B, Boutonnière deformity.
C, Hallux valgus. D, Swan neck deformity.
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40. Systemic Lupus Erythematosus
Clinical Manifestations and Complications, continued
Cardiopulmonary problems
Renal problems
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41. Systemic Lupus Erythematosus
Clinical Manifestations and Complications, continued
Nervous system problems
Hematologic problems
Infection
Diagnostic Studies
Collaborative Care
Drug therapy
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42. Nursing Management: Systemic Lupus Erythematosus
Nursing Assessment
Nursing Diagnoses
Planning
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43. Nursing Management: Systemic Lupus Erythematosus
Nursing Implementation
Health promotion
Acute intervention
Ambulatory and home care
Lupus and pregnancy
Psychosocial issues
Evaluation
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44. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Systemic Sclerosis
Etiology and Pathophysiology
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45. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Systemic Sclerosis
Fig Skin changes in systemic sclerosis.
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Systemic Sclerosis
Clinical Manifestations
Raynaud’s phenomenon
Skin and joint changes
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Systemic Sclerosis
Fig Hand of a patient with systemic sclerosis showing sclerodactyly.
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Systemic Sclerosis
Clinical Manifestations, continued
Internal organ involvement
Diagnostic Studies
Collaborative Care
Drug therapy
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49. Nursing Management: Systemic Sclerosis
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50. Polymyositis and Dermatomyositis
Etiology and Pathophysiology
Clinical Manifestations and Complications
Muscular
Dermal
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51. Polymyositis and Dermatomyositis
Fig Dermatomyositis skin changes. Gottron’s papules.
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52. Polymyositis and Dermatomyositis
Clinical Manifestations and Complications, continued
Other manifestations
Diagnostic Studies
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53. Nursing and Collaborative Management: Polymyositis and Dermatomyositis
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54. Mixed (Overlapping) Connective Tissue Disease
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55. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Sjögren's Syndrome
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56. Soft Tissue Rheumatic Syndromes
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57. Myofascial Pain Syndrome
Table Comparison of Fibromyalgia and Myofascial Pain
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58. Fibromyalgia Syndrome
Etiology and Pathophysiology
Clinical Manifestations and Complications
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59. Fibromyalgia Syndrome
Fig Tender points in fibromyalgia syndrome.
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60. Fibromyalgia Syndrome
Diagnostic Studies
Collaborative Care
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61. Nursing Management: Fibromyalgia Syndrome
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62. Chronic Fatigue Syndrome
Etiology and Pathophysiology
Clinical Manifestations
Diagnostic Studies
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63. Nursing and Collaborative Management: Chronic Fatigue Syndrome
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