IMMUNE SYSTEM

DISORDERS
 GOUT
 GENETIC DEFECT OF PURINE
METABOLISM:
• OVER SECRETION OF URIC ACID or
• RENAL DEFECT = DECREASED
EXCRETION OF URIC ACID or
• BOTH

 ELEVATED URIC ACID

 GOUT
 CAUSES:
• SEVERE DIETING/STARVATION
• EXCESSIVE INTAKE OF FOODS HIGH IN
PURINES
• HEALTH CONDITIONS WHICH CAUSE AN
INCREASE IN CELL TURNOVER
(LEUKEMIA, MULTIPLE MYELOMA, SOME
ANEMIAS, etc.)
• SIDE EFFECT OF CERTAIN MEDS
 Precipitating Factors
 Trauma
 Alcohol ingestion
 Surgical stress
 Illness
 HYPERURICEMIA (ELEVATED
URIC ACID)
 Greater than 7 mg/dl
 Symptoms related to sudden
increase of uric acid levels
 Urate crystals precipitate within a
joint – inflammatory response occurs
 Tophi – accumulations of urate
crystals
 Tophi
 1 IN 5 will develop
tophi
 Deposited in
peripheral areas:
• Great toe
• Hands
• ear
 ASSESSMENT
 ACUTE PAIN
 TOPHI
 RENAL IMPAIRMENT
 RISK OF URINARY CALCULI
 ELEVATED SERUM URIC ACID
>8mg/dl
 Untreated: will lead to destruction of
the synovium, bursa, bone and
tendons.
 Tophi have also been found in walls
of aorta, heart valves, eyelids,
cornea and sclerae
 TREATMENT
 Adequate Hydration
 Medication:
• Chochicine – antiinflammatory
• NSAID - analgesic
 Diet:
• Restrict foods high or moderately high in
purines (anchovies, scallops, organ
meats, oysters)
• Grodner, page 844
 RHEUMATOID ARTHRITIS
 Allergic

 Cytotoxic

 Immune complex disorders

Inflammatory Rheumatic
Disorders
Rheumatoid Arthritis
(RA)
 Causes of RA
 Autoimmunity

 Genetic factors
 Inflammation = synovitis +
pannus
 Stages:
• Early
• Moderate
• Severe
• Terminal
 CLINICAL SYMPTOMS
 Early vs. advanced disease
• Early: fatigue, anorexia, weight loss,
generalized stiffness
• Moderate: joint stiffness, limitation in
ROM, signs of inflammation
• Severe: joint deformity (cartilage and
bone destruction)
Swan Neck Deformity
 hyperextension of the
proximal
interphalangeal joint,
while the distal
interphalangeal joint is
flexed
 Diagnosis of RA
 History and physical assessment
 Positive RF
 Elevated Sed rate
 Elevated C-reactive protein
 Synovial fluid analysis
 DRUG THERAPY
 NSAIDS
 CORTICOSTEROIDS
 DMARD’s
 NURSING CARE OF THE
CLIENT WITH RA
 NURSING DIAGNOSES:
• PAIN
• MOBILITY
• BODY IMAGE
• KNOWLEDGE DEFICIENT
• SELF CARE DEFICIT
 INTERVENTIONS
 NUTRITION
 MANAGE PAIN
 PREVENT/CORRECT JOINT
DEFORMITY:
• MEDS
• JOINT PROTECTION
• HEAT AND COLD APPLICATION
• EXERCISE
 INTERVENTIONS
 REST AND PACED ACTIVITY
 RESTORE FUNCTION and make
 LIFESTYLE ADJUSTMENTS:
• PT
• OT
• Social Work