CHAPTER I

INTRODUCTION OF REUMATIC

Changes - changes will occur in the human body in line with the
increasing age. Body changes occur early in life until old age in all organs and
tissues. Such circumstances it seems well on all musculoskeletal system and other
tissues that have anything to do with the possibility of some classes of
rheumatism. One class of rheumatic diseases that often accompany old age which
cause musculoskeletal disorders mainly is osteoarthritis. Incidence of the disease
will increase in line with the increasing age of human.

Rheumatic changes can lead to muscle; to functions can be reduced if the

muscle is in part that suffers not trained in order to activate the muscle function.
With increasing age of the old muscle function can be trained properly. But old
age is not always experienced or suffered from rheumatism. How is this
rheumatism occurrence, until now not fully understood. Rheumatism is not a
disease, but is a syndrome featuring and kind of disease syndrome, rheumatic
manifestation quite a lot, but all show the characteristic equation. According to the
consensus of experts in the field of Rheumatology, rheumatism can be revealed as
a complaint and / or signs. From the agreement, otherwise there are three main
complaints in the musculoskeletal system are: pain, stiffness (stiffness) and
weakness, and there are three main signs: swelling of the joints. Muscle weakness,
and movement disorders. (Soenarto, 1982)
Rheumatism can occur at any age from childhood - childhood to old age, or as a
continuation before old age. And rheumatic disorders will increase with
increasing age. (Felson, 1993, Soenarto and Ward, 1994)
 CHAPTER II
BASIC CONCEPTS

A. Definition.

Rheumatism term derived from Greek, meaning rheumatisms mucus, a

fluid which is considered evil flowing from your brain to the body's joints and
unfortunately structure causing pain or in other words, every condition that
accompanied the pain and stiffness in the musculoskeletal system, including
diseases called rheumatic connective tissue.
Classification:
Rheumatism can be grouped on some classes, namely:
1. Osteoarthritis.
This disease is a disease of joint cartilage damage that develops slowly and is
associated with advanced age. Clinically characterized by pain, deformity,
enlarged joints, and barriers to movement in the joints - the joints of the hands and
joints that bear the burden.
2. Rheumatoid arthritis.
Rheumatoid arthritis is a chronic systemic inflammatory disease with primary
manifestation poliarthritis progressive and involve all organs of the body. Joint
involvement in patients with rheumatoid arthritis after the disease develops further
in accordance with the nature progressivity. Patients may also show symptoms of
general weakness tired quickly.
3. Polimialgia rheumatic.
This disease is a syndrome consisting of pain and stiffness are mainly on the
proximal limb muscles, neck, shoulder and pelvis. Especially about middle age or
old age about 50 years and over.
4. Arthritis Gout (Gout).
Gout arthritis is a clinical syndrome that has a special picture, namely acute
arthritis. Gout arthritis is more widely available in men than in women. In men
often about middle age, whereas in women is usually close to menopause.
OSTEOARTHRITIS
1. Definition
Osteoarthritis is joint inflammation diseases that often appear in the elderly. Rare
under the age of 40 years and more frequently encountered at the age above 60
years.
Etiology: The cause of osteoarthritis to date remain unclear, but several risk
factors for the occurrence of osteoarthritis include:
a. Age.
Of all risk factors for the occurrence of osteoarthritis, aging is the strongest factor.
Orteoartritis prevalence and severity increasing with age. Osteoarthritis almost
never in children, rare in the age under 40 years of age and often over 60 years.
b. Sex.
Women more often osteoarthritis and knee joints, and men more often
osteoarthritis thighs, wrists and neck. In less than 45 years of osteoarthritis is
approximately the same frequency in men and women above 50 years but the
frequency oeteoartritis more in women than in men it shows the hormonal role in
the pathogenesis of osteoarthritis.
c. Genetic
Hereditary factors also play a role in the incidence of osteoarthritis missal, the
mother of a woman with osteoarthritis in the joints of the distal phalanx inter there
are two times more often osteoarthritis in these joints, and the children of women
tend to have three times more often than in women and child’s women than
women without osteoarthritis.
d. Tribe.
Prevalence and patterns of osteoarthritis in the joints seems there is a difference
between their respective tribes, such as osteoarthritis thigh more rare among black
people and the age of the Caucasian. Osteoarthritis is more often found in people -
Native Americans than in whites.
This may be related to differences in lifestyle and the difference in frequency of
congenital abnormalities and growth.
e. Obesity
Excessive body weight significantly associated with increased risk for the
occurrence of osteoarthritis both in women and in men. Obesity was not only
associated with osteoarthritis in joints that bear the burden, but also with other
joint osteoarthritis (hand or sternoklavikula).

