Episode Details

🧑‍⚕️ Med-Surg Exam Guide: Rheumatic Disorders

1) 🦴 Osteoarthritis (OA)

Patho: Local, non-systemic wear of articular cartilage → osteophytes; brief AM stiffness (<30 min). Meds:

• Acetaminophen → pain (watch max dose).
• NSAIDs/COX-2 → pain/↑GI & CV risk; take w/ food.
• Intra-articular steroids → short-term relief; rest joint x1 wk.
• Topicals (capsaicin/diclofenac) → regular use; avoid heat/sun. Team: HCP (rx ± surgery), RN (education, safety), PT/OT (ROM, devices), RD (weight loss). Key sx: Activity pain ➜ rest relief, crepitus, ↓ROM, Heberden/Bouchard nodes, deformity (varus/valgus). RN priorities: NSAID safety, heat for stiffness/cold if inflamed, joint protection, weight mgmt.

OA Quick Hits: Asymmetric weight-bearing joints; XR: joint-space narrowing; synovial fluid clear.

2) 🔥 Rheumatoid Arthritis (RA)

Patho: Systemic autoimmune synovitis → pannus → erosions; symmetric small joints; AM stiffness >60 min; flares/remission. Meds:

• DMARDs (MTX, SSZ, LEF, HCQ) → slow disease; labs; teratogenic (MTX/LEF); eye exams (HCQ).
• Biologics (TNF-i, etc.) → screen TB/Hep; ↑infection risk.
• Steroids → short bursts; taper; watch BP/glucose/weight.
• NSAIDs/salicylates → symptom relief; GI/renal watch. Team: Rheum leads; RN = med teaching & infection vigilance; PT/OT; psychosocial support. Key sx: Symmetric polyarthritis, prolonged stiffness, fatigue/low-grade fever, nodules; extra-articular: pleurisy, pericarditis, vasculitis. RN priorities: Balance rest/activity (8–10h sleep), splints, monitor ESR/CRP, strict infection precautions.

RA Quick Hits: Early aggressive therapy; energy conservation; monitor for immunosuppression.

3) 💥 Gout

Patho: Hyperuricemia → urate crystals (joints/tissues). Acute meds: Colchicine, NSAIDs (start fast). Chronic meds: Allopurinol/Febuxostat (↓production; febuxostat CV/hepatic alerts), Probenecid (↑excretion; fluids 2–3 L/day). Team: HCP confirms (crystals), starts ULT; RN pain/joint protection; RD diet. Key sx: Podagra (1st MTP) red, hot, exquisitely tender; tophi (chronic); renal stones risk. RN priorities: Bedrest affected joint; cradle for sheets; hydrate; monitor uric acid/renal labs; diet ↓purines; no alcohol (esp. beer/wine).

Gout Quick Hits: Rapid pain control + fluids; lifestyle + adherence prevent flares.

4) 🦋 Systemic Lupus Erythematosus (SLE)

Patho: Multisystem autoimmune (Type III ICs) → skin, joints, kidneys, heart, CNS. Meds: Steroids (organ threats), HCQ (rash/fatigue; eye exams), Immunosuppressants (AZA, CYC, MMF; labs/infection risk), NSAIDs (caution kidneys). Team: Rheum ± nephro/cardio; RN monitors organs & infection; sun safety; psychosocial; nutrition. Key sx/risks: Malar rash & photosensitivity, profound fatigue; lupus nephritis (proteinuria/HTN), serositis, neuropsych sx, infection risk. RN priorities: Daily weights/I&O/BP; strict med adherence; sun block/clothing; plan rest/activity; fever = evaluate for infection.

SLE Quick Hits: Sun protection mandatory; watch kidneys & infections.