RNSG 2432-Mod_17 Notes Musculoskeletal Autoimmune, Inflammatory, Metabolic, & Infectious Disorde

RNSG 2432-Mod_17 Notes Musculoskeletal Autoimmune, Inflammatory, Metabolic, & Infectious Disorde

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NOTES Musculoskeletal  cmj Disorders. Part I  Autoimmune/Inflammatory  (RA/SLE/ALk/Sclero/Lyme) Etiology/Pathophysiology  (general) Complete PDS-Ms Michaels  A. Normal physiology- autoimmune/inflammatory musculoskeletal disorders. 1. Commonly called “arthritis”; more than 100 types of “arthritic”  disorders affecting skeletal  system: focus- “chronic systemic disorder” 2. Diffuse inflammatory lesions and degenerative changes in connective tissue 3. *Review osteoarthritis (p. 1239-1241) Rheumatoid Arthritis A. Etiology/Pathophysiology of Rheumatoid Arthritis 1. Normal antbodies become autoantibodies (rheumatoid factors or RF); attack host tissues  which bind with target antigens in blood and with synovial membranes > immune  complexes. 2. Synovial membrane damaged from inflammatory and immune processes > erosion of  articular cartilage and inflammation of ligaments and tendons.  3. Granulation tissue (pannus ) forms over denuded areas of synovial membrane and scar  tissue > immobilizing joint. (p. 1249 Fig  39-5).  See joint changes and deformities in  Power Point as disease progresses (refer to PPT slides in “Required” resources).  What  is “pannus”   (p. 1249)  4. Diarthroidal      or synovial joints - primarily involved.  RNSG 2432 125 Moderately advanced  pannus  formation
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5. Compare to osteoarthritis (as above). B. Common Manifestations/Complications of Rheumatoid Arthritis  1. Joint manifestations a. Onset insidious; may be acute after stressor b. Systemic manifestations (See p.1251)  c. Joint swelling- stiffness, warmth, tenderness and pain; usually multiple joints;  symmetric involvement, small, non-weight bearing joints d. Proximal interphalangeal and metacarpophalangeal joints of fingers, wrists, knees,  ankles, and toes most frequent. Assessment RA Deformities that may occur with RA Synotenovitis Ulnar drift Swan neck deformity Boutonniere deformity e. Joint deformity results: swan neck and boutoniere; wrist deformity, etc. See p. 1250  fig 39-6 2. Exra-articular manifestations a. While disease active: fatigue: fatigue, weakness, anorexia, weight loss, low-grade  fever b. Anemia; skeletal muscle atrophy c. “Rheumatoid nodules”  or subcutaneous nodules;  develop in subcutaneous  tissue in areas subject to pressure on forearm *  do not cause problems except  pressure areas, disfiguring… 126 RNSG 2432
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Hammer toes Subcutaneous nodules ( disappear and appear without warning) d. Pleural effusion, pericarditis, etc  C. Therapeutic Interventions for Rheumatoid Arthritis 1. Diagnostic tests  *key is R/O other  causes  (*need to understand this) a. Client history and physical assessment
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RNSG 2432-Mod_17 Notes Musculoskeletal Autoimmune, Inflammatory, Metabolic, & Infectious Disorde

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