B. Pathophysiology.
AGE SEX GENETIC OBESITY RATE

Damage to cartilage focal new bone formation on

Progressive joint cartilage, joints and edge joints

Changes in bone metabolism

Increased activity of enzymes that damage

Macro-molecular matrix of joint cartilage

Decreased levels of proteoglycans

Reduced levels of proteoglycans

Changes in collagen properties

Reduced water content in joint cartilage

Joint cartilage surface rupture with rags split

A rise laceration

C. Clinical manifestation
The main symptoms are the presence of pain in the affected joint, especially when
moving. Generally occur slowly, feeling stiff at first, then emerged that reduced
pain at rest. There are constraints on the movement of joints, morning stiffness,
krepitasi, enlarged joints, and gait changes

D. Management
1. Medication
Until now there has been no specific drug which is specific for osteoarthritis,
because pathogenesis is unclear, given medicine intended to reduce pain, improve
mobility and reduce disability. The drugs work as anti inflamasinon steroid
analgesic and reducing sinovitis, although unable to fix or stop the pathological
process of osteoarthritis.
2. Joint protection
Osteoarthritis may arise or be strengthened because the body's mechanisms that is
less good. Need to avoid excessive activity in the joints that hurt. Use sticks,
electric tools that can simplify the joint work is also worth noting. Excessive load
on the knee because legs are bent (pronatio).
3. Diet
Diet to lose weight osteoarthritis patients who are obese should be a main course
of treatment of osteoarthritis. Losing weight often can reduce the incidence of
complaints and inflammation.
4. Psychosocial Support
psychosocial support needed by patients with osteoarthritis because it is chronic
and the resulting inability. On one hand the patient wants to hide his inability, on
the other hand he wants others to think the disease participated. Osteoarthritis
Patients are often reluctant to use auxiliary tools for psychological factors.
5. Sexual Problems
Sexual harassment can be found in patients with osteoarthritis, especially of the
spine, thigh and knee. Often the discussion because this should start from the
doctor because the patient usually reluctant to say it.
6. Physiotherapy
Physiotherapy plays an important role in the management of osteoarthritis, which
involves the use of heat and cold and exercise program, that right. The use of heat
that is given before exercise remedy to reduce pain and stiffness. In joints that are
still active should be given the cold and the drugs should not be used before
warming rub. Various heat sources can be used as Hidrokolator, electric pads,
ultrasonic, infrared, paraffin bath and shower from the shower warm. Program
exercise aims to improve joint movement and strengthen muscles around joints
usually atrophic in osteoarthritis. Isometric exercise is better than isotonic because
it reduces the stress on the joints. Joint cartilage and bone atrophy resulting in a
paralyzed limb arising due to fewer loads to the joints because of muscle
contraction. Because the muscles periartikular has important role in the protection
of vulnerable same burden, the strengthening of these muscles is important.
g. Operation
Surgery should be considered in patients with osteoarthritis with joint damage is
evident with persistent and weaknesses function. The action taken is osteotomy to
correct wrong or discrepancy, joint debridement to remove cartilage fragments
joints, osteosit cleaning
 CHAPTER III
BASIC NURSING CONCEPTS

A. PATIENT ASSESSMENT OF BASIC DATA

1. Activity and rest
Symptoms: Joint pain due to movement, tenderness, worsened by stress on the
joints: stiffness in the morning.
Fatigue
Signs: Depression
The limited range of motion, muscle atrophy, skin: contracture or abnormal joint
and muscle
2. Cardiovascular
Symptoms: rapid heart, decreased blood pressure
3. Integrity Ego
Symptoms: Factors acute or chronic stress: for example financial, employment,
disability, relationship factors
Hopelessness and helplessness
Threats to the self-concept, body image, personal identity such as dependence on
others
4. Food and liquid
Symptoms: Inability to produce / consume food / fluids adequately: nausea.
Anorexia
Difficulty chewing
Signs: Weight loss
Drought in the mucous membrane
5. Hygiene

Symptoms: the difficulties to carry out personal activities, dependence on others.

6. Neurosensory
Symptoms: numbness / tingling in hands and feet, loss of sensation in fingers
Signs: Swollen joints
7. Pain/ comfort
Symptoms: acute phase of pain
chronic pain and stiffness
8. Security
Symptoms: Difficulty in handling the task / household maintenance
Dryness in the eyes and mucous membranes
9. Social interaction
Symptoms: damage interaction and family / person lsin: changing roles: isolation

