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Arthritis and Common Tissue Diseases 2023, Exams of Nursing

Saint Francis Medical Center College of Nursing Nursing

Information on lupus erythematosus (DLE/SLE), systemic sclerosis (SSc), and Lyme disease. It covers the pathophysiology, assessment, lab tests, interventions, drug therapy, and care management of these diseases. It also includes skin protection measures for lupus erythematosus and care for SSc and esophagitis. useful for healthcare professionals and students studying rheumatology and related fields.

Typology: Exams

2022/2023

Available from 12/02/2023

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18: ARTHRITIS AND COMMON TISSUE DISEASES

2023.Guaranteed Success.

LUPUS ERYTHEMATOSUS (DLE/SLE)

>>> PATHO

•Lupus is probably caused by a complex combo of genetic and environmental factors

•2 main classifications:

oDiscoid lupus erythematosus (DLE) – effects only the skin

oSystemic lupus erythematosus (SLE) – more common

•Systemic lupus erythematosus (SLE):

oChronic, progressive, inflammatory connective tissue disorder that can

cause major body organs/systems to fail

oSpontaneous remissions and exacerbations

oOnset may be acute or insidious (slow)

oPotentially fatal, but most live many years

oAutoimmune process – invades organs or deprives them of blood and oxygen

oImmune complexes invade organs directly or cause vasculitis (vessel

inflammation), which deprives the organs of arterial blood and

oxygen.

oAutoimmune complexes tend to be attracted to glomeruli of the kidneys

oOften some degree of kidney involvement (lupus nephritis) – this is the

leading cause of death from this disease

oOnset at 20-40 years old

>>> ASSESSMENT

>> PHYSICAL ASSESSMENT

•When in remission pt. may

appear fully healthy

•When disease flares up, pt. may

need to be admitted to the

hospital

Partial preview of the text

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18: ARTHRITIS AND COMMON TISSUE DISEASES

2023.Guaranteed Success.

LUPUS ERYTHEMATOSUS (DLE/SLE)

>>> PATHO

- Lupus is probably caused by a complex combo of genetic and environmental factors

2 main classifications: o Discoid lupus erythematosus (DLE) – effects only the skin o Systemic lupus erythematosus (SLE) – more common - Systemic lupus erythematosus (SLE): o Chronic, progressive, inflammatory connective tissue disorder that can cause major body organs/systems to fail o Spontaneous remissions and exacerbations o Onset may be acute or insidious (slow) o Potentially fatal, but most live many years o Autoimmune process – invades organs or deprives them of blood and oxygen o Immune complexes invade organs directly or cause vasculitis (vessel inflammation), which deprives the organs of arterial blood and oxygen. o Autoimmune complexes tend to be attracted to glomeruli of the kidneys o Often some degree of kidney involvement (lupus nephritis) – this is the leading cause of death from this disease o Onset at 20-40 years old

ASSESSMENT

>> PHYSICAL ASSESSMENT

When in remission pt. may appear fully healthy
When disease flares up, pt. may need to be admitted to the hospital

MT skin condition daily and at every home visit

OTHER Fever (indicates exacerbation) Fatigue Anorexia Weight loss Generalized weakness Vasculitis Osteonecrosis (bone necrosis from lack of oxygen)

most common in the hip Fever Fatigue Anorexia Vasculitis

PSYCHOSOCIAL ASSESSMENT

Psychosocial results can be devastating
Chronic weakness and fatigue may prevent pt. from being as active
May avoid social gatherings
Fear and anxiety from unpredictability
Limit sun exposure to prevent exacerbations

LABS - Skin biopsy – confirms diagnosis o MD scraps skin cells from rash to be looked at under a microscope - Immunologic-based lab tests – same as rheumatoid arthritis

CBC – often shows pancytopenia (a decrease of all cell types)
Electrolytes
Kidney fx.
Cardiac and liver enzymes - Clotting factors

