Nursing Care & Interventions
for the Client with Connective
Tissue Disorders
Keith Rischer RN, MA, CEN
3/19/2016
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Today’s Objectives…
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Review pathophysiology of the inflammatory response.
Compare and contrast pathophysiology &
manifestations of RA, lupas, gout, lyme’s disease &
fibromyalgia.
Identify the diagnostic tests, nursing priorities, and
client education with RA, lupas, gout, lyme’s disease &
fibromyalgia.
Discuss medical and pharmocologic management for
clients with RA, lupas, gout, lyme’s disease &
fibromyalgia.
Describe the mechanism of action, side effects and
nursing responsibilities with pharmacologic
management of connective tissue disorders.
3/19/2016
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Antigen-Antibody Interactions
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Exposure
Antigen recognition
Lymphocyte
recognition
Anti-body production
& release
Anti-body/binding
actions
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Agglutination
Lysis
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Autoimmunity
Recognizes self
antigens as foreign
 Produces
antibodies against
own tissue
 Examples
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Lupus
Rheumatoid
Arthritis
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Rheumatoid Arthritis
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Patho
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Inflammation
Auto-immune disease
Cartilage damage
Exacerbations
Vasculitis
Causes
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Unknown
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3/19/2016
Possible combo
environment/genetic
factors
Women>men
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Rheumatoid Arthritis: Assessment
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Early disease
manifestations
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Late disease
manifestations
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Joint stiffness/swelling/pain
Fatigue, weakness, fever
Joint deformities/effusions
Osteoporosis
Systemic complications
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Anemia
Vasculitis
Renal disease
Sjogrens syndrome
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Rheumatoid Arthritis: Diagnostic
Rheumatoid factor
 Erythrocyte sedimentation rate
 Serum immunoglobulins
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IgG elevated
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RA: Pharmocologic Management
Mild disease
 Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Celecoxib (cox-2 inhibiting properties)
• ASA
Moderate to severe disease
 Methotrexate
• SE:N&V, anorexia, liver toxicity
 Prednisone
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RA: Nursing Diagnostic Priorities
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Impaired physical mobility r/t…
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Chronic pain r/t…
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ROM, physical therapy…assistive devices
Encourage ambulation
Analgesics per schedule…Assess effectiveness
Non-pharmacologic
Fatigue r/t…
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Monitor nutritional intake
Alternate rest/activity…avoid over exertion
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Systemic Lupus Erythematosus (SLE)
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Patho
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Auto-immune
Exacerbations
Vasculitis
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Kidneys
Causes
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Unknown
Women 15-40 yrs
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3/19/2016
10x more than men
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SLE: Assessment
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Skin involvement
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Musculoskeletal changes
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Butterfly rash
Joint inflammation
Systemic
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Fever
Fatigue
Anorexia
Pleural effusions
Raynaud’s
Pericarditis
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Lupus: Management
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Same as RA
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Sed rate
Complete blood count
 r/o
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pancytopenia
Immunologic testing
Drug management
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Prednisone
 Oral
 Topical
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Lupas: Education Priorities
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Skin care
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Avoid prolong exposure to sun
Mild soap
Stress reduction
 Fatigue
 Signs of exacerbation
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fever
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Gout
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Patho
• Primary gout
 Most common
 Excess uric acid
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Secondary gout
 Excess uric acid
– Renal
insufficiency
– Diuretics
– Oncology dx
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Gout: Assessment-Treatment
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Pain-inflammation
small joints
Renal calculi
Labs
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Sed rate elevated
WBC elevated
Drugs
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Indocin (NSAID)
Colchicine
Allopurinol
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Lyme Disease
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Patho
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Deer tick bite
Spirochete
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Lyme Disease:
Assessment/Treatment
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Stage 1 (early)
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Stage 2 (2-12 weeks)
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Dizziness/palpatations
CNS changes
meningitis
Stage 3
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Flu-like sx
Bull’s eye rash
Joint pain/stiffness
Arthritis
Fatigue
Memory/cognitive deficits
Drugs
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Doxycycline po
Ceftriaxone IV
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Fibromyalgia Syndrome
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Patho
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Assessment
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Cronic pain syndrome
Mental health overlay
Women 30-50 yrs
Muscle pain at trigger points
Fatigue
Insomnia
Abd/pelvic pain
Treatment
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Increase sleep time
NSAIDS
Muscle relaxants
Physical therapy/exercise
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Case Study #2
Marge, a 35 year old female, presents to the ER
with complaints of abdominal pain and blood in her
urine
 Marge also appears to have an inflamed, red rash
on her face. She states she is extremely fatigued
and all her muscles ache. Her appetite is poor
and she states she has lost several pounds over
the past few weeks
 Marge’s BP is 146/90, P is 114, RR 28, sats 92%,
temp is 101. The nurse notes that Marge has
swollen lymph nodes in her neck and groin areas
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Case Study #2
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According to the above assessment data, what disease
is Marge probably suffering from? What data points to
this?
What labs/diagnostic procedures will the provider most
likely order?
Knowing that this disease affects highly vascular tissues
and organs such as the kidney, what should the nurse
teach Marge to monitor?
What broad classifications of drugs can the nurse expect
the provider to order for Marge?
What will the nurse teach Marge about exposure to
sunlight?
What other hygiene measures are important for the
nurse to teach Marge about?
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