B. NURSING DIAGNOSIS

1: Pain b / d decline in function of bone

Criteria result: pain is lost or control
Intervention
independent
- Examine complaints of pain, note the location and intensity (scale 0 - 10). Write
down the factors that accelerate and signs of non-verbal pain
- Give a mattress or hard mattress, small pillow. Elevate the bed linens as needed
- Let the patient take a comfortable position when sleeping or sitting in a chair.
Increase bed rest as indicated
- Encouraged to frequently change positions. Help the patient to move in bed,
prop a sore joints above and below, avoid jerky movements
- Instruct the patient to a warm bath or shower at the time awake. Provide a warm
washcloth to compress the joints is sick several times a day. Monitor the
temperature of the water compresses, bathing water
- Give a gentle massage
collaboration
give the drug before the planned activity or exercise in accordance with directions
such as acetyl salicylate (aspirin)

Rational
-Assist in determining needs and the effectiveness of pain management program
Rational
- Mat soft / soft, big pillow that will prevent the maintenance of proper body
alignment, put ‘’setres’’ in the joints that hurt. Elevation of bed linen reduce stress
on joints that inflammation /pain
- In severe illness, bed rest may be necessary to limit joint pain or injury.
- Preventing the general fatigue and joint stiffness. Stabilize joints, reduce the
movement / pain in joints
- Heat enhance muscle relaxation and mobility, reduce pain and stiffness in the
morning release. Sensitivity to heat can be removed and dermal wound can be
healed
- Increase relaxes reduce muscle tension
- Increase relaxation, reduce
- Muscle tension, making it easier to participate in therapy

2. Activity intolerance b / d of changes in muscle.

Criteria Results: Clients are able to participate in desired activities.
Intervention
• maintenance rest bed rest / sit if necessary.
• Help move with minimal assistance.
• Encourage clients to maintain an upright posture, sitting height, standing and
walking.
• Provide a safe environment and encourage for using tools.
• Provide appropriate medications
indications such as steroids. • To prevent fatigue and maintain power.
Rational
• Improve joint function, muscle strength and general stamina.
• Maximizes joint function and maintain mobility.
• Avoid injuries from accidents like falling.
• To suppress acute inflammation systemic

3. High risk of injury b / d decline in function of bone.

Criteria Results: Clients can maintain physical safety.
Intervention
• Control your environment by: Eliminate the obvious hazards, reduce potential
injury from a fall during sleep for example using a buffer bed, try to position the
lower bed, use night lighting
• Monitor the medication regimen
• Allow a maximum of independence and freedom to provide freedom in a safe
environment, avoid the use of restrain, when patients daydreaming distract rather
than startled

Rational

• Hazard-free environment will reduce the risk of injury and release family of
constant concern.
• This will give the patient feel autonomy, can restrain the patient will increase the
agitation for increasing anxiety

4. Changes in sleep patterns b / d pain

Criteria Results: Clients can meet the needs rest or sleep.
intervention
Independent
• Determine the usual sleeping habits and changes occur
• provide a bed comfortable
• create a new bedtime routine that included in the pattern of old and new
environments
• instruct the relaxation action
• increase the comfort of a bedtime regimen, such as a warm bath and masage
• use a bed rail according to indications: lowering the bed if possible
• Avoid disturbing if possible like to wake to take medicine or therapy
Collaboration
• give sedatives, hypnotics as indicated
• assess the need and identify appropriate interventions
Rational
• increase the comfort of sleep physiology and psychology support
• When the new routines contain as many aspects of old habits, stress and anxiety
that
related to reduced
Help to induce sleep
• Increasing the relaxation effect
• Can feel the fear of falling because of changes in size and height of the bed,
fence the place to give security to help change the position
• Sleep without further interruption creates a feeling of fresh, and the patient may
not be able to go back to sleep if awakened
• May be given to help the patient sleep or rest

5. Self-care deficit b / d pain

Criteria Results: Clients can perform self-care activities by independent.
Intervention
• Assess the level of physical function
• Maintain mobility, control of pain and programming exercises
• Assess barriers to participation
in self-care, identification for environmental modification
• Identify for treatment required, for example, lifts, higher sit of toilet chair
• Identify the level of assistance / support needs
• Support the independence of physical / emotional
• Prepare increased autonomy that would enhance self-esteem
• Provide chance for performing activities independently

REFERENCES
 Doenges E Marilynn, 2000., Rencana Asuhan Keperawatan, EGC, Jakarta
Kalim, Handono, 1996., Ilmu Penyakit Dalam, Balai Penerbit FKUI,
Jakarta.
Mansjoer, Arif, 2000., Kapita Selekta Kedokteran, Media Aesculaapius
FKUI, Jakarta.
Prince, Sylvia Anderson, 1999., Patofisiologi: Konsep Klinis Proses-
Proses Penyakit., Ed. 4, EGC, Jakarta
 THEORITICAL CONCEPT

OF REUMATHIC

Arranged by

Danang Setiono

P.27220008 006

Nursing Mayor

The Health Polytechnics of Surakarta

2010