Musculoskeletal Lecture II part II narrated

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RHEUMATOID ARTHRITIS:

RHEUMATOID ARTHRITIS

Rheumatoid Arthritis:

Rheumatoid Arthritis Systemic Inflammatory Disease that affects the synovial lining of the joints CAUSES: Autoimmune disease Abnormal IgG is formed then autoantibodies against the abnormal IgG are formed (RF) Genetic transmission increases susceptibility to the disease

Pathophysiology:

Pathophysiology Inflammation of the synovial membranes is followed by formation of pannus, an inflammatory exudate, and destruction of cartilage, bone, and ligaments. Pannus is replaced by fibrotic tissue and calcification, which causes subluxation of the joint

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Typical deformities A. Ulnar drift B. Boutonniere deformity C. Hallux Valgus D. Swan-neck deformity

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Extra-articular Manifestations of RA

Assessment findings:

Assessment findings Fatigue, malaise, anorexia Elevated body temperature Painful swollen joints, subcutaneous nodules Limited ROM, paresthesias of hands/feet Symmetrical joint swelling Morning stiffness and crepitus Pericarditis, Leukopenia Splenomegaly, Enlarged lymph nodes

Diagnostic findings:

Diagnostic findings Elevated Inflammatory Markers (ESR and CRP) Serum Rheumatoid factor positive Serum ANA (antinuclear antibodies) titers may be positive Synovial fluid may be straw colored with fibrin flecks - WBC count may be elevated. X-rays: bone demineralization and soft tissue swelling during early phases. Later may reveal narrowing of joint spaces, destruction of articular cartilage, erosion, and deformity.

Clinical Evaluation: (4 or more of the following) :

Clinical Evaluation: (4 or more of the following) Morning stiffness lasting at least one hour Arthritis of three or more joint areas Arthritis of the hand joints Symmetric arthritis Rheumatoid nodules Abnormal amounts of serum rheumatoid factor Radiographic changes

Nursing Management:

Nursing Management Assess for adequate pain management Non-pharmacologic pain management Patient education Balancing periods of activity with rest Exercise to maintain joint function and mobility Patient support related to chronic illness Assistive devices for joint protection Support groups and other information

Pharmacological Management:

Pharmacological Management NSAIDs Non-Biologic – Immunosupress Inflammation corticosteroids, hydroxychloroquine (antimalarial) Biologic – Immunosupress w/ recombinate DNA TNF Antagonists B-lymphocyte depleating T-cell activation inhibitors Minor non-Biologic and Biologic IL1 blockers Plasma phresis Gold salts Chelating therapy

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She should stop working outside the home because having a career is always stressful on mothers B. Typing will be good exercise for her fingers as long as she rests her hands several times a day C. Typing will increase the stress on her finger joints, and she may want to reevaluate her career goals D. Her job should not be a problem since it is expected that the drug therapy will promote a remission of her symptoms A 32 year old patient has just been diagnosed with RA. She asks the nurse what she will be able to do about her job. She says she needs to work to help meet the family’s financial needs. The nurse’s best answer to her is that:

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