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Inflammatory Disorders

Inflammatory Disorders. Inflammatory Disorders of the Musculoskeletal System. Bursitis Inflammation of Bursa (fluid filled sac allowing joint movement) Usually from trauma or repetitious movement Appears calcified on X-ray Treatment Rest-Immobilization with heat or cold pack

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Inflammatory Disorders

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  1. Inflammatory Disorders

  2. Inflammatory Disorders of the Musculoskeletal System • Bursitis • Inflammation of Bursa (fluid filled sac allowing joint movement) • Usually from trauma or repetitious movement • Appears calcified on X-ray • Treatment • Rest-Immobilization with heat or cold pack • Anti-inflammatory (NSAIDS) and analgesics • Sometimes injectable steroids and anesthetics into joint

  3. Inflammatory Disorders of the Musculoskeletal System • Polymyositis • Inflammation of striated/skeletal muscle • Etiology unknown (possibly autoimmune) • Can affect heart, GI tract, and lungs

  4. Inflammatory Disorders of the Musculoskeletal System • Arthritis • Most common type of joint disorder • Defined as “inflammation of the joints” • 4 types of arthritis • Rheumatoid, osteoarthritis, gout and septic (infectious) arthritis

  5. Rheumatoid Arthritis Etiology/pathophysiology • Most serious form of arthritis • Chronic, systemic disease • Most common in women of childbearing age • Autoimmune disorder, but may also be genetic • May affect lungs, heart, blood vessels, muscles, eyes, and skin • Chronic inflammation of the synovial membrane of the diarthrodial joints (movable)

  6. Rheumatoid Arthritis • Characteristics • Symmetrical joint swelling • Joint swelling rather than bony enlargement (osteoarthritis) • Permanent deformity as result of inflammatory process

  7. Rheumatoid Arthritis • Clinical manifestations/assessment • Characterized by periods of remission and exacerbation • Exacerbations increased by physical, emotional stress • Muscle weakness • Malaise • Loss of appetite • Generalized aching • Edema and tenderness of joints • Limited range of motion (morning stiffness)

  8. Figure 44-7 (From Kamal, A., Brocklehurst, J.C. [1991]. Color atlas of geriatric medicine. [2nd ed.]. St. Louis: Mosby.) Rheumatoid arthritis of hands.

  9. Rheumatoid Arthritis • Clinical manifestations/assessment • Inflammation, tenderness, swelling of joints • Moderate to severe pain; morning stiffness lasting longer than 30 min • Joint deformities • Spongy, soft feeling to joints • Low grade temperature, fatigue, weakness • Anorexia, weight loss, anemia

  10. Rheumatoid Arthritis • Diagnostic tests • Radiography studies show loss of articular cartilage and change in bone structure • Laboratory tests • Erythrocyte sedimentation rate (ESR) • Rheumatoid factor (RF) • Latex agglutination test • Synovial fluid aspiration

  11. Rheumatoid Arthritis • Medical management/Nursing Interventions • Medications • Rest: 8-10 hours of sleep a night • Exercise: Range of motion 2-3 times per day; balance rest/activity • Heat: Hot packs, heat lamp, and/or hot paraffin • Rehabilitation: splints to prevent deformity • Surgical intervention-joint replacement

  12. Rheumatoid Arthritis • Goals for Treatment • Control of Disease (Medications) • Pain Relief (Medications, nrsg interventions) • Prolong Joint Function (Physical Therapy) • Slow Progression of Damage (Healthy Lifestyle, Exercise, Weight Loss)

  13. AnkylosingSpondilitis • Etiology/pathophysiology • Chronic, progressive disorder of the sacroiliac and hip joints, the synovial joints of the spine, and the adjacent soft tissues • Most common in young men • Strong hereditary tendency • Clinical manifestations/assessment • Pain and stiffness in back; decreased ROM • Elevated temperature; tachycardia; hyperpnea

  14. AnkylosingSpondylitis • Diagnostic tests • Hemoglobin, hematocrit, ESR, alkaline phosphatase • Radiographic • Medical management/nursing interventions • Analgesics, NSAIDs • Exercise program: swimming and walking • Surgery: replace fused joints • Maintain spine alignment • Turn, position, and breathing exercises every 2 hours

  15. Degenerative Joint Disease Osteoarthritis

  16. Osteoarthritis or DJD • Degenerative Joint Disease- progressive degeneration of joints • Non-systemic, non-inflammatory • Primary osteoarthritis-cause unknown • Secondary osteoarthritis-caused by trauma, infection, RA. stress on weight-bearing joints

  17. Osteoarthritis • Clinical manifestations/assessments • Joint edema, tenderness, instability and deformity • Heberden’s Nodes and Bouchard’s Nodes • Diagnostic tests • Radiographic studies • Arthroscopy • Arhtrocentesis • Bone Scan

  18. Figure 44-8 Heberden’s Nodes (From Kamal, A., Brocklehurst, J.C. [1991]. Color atlas of geriatric medicine. [2nd ed.]. St. Louis: Mosby.) Heberden’s nodes.

