TimbySmith Introductory MedicalSurgical Nursing 11e Chapter 63 Caring

Timby/Smith: Introductory Medical-Surgical Nursing, 11/e Chapter 63: Caring for Clients With Orthopedic and Connective Tissue Disorders Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Inflammatory Disorders: Rheumatoid Arthritis • Pathophysiology and Etiology: synovial tissue • Assessment Findings: Signs and Symptoms – Subcutaneous nodules, muscles atrophy, flexion contractures, classic deformities • Diagnostic Findings: radiography, serum protein electrophoresis, arthrocentesis, CRP/ANA tests • Medical and Surgical Management: decreasing joint inflammation, relieving discomfort, preventing deformities, restoring function • Nursing Management Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Degenerative Joint Disease • Pathophysiology and Etiology: repeated trauma; degenerative joint changes • Assessment Findings: Signs and Symptoms – Stiffness, painless nodules, Heberden’s nodes, Bouchard’s nodes; limited ROM; crepitus • Diagnostic Findings: radiography • Medical and Surgical Management: rest, exercise program, TENS unit, drug therapy, joint surgery • Nursing Management Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Temporomandibular Disorder • Symptoms include jaw pain, pronounced muscle spasm, and tenderness of the masseter and temporalis muscles. Headache, tinnitus (ringing in the ears), and ear pain accompany the localized discomfort. • The client experiences clicking of the jaw when moving the joint, or the jaw can lock, which interferes with opening the mouth. • Some clients experience difficulty or discomfort chewing. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Gout • Pathophysiology and Etiology: inherited; painful metabolic disorder; inflammatory reaction in joints; affects men > women • Assessment Findings: Signs and Symptoms: edema, recurring pain, tenderness of one joint, fever, tophi may be palpated, hyperuricemia • Diagnostic Findings: clinical signs, urine test, arthrocentesis, radiography • Medical and Surgical Management: uricosuric drugs, decreased ingestion of purine, NSAIDs, colchicine, phenylbutazone, surgery • Nursing Management Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Is the following statement true or false? Gout affects more women than men.

Answer False Rationale: Gout is a very painful metabolic disorder, which causes inflammatory reactions in the joints, usually the feet, hands, elbows, ankles, and knees. Gout affects more men than women. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Fibromyalgia • Pathophysiology and Etiology: unknown • Assessment Findings: Signs and Symptoms – Chronic syndrome of pain, fatigue, sleep disturbances; middle-aged women most common • Diagnostic Findings: diagnosis difficult; rule out other conditions to diagnose • Medical and Surgical Management: analgesics; nontraditional therapies • Nursing Management Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Bursitis • Pathophysiology and Etiology: trauma, infection • Assessment Findings: painful movement of joint; distinct lump • Diagnostic Findings: radiograph, fluid aspiration • Medical and Surgical Management: rest; salicylates, NSAIDs; corticosteroids; mild ROM exercises • Nursing Management Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Ankylosing Spondylitis • Pathophysiology and Etiology: chronic connective tissue disorder progressive immobility, fixation • Assessment Findings: Signs and Symptoms – Low back pain, flattened lumbar curve, aortic regurgitation, permanently flexed neck, reduced lung sounds • Diagnostic Findings: ESR, CT scan, radiographs • Medical and Surgical Management: supportive treatment including medications, back brace, sleeping instructions, prescribed exercise, total hip replacement • Nursing Management Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Is the following statement true or false? There is no cure for ankylosing

Answer True There is no cure for ankylosing spondylitis. The aim of supportive treatment is to maintain functional posture. Medications are prescribed to relieve inflammation and pain. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Systemic Lupus Erythematosus (SLE) • Pathophysiology and Etiology: unknown triggering mechanism; destruction of diffuse connective tissues; affects multiple body systems; autoimmune; great imitator • Assessment Findings: Signs and Symptoms – Clinical signs; facial rash, behavioral disturbances, fluid retention, proteinuria, hematuria, many others • Diagnostic Findings: presenting symptoms; blood tests, renal biopsy, urinalysis Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Systemic Lupus Erythematosus (SLE)— (cont. ) • Medical Management: producing remission; prevent/treat exacerbations; medications – Renal, cardiac, GI, CNS symptomatic treatment • Nursing Management Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Infectious Disorders: Osteomyelitis • Pathophysiology and Etiology: pathogens; complications • Assessment Findings: Signs and Symptoms – Sudden acute or chronic infection • Diagnostic Findings: elevated leukocyte count and ESR; positive blood culture; anemia; radiographs; bone scans, MRI: definitive diagnoses • Medical and Surgical Management: immobilization, surgical debridement, closed saline irrigation, antibiotic-impregnated bead application, bone or muscle flap grafts • Nursing Management Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Lyme Disease • Pathophysiology and Etiology: ticks act as vectors to transmit bacteria • Assessment Findings: Signs and Symptoms – Stages of disease • Diagnostic Findings: serologic studies • Medical and Surgical Management: antibiotics; supportive measures; prognosis • Nursing Management Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Is the following statement true or false? Lyme disease is spread via mosquito

Answer False Rationale: Lyme disease is spread via deer tick bites. It is most common in the northeast and mid-Atlantic states and in other northern areas of the United States. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Structural Disorders: Osteoporosis • Pathophysiology and Etiology: loss of bone mass; women > men; causes • Assessment Findings: Signs and Symptoms – Lumbosacral, thoracic back pain; kyphosis • Diagnostic Findings: radiography, DEXA, QUS • Medical and Surgical Management: calcium, vitamin D, drug therapy, HRT (decreasing use), exercise; relieving pain, preventing injury • Nursing Management Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Osteomalacia • Pathophysiology and Etiology: insufficient calcium absorption; phosphate deficiency • Assessment Findings: bone pain, deformities, waddling gait • Diagnostic Findings: radiography; serum levels • Medical and Surgical Management: adequate nutrition; exposure to sunlight; exercise; braces or surgery • Nursing Management Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Paget’s Disease • Pathophysiology and Etiology: abnormal bone remodeling • Assessment Findings: bone pain, tenderness, skeletal deformity • Diagnostic Findings: radiography, bone scans • Medical and Surgical Management: drug therapy, surgery • Nursing Management Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Disorders of the Feet • Pathophysiology and Etiology: heredity, arthritis, improperly fitting shoes – Bunions; hammer toes • Assessment Findings: Signs and Symptoms: pain, tenderness, deformity, corns and calluses • Diagnostic Findings: radiography • Medical and Surgical Management: well-fitted shoes, exercises, pads, surgery • Nursing Management Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Benign Bone Tumors • Pathophysiology and Etiology: overgrown clusters of normal bone cells • Assessment Findings: Signs and Symptoms: pain, deformity, swelling • Diagnostic Findings: radiography, bone scans, biopsy • Medical and Surgical Management: surgery, curettage, bone grafts, splints or casts • Nursing Management Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Malignant Bone Tumors • Pathophysiology and Etiology: radiation, toxic chemical exposure, heredity • Assessment Findings: Signs and Symptoms: primary tumors, location; pathologic fracture; difficulty in movement; abnormal gait • Diagnostic Findings: radiography, MRI, bone scan, biopsy • Medical and Surgical Management: surgery, radiation, chemotherapy • Nursing Management Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins