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Orthopedic and Connective Tissue Disorders: An Overview

Explore rheumatoid arthritis, degenerative joint disease, gout, fibromyalgia, bursitis, ankylosing spondylitis, lupus, osteomyelitis, Lyme disease. Learn pathophysiology, symptoms, diagnostics, and management in nursing practice.

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Orthopedic and Connective Tissue Disorders: An Overview

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  1. Timby/Smith: Introductory Medical-Surgical Nursing, 10/e Chapter 63: Caring for Clients with Orthopedic and Connective Tissue Disorders

  2. Inflammatory Disorders: Rheumatoid Arthritis • Pathophysiology, 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, Surgical Management: Decreasing joint inflammation; Relieving discomfort; Preventing deformities; Restoring function • Nursing Management

  3. Rheumatoid Arthritis Figure 63-2 Joint changes in rheumatoid arthritis

  4. Degenerative Joint Disease Pathophysiology, Etiology: Repeated trauma; Degenerative joint changes Assessment Findings: Signs and Symptoms Stiffness; Pain; Painless nodules; Heberden’s nodes, Bouchard’s nodes; Limited ROM; Crepitus Diagnostic Findings: Radiography Medical, Surgical Management: Rest; Exercise program; TENS unit; Drug therapy; Joint surgery Nursing Management

  5. Degenerative Joint Disease Figure 63-4 Joint changes in osteoarthritis

  6. Gout • Pathophysiology, Etiology: Inherited; Painful metabolic disorder; Inflammatory reaction in joints; Affects men > women • Assessment Findings: Sign and Symptoms – Edema; Recurring pain; Tenderness of one joint; Fever; Tophi may be palpated; Hyperuricemia • Diagnostic Findings: Clinical signs; Urine test; Arthrocentesis; Radiography • Medical, Surgical Management: Uricosuric drugs; Decreased ingestion of purine; NSAIDs; Colchicine; Phenylbutazone; Surgery • Nursing Management

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

  8. Answer False. 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.

  9. Fibromyalgia • Pathophysiology, 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, Surgical Management: Analgesics; Nontraditional therapies • Nursing Management

  10. Bursitis • Pathophysiology, Etiology: Trauma; Infection • Assessment Findings: Painful movement of joint; Distinct lump • Diagnostic Findings: Radiograph; Fluid aspiration • Medical, Surgical Management: Rest; Salicylates, NSAIDs; Corticosteroids; Mild ROM exercises • Nursing Management

  11. Ankylosing Spondylitis • Pathophysiology, 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, Surgical Management: Supportive treatment including medications; Back brace; Sleeping instructions; Prescribed exercise; Total hip replacement • Nursing Management

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

  13. 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.

  14. Systemic Lupus Erythematosus (SLE) • Pathophysiology, 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

  15. Medical Management: Producing remission; Prevent/Treat exacerbations; Medications • Renal, Cardiac, GI, CNS symptomatic treatment • Nursing Management Systemic Lupus Erythematosus

  16. Infectious Disorders: Osteomyelitis • Pathophysiology, 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, Surgical Management: Immobilization; Surgical debridement; Closed saline irrigation; Antibiotic-impregnated bead application; Bone or muscle flap grafts • Nursing Management

  17. Lyme Disease • Pathophysiology, Etiology: Ticks act as vectors to transmit bacteria • Assessment Findings: Signs and Symptoms • Stages of disease • Diagnostic Findings: Serologic Studies • Medical, Surgical Management: Antibiotics; Supportive measures; Prognosis • Nursing Management

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

  19. Answer False. Lyme disease is spread via deer tick bites. It is most common in the Northeast, mid-Atlantic, and other northern areas of the United States.

  20. Structural Disorders: Osteoporosis • Pathophysiology, Etiology: Loss of bone mass; Women > Men; Causes • Assessment Findings: Signs and Symptoms • Lumbosacral, thoracic back pain; Kyphosis • Diagnostic Findings: Radiography; DEXA; QUS • Medical, Surgical Management: Calcium; Vitamin D; Drug therapy; HRT (decreasing use); Exercise; Relieving pain; Preventing injury • Nursing Management

  21. Osteomalacia • Pathophysiology, Etiology: Insufficient calcium absorption; Phosphate deficiency • Assessment Findings: Bone pain; Deformities; Waddling gait • Diagnostic Findings: Radiography; Serum levels • Medical, Surgical Management: Adequate nutrition; Exposure to sunlight; Exercise; Braces or surgery • Nursing Management

  22. Paget’s Disease • Pathophysiology, Etiology: Abnormal bone remodeling • Assessment Findings: Bone pain; Tenderness; Skeletal deformity • Diagnostic Findings: Radiography; Bone scans • Medical, Surgical Management: Drug therapy; Surgery • Nursing Management

  23. Disorders of the Feet • Pathophysiology, Etiology: Heredity; Arthritis; Improperly fitting shoes • Bunions; Hammertoes • Assessment Findings: Signs and Symptoms - Pain; Tenderness; Deformity; Corns and calluses • Diagnostic Findings: Radiography • Medical, Surgical Management: Well-fitted shoes; Exercises; Pads; Surgery • Nursing Management

  24. Benign Bone Tumors • Pathophysiology, Etiology: Overgrown clusters of normal bone cells • Assessment Findings: Signs and Symptoms - Pain; Deformity; Swelling • Diagnostic Findings: Radiography; Bone scans; biopsy • Medical, Surgical Management: Surgery; Curettage; Bone grafts; Splints or casts • Nursing Management

  25. Malignant Bone Tumors • Pathophysiology, 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, Surgical Management: Surgery; Radiation; Chemotherapy • Nursing Management

  26. End of Presentation

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