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Pediatric Rheumatic Diseases by JJ Laspoñas
- 1. PEDIATRIC RHEUMATIC DISEASES Presented By: Laspoñas, JonnahJalyn M. BSN – 4
- 2. WHAT ARE PEDIATRIC RHEUMATICDISEASES? Pediatric rheumatic diseases, also called juvenile arthritis, is an umbrella term used to describe the many autoimmune and inflammatory conditions that can develop in children ages 16 and younger. Pediatric rheumatic diseases affect nearly 300,000 children in the United States. That’s more than juvenile diabetes and cystic fibrosis combined.
- 3. Although they sharemany common telltale symptoms, like pain, joint swelling, redness and warmth, they are distinct and each have their own special concerns and symptoms. Some pediatric rheumatic diseases affect the musculoskeletal system, but joint symptoms may be a minor or nonexistent component. Pediatric rheumatic diseases can involve the eyes, skin, muscles and gastrointestinal tract as well.
- 4. THE TYPES OFPEDIATRIC RHEUMATIC DISEASES INCLUDE: 1. Juvenile Idiopathic Arthritis (JIA) - Considered the most common form of arthritis (JIA), includes six subtypes: oligoarthritis, polyarthritis, systemic, enthesitis-related, juvenile psoriatic arthritis or undifferentiated. 2. Juvenile Dermatomyositis - An inflammatory disease, juvenile dermatomyositis causes muscle weakness and a skin rash on the eyelids and knuckles.
- 5. 3. Juvenile Lupus- Lupus is a disease of the immune system. The most common form is systemic lupus erythematosus, or SLE. Lupus can affect the joints, skin, kidneys, blood and other areas of the body. 4. Juvenile Scleroderma - Scleroderma, which literally means “hard skin,” describes a group of conditions that causes the skin to tighten and harden. 5. Kawasaki Disease - This disease causes blood- vessel inflammation that can lead to heart complications.
- 6. 6. Mixed connectivetissue disease - This disease may include features of arthritis, lupus dermatomyositis and scleroderma, and is associated with very high levels of a particular antinuclear antibody (anti-RNP). 7. Fibromyalgia - This chronic pain syndrome is an arthritis-related condition. It can cause stiffness and aching, along with fatigue, disrupted sleep and other symptoms. More common in girls, fibromyalgia is seldom diagnosed before puberty.
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- 13. No known causehas been pinpointed for most forms of pediatric rheumatic diseases, nor is there evidence to suggest that toxins, foods or allergies cause children to develop any of the diseases. Some research points toward a genetic predisposition, which means the combination of genes a child receives from his or her parents may cause the onset of a pediatric rheumatic disease when triggered by other factors. PEDIATRIC RHEUMATIC DISEASE CAUSES:
- 14. SIGNS & SYMPTOMS: Eachof the different pediatric rheumatic diseases have their own set of signs and symptoms. But in general, symptoms may include: • joint pain • swelling in one or more joints • joint stiffness that lasts for at least 1 hour in the early morning • chronic pain or tenderness in the joint(s) • warmth and redness in the joint area • limited movement in the affected joint(s) • erythema • fatigue • persistent fevers
- 15. DIAGNOSIS: The most importantstep in properly treating any of the pediatric rheumatic diseases is getting an accurate diagnosis. The diagnostic process can be long and detailed. There is no single blood test that confirms any of the diseases. In children, the key to diagnosis is a careful physical examination, along with a thorough medical history. Any specific tests a doctor may order will depend upon the type of rheumatic disease suspected.
- 16. ASSESSMENT & DIAGNOSTIC: Antinuclear antibody(ANA) titer: Screening test for rheumatic disorders, elevated in 25%–30% of RA patients. Follow-up tests are needed for the specific rheumatic disorders, e.g., anti-RNP is used for differential diagnosis of systemic rheumatic disease. Rheumatoid factor (RF) / Rose-Waaler test: Positive in more than 80% of cases. CBC: Usually reveals moderate anemia. WBC is elevated when inflammatory processes are present. Radionuclide scans: Identify inflamed synovium.
- 17. X-rays of involvedjoints: Reveals soft-tissue swelling, erosion of joints, and osteoporosis of adjacent bone (early changes) progressing to bone- cyst formation, narrowing of joint space, and subluxation. Concurrent osteoarthritic changes may be noted. Direct arthroscopy: Visualization of area reveals bone irregularities/degeneration of joint. Synovial/fluid aspirate: May reveal volume greater than normal; opaque, cloudy, yellow appearance (inflammatory response, bleeding, degenerative waste products); elevated levels of WBCs and leukocytes; decreased viscosity and complement (C3 and C4). Synovial membrane biopsy: Reveals inflammatory changes and development of pannus (inflamed synovial granulation tissue).
- 18. MEDICAL MANAGEMENT: Rest andexercise. There should be a balance of rest and exercise planned for a patient with RD. Referral to community agencies such as the Arthritis Foundation could help the patient and the family gain more support. Therapy. A formal program with occupational and physical therapy is prescribed to educate the patient and the family about the principles of joint protection, pacing activities, work simplification, range of motion, and muscle-strengthening exercises. Nutrition. Food selection should include the daily requirements from the basic food groups, with emphasis on foods high in vitamins, protein, and iron for tissue building and repair.
- 19. NURSING MANAGEMENT: Nursing Assessment Theassessment of a patient with RA can contribute to its diagnosis. History and Physical Exam The history and physical examination address manifestations such as bilateral and symmetric stiffness, tenderness, swelling, and temperature changes in the joints. Extra-articular changes The patient is also assessed for extra-articular changes and these include weight loss, sensory changes, lymph node enlargement, and fatigue.
