ANKYLOSING SPONDYLITIS (MEDICAL SURGICAL NURSING)

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EXPLORING ANKYLOSING SPONDYLITIS: A THOROUGH INSIGHT

INTRODUCTION

Ankylosing spondylitis, a persistent inflammatory disorder predominantly affecting the spine and sacroiliac joints, takes its name from the Greek roots "ankylos" (indicating joint stiffness) and "spondylo" (referring to vertebra). This condition unfolds as a gradual progression of chronic inflammation, culminating in the bony ankylosis of spinal joints and, occasionally, major limb joints.

DEFINITION

Ankylosing spondylitis (AS) is a chronic systemic inflammatory disorder impacting the axial skeleton, demonstrating varying degrees of involvement in peripheral joints and non-articular structures.

RISK FACTORS AND CAUSES

GENDER

Prevalent among males.

AGE

Typically manifests between 15 to 35 years.

GENETIC PREDISPOSITION

HLA (Human leukocyte antigen) – B27 emerges as a significant genetic factor.

UNKNOWN FACTORS

PATHOPHYSIOLOGY

Involvement of HLA-B27 leads to:

  • Inflammation of vertebral joints
  • Formation of syndesmophytes
  • Fusion of inflammatory vertebral discs

Resulting in the distinctive ankylosing spondylitis presentation.

CLINICAL FEATURES

Manifestations encompass:

  • Severe low back pain
  • Neck stiffness
  • Joint inflammation
  • General symptoms: fever, fatigue, joint pain, uveitis, chest pain, and sternal tenderness.

DIAGNOSTIC EVALUATION

A comprehensive assessment includes:

  • History collection
  • Physical examination
  • Imaging tests (radiographic features, CT/MRI)
  • ESR rate measurement
  • X-rays
  • Schober’s test.

MANAGEMENT

  • Anti-inflammatory drugs - NSAIDs (e.g., aspirin, ibuprofen)
  • COX-2 inhibitors
  • DMARDs - Cyclosporin, methotrexate
  • TNF alpha blockers - Infliximab

SURGICAL MANAGEMENT

  • Osteotomy
  • Arthroplasty

NURSING MANAGEMENT

Critical aspects involve:

  • Evaluating the nature of the disease
  • Establishing baseline range of motion (ROM), including chest expansion
  • Alleviating pain and inflammation
  • Encouraging mobility
  • Mitigating fatigue
  • Providing psychological support.

NURSING DIAGNOSIS

  1. Pain related to joint inflammation and stiffness.
  2. Ineffective breathing pattern due to reduced chest expansion from vertebral spine involvement.
  3. Impaired physical mobility attributed to hip joint inflammation and pain.
  4. Fatigue linked to pain and fever.

CONCLUSION

This comprehensive overview delves into ankylosing spondylitis, encompassing its definition, causes, risk factors, clinical features, diagnostic evaluation, management, nursing considerations, and diagnoses. A valuable resource for medical-surgical nursing practitioners grappling with this challenging condition.

Best of luck, and thank you for your attention. Feel free to ask any questions in the comments section.

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