Chapter 54

Assessment and Management of

Patients With Rheumatic
Disorders

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Question
Is the following statement True or False?

Diarthrodial is bleeding into a joint.

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Answer
False

Diarthrodial is a joint with two freely movable parts.

Hemarthrosis is bleeding into a joint.

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Rheumatic Diseases

• “Arthritis”
• More than 100 different disorders
• Affect primary the joints, but also muscles, bone,
ligament, tendons, cartilage
• Classification
– Monoarticular or polyarticular
– Inflammatory or noninflammatory

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Characteristic Degenerative Changes—
“Degradation”

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Clinical Manifestations

• Pain
• Joint swelling
• Limited movement
• Stiffness
• Weakness
• Fatigue

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Pathophysiology and Associated Physical
Signs of Rheumatoid Arthritis

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Patient Assessment and Diagnostic
Findings
• Health history: include onset of and evolution of
symptoms, family history, past health history, and
contributing factors
• Functional assessment
• Arthrocentesis
• X-rays, bone scans, CTs, and MRIs
• Tissue biopsy
• Blood studies

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Nursing Interventions

• Understanding of the underlying disease process guide;

the nurse’s critical thinking to provide interventions
• The extent of the disease process, and whether it is
localized or more systemic, will also affect nursing
activities

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Nursing Process: The Care of the Patient
with a Rheumatic Disease—Assessment

• Health history and physical assessment focus on current

and past symptoms, and also include the patient's
psychological and mental status, social support systems,
ability to participate in daily activities, comply with
treatment regimen, and manage self-care

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Nursing Process: The Care of the Patient
with a Rheumatic Disease—Diagnoses

• Acute and chronic pain

• Fatigue
• Disturbed sleep pattern
• Impaired physical mobility
• Self-care deficits
• Disturbed body image
• Ineffective coping

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Collaborative Problems/Potential
Complications

• Adverse effects of medications

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Nursing Process: The Care of the Patient
with a Rheumatic Disease—Planning
• Major goals may include:
– Relief of pain and discomfort
– Relief of fatigue
– Promotion of restorative sleep
– Increased mobility
– Maintenance of self-care
– Improved body image
– Effective coping
– Absence of complications
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Diffuse Connective Tissue Diseases

• A group of chronic disorders characterized by diffuse

inflammation and degeneration in the connective tissue
• Cause is unknown but thought to have an immunologic
basis
• Characterized by a clinical course of exacerbations and
remissions
• Includes RA, SLE, scleroderma, polymyositis, and
polymyalgia rheumatica

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Systemic Effects: Extraarticular Features
• Fever
• Fatigue
• Anemia
• Lymph node enlargement
• Raynaud’s phenomenon and Sjögren’s syndrome
• Any organ system may be involved; arteritis, neuropathy
and other neurologic manifestations, scleritis,
pericarditis, pleural effusion, splenomegaly, renal
involvement
• Skin and mucosal manifestations
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Teaching Patients Self-Care

• Explain the disease and principles of disease

management
• Medication teaching
• Monitoring
• Sources of information
• Pain management
• Joint protection
• Self-care with assistive devices
• Exercise and relaxation

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Question
With which of these diagnoses should the nurse encourage
the patient to restrict consumption of foods high in
purine?
A.Fibromyalgia
B.Gout
C.Osteoarthritis
D.Rheumatoid arthritis

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer
B

The nurse encourage the patient to restrict consumption of

foods high in purine for gout.

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