- 20. Nursing Diagnosis Bases onthe assessment data, the major nursing diagnoses appropriate for the patient are: Acute and chronic pain related to inflammation and increased disease activity, tissue damage, fatigue, or lowered tolerance level. Fatigue related to increased disease activity, pain, inadequate sleep/rest, deconditioning, inadequate nutrition, and emotional stress/depression Impaired physical mobility related to decreased range of motion, muscle weakness, pain on movement, limited endurance, lack or improper use of ambulatory devices. Self-care deficit related to contractures, fatigue, or loss of motion. Disturbed body image related to physical and psychological changes and dependency imposed by chronic illness. Ineffective coping related to actual or perceived lifestyle or role changes.
- 21. Nursing Care Planning& Goals (6 Rheumatic Diseases Nursing Care Plans) The major goals for a patient with RD are: 1. Improvement in comfort level. 2. Incorporation of pain management techniques into daily life. 3. Incorporation of strategies necessary to modify fatigue as part of the daily activities. 4. Attain and maintain optimal functional mobility. 5. Adapt to physical and psychological changes imposed by the rheumatic disease. 6. Use of effective coping behaviors for dealing with actual or perceived limitations and role changes.
- 22. Teaching Points o Focuspatient teaching on the disease, possible changes related to it, the prescribed therapeutic regimen, side effects of medications, strategies to maintain independence and function, and safety in the home. o Encourage patient and family to verbalize their concerns and ask questions. o Address pain, fatigue, and depression before initiating a teaching program, because they can interfere with patient’s ability to learn. o Instruct patient about basic disease management and necessary adaptations in lifestyle.
- 23. Continuing Care Refer forhome care as warranted (e.g., frail patient with significantly limited function). Assess the home environment and its adequacy for patient safety and management of the disorder. Identify any barriers to compliance, and make appropriate referrals. For patients at risk for impaired skin integrity, monitor skin status and also instruct, provide, or supervise the patient and family in preventive skin care measures.
- 24. Assess patient’s needfor assistance in the home, and supervise home health aides. Make referrals to physical and occupational therapists as problems are identified and limitations increase. Alert patient and family to support services such as Meals on Wheels and local Arthritis Foundation chapters. Assess the patient’s physical and psychological status, adequacy of symptom management, and adherence to the management plan. Emphasize the importance of follow up appointments to the patient and family.
- 25. TREATMENT: Unfortunately, there isno cure for the pediatric rheumatic diseases, although with early diagnosis and aggressive treatment, remission is possible. The goal of treatment is to relieve inflammation, control pain and improve the child’s quality of life, and possibly achieve remission. Most treatment plans involve a combination of medication, physical activity, eye care and healthy eating.
- 26. SELF CARE /FAMILY MANAGEMENT: Self management/Family management for a child with a rheumatic disease involves teaching the child and his family the importance of how to follow the treatment prescribed by doctors and other healthcare providers. Self care also involves helping the child address the emotional and social effects of the disease. Self management encompasses the choices made each day to live well and stay healthy and happy.
- 27. THAT WOULD BEALL… THANK YOU FOR LISTENING KINDLY PREPARE ¼ SHEET OF YELLOW PAPER FOR THE 10-ITEM QUIZ
- 28. QUIZ:1. PEDIATRIC RHEUMATICDISEASES IS ALSO KNOWN AS? 2. – 3. GIVE AT LEAST 2 TYPES OF PEDIATRIC RHEUMATIC DISEASES. 4. – 6. GIVE AT LEAST 3 SYMPTOMS OF PEDIATRIC RHEUMATIC DISEASES. 7. GIVE 1 DIAGNOSTIC PROCEDURE. 8. – 9. GIVE AT LEAST 2 MAJOR GOALS FOR A PEDIATRIC PATIENT WITH RHEUMATIC DISEASES. 10. GIVE 1 TEACHING POINT.
- 30. ANSWER KEY:1. JuvenileArthritis 2. – 3. Juvenile Idiopathic Arthritis (JIA); Juvenile Dermatomyositis; Juvenile Lupus; Juvenile Scleroderma; Kawasaki Disease; Mixed connective tissue disease; Fibromyalgia 4. – 6. Joint pain; Swelling in one or more joints; Joint stiffness that lasts for at least 1 hour in the early morning; Chronic pain or tenderness in the joint(s); Warmth and redness in the joint area; Limited movement in the affected joint(s); Erythema; Fatigue; Persistent fevers 7. Antinuclear antibody (ANA) titer; Rheumatoid factor (RF) / Rose-Waaler test; CBC; Radionuclide scans; X-rays of involved joints; Direct arthroscopy; Synovial/fluid aspirate; Synovial membrane biopsy 8. – 9. Improvement in comfort level; Incorporation of pain management techniques into daily life; Incorporation of strategies necessary to modify fatigue as part of the daily activities; Attain and maintain optimal functional mobility; Adapt to physical and psychological changes imposed by the rheumatic disease; Use of effective coping behaviors for dealing with actual or perceived limitations and role changes 10. Focus patient teaching on the disease, possible changes related to it, the prescribed therapeutic regimen, side effects of medications, strategies to maintain independence and function, and safety in the home; Encourage patient and family to verbalize their concerns and ask questions; Address pain, fatigue, and depression before initiating a teaching program, because they can interfere with patient’s ability to learn; Instruct patient about basic disease management and necessary adaptations in lifestyle.