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Lecture 3

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University of Calgary
NURS 287
Rick Nilson

Lecture 3 SEPTIC ARTHRITIS  Septic arthritis (infectious or bacterial arthritis) is caused by invasion of joint cavity with microorganisms.  Large joints (knee and hip) are frequently involved, causing severe pain, erythema, and swelling.  This condition requires prompt treatment with antibiotics to prevent joint destruction.  Nursing care includes assessment and monitoring of joint inflammation, pain, and fever. LYME DISEASE  Lyme disease is a spirochetal infection transmitted by bite of an infected deer tick.  A characteristic symptom of the early localized disease is erythema migrans, a skin lesion occurring at site of tick bite 2 to 30 days after exposure.  Viral-like symptoms, such as fever, chills, headache, swollen lymph nodes, and migratory joint and muscle pain, also occur.  In late disease, arthritis pain and swelling may occur in large joints.  Antibiotics are used for active disease and to prevent late disease.  Reducing exposure to ticks is the best way to prevent Lyme disease. GOUT  Gout is caused by an increase in uric acid production, underexcretion of uric acid, or increased intake of foods containing purines, which are metabolized to uric acid by the body.  Deposits of sodium urate crystals occur in articular, periarticular, and subcutaneous tissues. This leads to recurrent attacks of acute arthritis.  Risk factors are obesity (in men), hypertension, diuretic use, and excessive alcohol consumption.  Affected joints may appear dusky or cyanotic and are extremely tender. Inflammation of great toe (podagra) is a common initial problem.  Chronic gout is characterized by multiple joint involvement and visible deposits of sodium urate crystals (tophi).  Treatment includes drug therapy for pain management and to terminate an acute attack.  Future attacks are prevented by drugs, weight reduction as needed, and possible avoidance of alcohol and food high in purine (red and organ meats).  Nursing interventions include supportive care of inflamed joints. SYSTEMIC LUPUS ERYTHEMATOSUS  Systemic lupus erythematosus (SLE) is a chronic multisystem inflammatory disease with immune system abnormalities.  The etiology of abnormal immune response is unknown; a genetic influence is suspected.  Extremely variable in its severity, ranging from a relatively mild disorder to rapidly progressive and affecting many organ systems.  Commonly affected are the skin (butterfly rash over nose, cheeks), muscles (polyarthralgia with morning stiffness), lungs (tachypnea), heart (dysrhythmias), nervous tissue (seizures), and kidneys (nephritis).  Other signs include anemia, mild leukopenia, and thrombocytopenia. Infection is a major cause of death.  A major treatment challenge is to manage active disease while preventing treatment complications that cause long-term tissue damage.  Patients with mild polyarthralgias or polyarthritis are treated with NSAIDs. Corticosteroids are given for severe cutaneous SLE. Antimalarial agents and immunosuppressive drugs may also be used.  Nursing care emphasizes health teaching and importance of patient cooperation for successful home management. SYSTEMIC SCLEROSIS  Systemic sclerosis (SS), or scleroderma, is a connective tissue disorder with fibrotic, degenerative, and occasionally inflammatory changes in the skin, blood vessels, synovium, skeletal muscle, and internal organs.  The cause of SS is unknown. Immunologic dysfunction and vascular abnormalities may play a role in systemic disease.  In this disorder, collagen is overproduced. Disruption of cell is followed by platelet aggregation and fibrosis. Proliferation of collagen
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