INTERVENTIONS - The primary health care provider often prescribes potent drugs that are used topically and systemically

Many of the skin lesions do not disappear with treatment, but will usually fade when in remission

DRUG THERAPY

DLE major concern is the rash or discoid lesions
Topical cortisone drugs – help reduce inflammation and promote fading of lesions - Tylenol or NSAIDs – treat joint and muscle pain and inflammation
Hydroxychloroquine – decreases the absorption of UV light by the skin, therefore decreasing the risk for skin lesions o Eye exams before starting drug and every 6 months while on it

- For severe renal involvement, immunosuppressants may be given in combo with steroids

New drugs: o Lupozor o Belimumab (Benlysta) ▪ Increases risk for infection ▪ Do not receive live viruses for 30 days before tx.

PROTECTING THE SKIN - PROTECT SKIN TO PREVENT AN EXACERBATION **- ACTION ALERT!! – Avoid prolonged exposure to sunlight and other forms of UV light, wear long sleeves and large-brimmed hat when outdoors, use sunblock SPF 30 or higher.

CHART 18-12 SKIN PROTECTION FOR LUPUS ERYTHEMATOSUS o Wash with mild soap (Ivory) and dry skin thoroughly by patting NOT rubbing. o** Avoid harsh perfumed substances o Cosmetics should include moisturizers and sun protectant o Use lotions o Avoid powders, rubbing alcohol, and drying agents. o Use gentle shampoos and avoid harsh hair treatments (Alopecia/hair loss is common) o Avoid direct sunlight and ultraviolet light including tanning beds o Wear long sleeves, wide-brimmed hats, long pants when in the sun o Use sunscreen – SPF 30 or higher o Inspect skin daily for rashes and lesions. CARE MANAGEMENT - 2 major differences exist between SLE and rheumatoid arthritis (RA) in terms of education of the pt. and family o 1. SLE – how to protect the skin o 2. SLE – MT body temp. (fever is a major S/S of exacerbation)

- Teach the importance of reporting any other unusual or new S/S to the primary MD immediately.

Identify coping strategies and support systems for the unpredictability of this condition – fear and anxiety - Pregnancy can be a stressor that causes an exacerbation (during and after birth) o Increased risk for stillbirth, miscarriage, and premature birth

1

SYSTEMIC SCLEROSIS –

(SCLERODERMA)

1

>>> PATHO

- Systemic sclerosis (SSc): “scleroderma” is a chronic, inflammatory, autoimmune connective tissue disease

Autoimmunity is the suspected cause
More common in women
Usually 25-55 y.o.
Most common are women in their 40’s - Scleroderma: hardening of the skin - SSc is less common than systemic lupus erythematosus (SLE) but has a higher mortality rate - Patients with the limited form of the disease often have the CREST syndrome: o Calcinosis (calcium deposits) o Raynaud’s phenomenon (1st^ S/S that occurs) o Esophageal dysmotility o Sclerodactyly (scleroderma of the digits) o Telangiectasia (spider-like hemangiomas)

COLLABORATIVE CARE

>>> ASSESSMENT

>> PHYSICAL ASSESSMENT

Arthralgia : joint pain and stiffness
- very common
Inspection of the skin depends on the stage of the scleroderma o Painless, symmetric, pitting edema of the hands and fingers “sausage-like” ▪ Skin is taut, shiny, and free of wrinkles o Edema may progress to include the entire upper and lower extremities and face

1 o Major organ damage is common – especially the renal and cardiopulmonary systems o The initial GERD S/S progress into other problems ▪ Esophagus loses its motility, resulting in dysphagia (difficulty swallowing)

- Assess for the pt. ability to swallow before allowing them to drink or eat food o Peristalsis is diminished – S/S of a partial bowel obstruction o Malabsorption is common, causing malodorous diarrheal stool o Cardiac S/S: ▪ Raynaud’s phenomenon