  19. Bouchard’s Nodes

  20. Osteoarthritis • Medical management/nursing interventions • Exercise balanced with rest • Heat applications • Gait enhancers (walkers, canes, etc.) • Medications-ASA, NSAIDS, steroids • Surgery-osteotomy (bone cut to correct joint deformity), joint replacement

  21. Nursing Considerations • Goals: • Encourage patient to maintain ADLs • Adapt to limitations of the disease • Reminders to older people with cognitive impairment to move, turn, etc. • Weight reduction if obesity a problem • Splint support – check for fit and potential pressure areas

  22. Nursing Considerations • If long-term anti-inflammatory med use: stool guiac and/or emesis guiac • Gait enhancers – for safety • Rubber tips on ends of mobility devices – walkers, canes • Proper size • Pt. knowledge re: use

  23. Gout • Metabolic disease resulting from excessive uric acid in blood; urate crystals deposit in joints • Caused by ineffective metabolism of purines • Primary cause: heredity; disorder of purine metabolism • Secondary cause: certain drugs, complication of other disease, idiopathic • More men than women, not before puberty in men, not before menopause in women

  24. Gout • Clinical manifestations • Excruciating pain • Edema of joints; low grade temp; pruritis • Inflammation (most often in great toe) • Tophi (hard, fairly large irregular shaped deposits in skin) • Diagnostic Tests • CBC, ESR, Serum uric acid • X ray, arthrocentesis

  25. Gout • Medical management/nursing interventions • Medications: Colchicine, phenylbutazone (Butazolidin), indomethacin (Indocin), corticosteroids, allopurinol (Zyloprim), sulfinpyrazone (Anturane) • Encourage fluid intake: greater than 2000cc/day! • Monitor I&O • Bedrest and joint immobilization during acute attacks • Diet-avoid foods high in purines (wine, cheese, organ meats)

  26. Osteomyelitis • Local or generalized infection of the bone and bone marrow • Staphylococci are the most common cause • Introduced through trauma (injury or surgery) or via the bloodstream from another site in body to bone • Bacteria invade the bone and degeneration occurs

  27. Osteomeylitis • Most common cause • Bacterial infection from open fracture • Also from infected teeth, tonsils, or URI • Common organisms • Staphylococusaureaus • Pseudomonas • E. Coli

  28. Osteomyelitis

  29. Osteomyelitis

  30. Osteomyelitis • Clinical manifestations • Persistent, severe and increasing bone pain • Wound draining purulent fluid • S/S of infection-fever, tachycardia, tachypnea • Edema of affected area • Diagnostic tests • Radiographic studies; bone scan • CBC, ESR, cultures of blood and drainage

  31. Osteomyelitis • Medical management/nursing interventions • Broad spectrum antibiotic therapy • Surgical removal of necrotic bone • Absolute rest of affected area • Wound care: irrigation of area with H2O2 or antibiotic solution and cover with sterile dressing • Drainage and secretion precautions • Diet: high in calories protein and vitamins

  32. Fibromyalgia • Etiology/pathophysiology • Musculoskeletal chronic pain syndrome • Fatigue and sleep disturbances • Multiple tender points-back of head, upper back of head and neck, upper chest, elbows, hips and knees • Unknown etiology, more common in women than in men

  33. Fibromyalgia • Clinical manifestations/assessment • Generalized aching • Irritable bowel syndrome • Tension headache • Paresthesia of upper extremities • Sensation of edematous hands

  34. Fibromyalgia • Diagnostic tests • No specific diagnostic tests can diagnose FMS • Medical management/nursing interventions • Patient education and reassurance • Tricyclic antidepressants • Exercise • Relaxation techniques

  35. Lyme Disease • Caused by bacterium Borreliaburgdoferi; transmitted to humans by bite of blacklegged tick • Symptoms include: fever, HA, characteristic rash called erythema migrans • If not treated, can spread to joints, heart and nervous system

  36. Lyme Disease • Diagnosis based on symptoms, physical findings (e.g. rash) and possibility of exposure to infected ticks • Treatment involves several weeks of antibiotics • Prevention: insect repellant, remove ticks promptly, pest management

  37. Other Musculoskeletal Disorders

  38. OSTEOPOROSIS • Reduction of bone mass • Most common: women ages 55-65 • Contributing Factors: • Immobilization • Steroids • High intake caffeine • Diet low in calcium, high in protein • Smoking • Sedentary lifestyle

  39. OSTEOPOROSIS • Hormonal influence • Postmenopausal osteoporosis • Poss. related to estrogen deficiency • Influences bone resorption and sensitivity to parathyroid hormone - i.e. parathyroid hormone weakens the bone by increasing calcium movement from bone into extracellular fluid.

  40. OSTEOPOROSIS • Clinical Manifestations • Backache • Porous and brittle bones • Dowager’s hump • Subjective Data: lifestyle pracitices; pain c/o • Objective Data: observable deformities; gait impairment; inability to maintain erect posture

  41. OSTEOPOROSIS • Medical Management • Lab work: serum calcium, phosphorus, alkaline phosphatase; CBC; BUN, Cr., UA; liver and thyroid function • Bone Mineral Density (BMD) Test • Medication/supplements: (See p. 129 Table 4-6) • Calcium Supplements, Vitamin D • Weight bearing exercises • Estrogen, Biphosphanates (Fosamax, Boniva) • Parathyroid hormone • Diet: milk, dairy; limit caffeine, low animal protein (red meat) and low sodium

  42. OSTEOPOROSIS • Medications: • Biphosphonates: (Fosamax, Actonel, Boniva) • Taken after arising in A.M. with full glass of water • No eating or drinking for 30 min. after taking med • Remain upright for 30 min. after taking med • Estrogen Receptor Modulator (Evista) • Mimic effect of estrogen on bone by reducing bone resorption • Teriparatide(Forteo) • Stimulates new bone formation • Used to treat osteoporosis in men and post menopausal women at high risk for fx.

  43. OSTEOPOROSIS • Treatment Dowager’s Hump: • Surgical Interventions • Kyphoplasty: a balloon is used to separate the vertebrae then bone cement is injected to fill the space • Vertebroplast: bone cement is injected between the vertebrae without separating the vertebrae

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