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Chapter: Medical Surgical Nursing: Assessment and Management of Patients With Rheumatic Disorders

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Arthritis Associated With Infectious Organisms

Arthritis, tenosynovitis, and bursitis can be associated with infectious organisms.

Arthritis Associated With Infectious Organisms

Arthritis, tenosynovitis, and bursitis can be associated with infec-tious organisms. Some inflammation of joints, tendons, and bur-sae is directly related to infection caused by bacterial, viral, fungal, or parasitic agents. Bacterial arthritis is the most rapidly destruc-tive form of infectious arthritis. There are two major classes of bacterial arthritis: arthritis caused by Neisseria gonorrhoeae and nongonococcal bacterium. The most prevalent of the nongono-coccal organisms include Staphylococcus aureus and the various streptococcal variants. Less common pathogens are related to syphilis, tuberculosis, leprosy, fungi (particularly coccidioidomy-cosis), mycoplasmas, and viral agents, such as rubella, parvovirus, and hepatitis B.

Clinical Manifestations

The characteristic symptom is acute onset of a warm, swollen joint. Culture of the bacterium from the synovial fluid confirms the diagnosis. The patient often immobilizes the joint and ele-vates the affected extremity because of pain and swelling. Fever may be high or it may be absent. Signs of systemic infection may be lacking in elderly patients, those with diabetes, and those with suppressed immune systems. Diagnosis and treatment may be delayed by patients with pre-existing arthritic conditions if they attribute the symptoms to a flare-up of arthritis.

Management

This condition is a medical emergency necessitating early diag-nosis and appropriate treatment to eliminate the causative or-ganism; otherwise, the joint may be destroyed relatively quickly. Treatment consists of parenteral antibiotics and drainage of the joint. The results of cultures are used to determine the appropri-ate antibiotic therapy. Immobilization of the joint and repeated joint aspirations may be necessary along with intravenous anti-biotics. Nursing management focuses on providing pain relief, administering antibiotics, and assisting the patient with self-care activities. If the patient is sent home on intravenous antibiotics, the nurse arranges home care and instructs the patient and care providers in safe administration and changes to report to a health care provider.

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