Agent he or she must be monitored for signs of

8. Client education
1. Client should be referred to a rheumatologist to coordinate management
of care
2. Assist the client to understand occurrence of flare-ups and chronic
nature of disease process
3. Discuss the importance of adequate symptom management to achieve an
optimal level of function
4. Discuss the importance of client self-monitoring and compliance with
treatment and medication therapy
5. Discuss potential dynamic life changes that might occur as a result of pro-
gression of deformity and loss of function

9. Evaluation
2. Etiology and pathophysiology
3. Assessment
a. Clinical manifestations

3) Cardiac changes can present in the form of Raynaud's phenomenon (va-
sospastic disease), secondary bacterial endocarditits, myocardial fibrosis,
left ventricular (LV) dysfunction, and heart failure
4) Raynaud's phenomenon: vasospasm of small arteries in hands or feet,
characterized by color changes (pallor and cyanosis) leading to a reactive
hyperemia (redness) of affected extremity
5) Respiratory changes can result from lung restriction caused by fibrosis
6) Renal changes lead to development of uremia, malignant hypertension,
and eventually renal failure
7)