From exposure to cold or emotional stress, the small arterioles in the fingers and toes rapidly constrict, causing decreased blood flow.
Severe cases – digital necrosis, severe pain, and autoamputation of the distal digits (tips of the fingers fall off spontaneously)
Periungual lesions: lesions around the nail beds. ▪ Myocardial fibrosis – seen in ECG (dysrhythmias and chest pain) o Lung S/S: ▪ May be undetected until late in the disease or sometimes until autopsy ▪ Fibrosis of the alveoli and interstitial tissue – present in most cases with no S/S o Renal S/S: ▪ Often causes malignant HTN and death ▪ Assess for S/S of impending organ failure – changes in urine output and increased BP

1

>> LABS

Similar to SLE - Clinical findings and the pt.’s response to drug therapy help the health care provider differentiate between the 2 diseases.

INTERVENTIONS

1

LYME DISEASE

1

- Lyme disease: systemic infectious disease caused by spirochete Borrelia burgdorferi and results from the bite of an infected deer tick (“black-legged tick”)

Most common vector-borne disease in the US and Europe o Most common in - New England, Maryland, Virginia, Wisconsin, Minnesota, and northern California

STAGE 1

- Early and localized stage - S/S: o Flu-like S/S o Erythema migrans : round or oval, flat or slightly raised rash o Pain and stiffness in the muscles and joints o Bull’s-eye lesion – a single lesion - Symptoms begin within 3-30 days of the tick bit, (usually 7-14 days) - Antibiotic therapy ( doxycycline or amoxicillin ) is prescribed during this uncomplicated stage for 14-21 days o Erythromycin – used for pt. allergic to penicillin o w/o treatment, S/S will disappear in about 4-5 weeks STAGE 2

If not treated or treatment is not successful - Early disseminated stage
Occurs 2-12 weeks after tick bite
S/S: o Carditis with dysrhythmias, dyspnea, dizziness, or palpitations o CNS disorders – meningitis and facial paralysis (often misdiagnosed as Bell’s palsy), and peripheral neuritis

265 EXAM 4

In some cases, the disease may not respond to ABX in any stage, and the pt. develops permanent damage to joints and the nervous system - Prevention is the best strategy for Lyme disease CHART 18-14 PREVENTION AND EARLY DETECTION OF LYME DISEASE
Avoid heavily wooded areas or areas with think underbrush, especially during spring and summer
Walk in the center of the trail - Avoid dark clothing – lighter-colored clothing makes spotting ticks easier
Use an insect repellent (DEET) on skin and clothes
Wear long sleeves and pants, tuck your shirt and pants in
Wear closed toed shoes and a hat
Bathe immediately after and inspect your body for ticks
Check your pets for ticks - Gently remove with tweezers or fingers covered with tissue or gloves o Flush down toilet o Burning could spread infection - After removal, clean the tick area with an antiseptic (rubbing alcohol) - Wait 4-6 weeks to be tested for Lyme disease – testing before this time is not reliable
Report S/S such as rash or flu-like illness immediately

265 EXAM 4

FIBROMYALGIA SYNDROME (FMS)

- Chronic pain syndrome, no inflammation present - Remissions and exacerbations

Arthritis and other comorbidities are commonly present

Arthritis and Common Tissue Diseases 2023, Exams of Nursing

Related documents

Partial preview of the text

Download Arthritis and Common Tissue Diseases 2023 and more Exams Nursing in PDF only on Docsity!

18: ARTHRITIS AND COMMON TISSUE DISEASES

2023.Guaranteed Success.

LUPUS ERYTHEMATOSUS (DLE/SLE)

>>> PATHO

>> PHYSICAL ASSESSMENT

SYSTEMIC SCLEROSIS –

(SCLERODERMA)

>>> PATHO

>>> ASSESSMENT

>> PHYSICAL ASSESSMENT

>> LABS

LYME DISEASE

STAGE 1

FIBROMYALGIA SYNDROME (FMS)