Introduction to Medical-Surgical Nursing, 6th ed.
43
Lesson Plans for
Connective Tissue Disorders
CHAPTER LESSON PLANS & OBJECTIVES
Lesson 43.1:
2. Describe the function of connective tissue.
4. Describe the nurse’s responsibilities for diagnostic tests and procedures used for assessing a patient
with connective tissue diseases.
7. Describe the characteristics and prevalence of connective tissue diseases.
Lesson 43.2:
5. Discuss the drugs used to treat connective tissue diseases.
6. Describe the pathologic basis for osteoarthritis (degenerative joint disease), rheumatoid arthritis,
8. Assist in developing a nursing care plan for a patient whose life has been affected by a connective
tissue disease.
CHAPTER TEACHING FOCUS
• In this chapter, the student is presented with information about connective tissue disorders, including
the characteristics and prevalence of these conditions.
• Students are provided with information about the function of connective tissue and the diagnostic tests
and procedures used to assess for connective tissue disease.
• The pathophysiology of major connective tissue disorders and their diagnosis and treatment are also
reviewed.
• The assessment of connective tissue disorders and the development of a nursing care plan for these
conditions will also be described.
CONCEPTS
The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2013).
Concepts for nursing practice. St. Louis: Elsevier. The specific exemplars chosen and listed below for
each concept have been tailored specifically to correspond to the Linton textbook.
THEME: Protection and Movement
• Concept: Inflammation
• Exemplar: Osteoarthritis, p. 949
• Cultural Considerations: What Does Culture Have to Do with Osteoarthritis? p. 950
• Figure 41-1: The structure of a diarthrodial joint, p. 950
• Figure 41-2: Osteoarthritis (degenerative joint disease), p. 950
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Introduction to Medical-Surgical Nursing, 6th ed.
THEME: Attributes and Resources
• Concept: Functional Ability
• Exemplar: Rheumatoid Arthritis, p. 956
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Introduction to Medical-Surgical Nursing, 6th ed.
CHAPTER PRETEST
Have the students answer these questions prior to covering this chapter to understand where they stand
in relation to the content.
1) A hard tissue that makes up most of the skeletal system is __________.
a) bone
b) cartilage
c) ligaments
d) muscles
2) Which of the following is composed of very strong, dense, fibrous connective tissue?
a) Skin
b) Cartilage
c) Tendons
d) Ligaments
3) The loss of bone mass begins approximately at what age?
a) 20 years
b) 30 years
c) 40 years
d) 50 years
4) Which of the following blood values is positive in systemic lupus erythematosus (SLE)?
a) Creatinine
b) Blood Urea Nitrogen
Erythrocyte sedimentation rate
c) Antinuclear antibodies
5) Which of the following blood levels is elevated in gout?
a) Red blood cell count
b) C-reactive protein
c) Creatinine
d) Uric acid
6) Heberden nodes are seen in which of the following disorders?
a) Degenerative joint disease
b) Gout
c) Periarteritis nodosa
d) Behçet’s syndrome
7) Following a hip replacement, which is the most appropriate intervention?
a) Position on the affected side
b) Bend from the waist
c) Do not flex hip more than 90 degrees
d) Cross the legs when turning
8) Following a hip replacement, the patient is at risk for __________.
a) deep vein thrombosis
b) bursitis
c) migraine headaches
d) bowel obstruction
9) The most common symptom of rheumatoid arthritis is __________.
a) pneumonia
b) fever
c) pain
d) anxiety
10) Which of the following foods is high in purine?
a) Strawberries
b) Kidney
c) Broccoli
d) Celery
4 Chapter 43Connective Tissue Disorders _______________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
Chapter Pretest Answers
CHAPTER BACKGROUND ASSESSMENT
Discuss these questions with your students prior to covering this chapter to understand where they stand
in relation to the content.
Question: A 38-year-old woman is diagnosed with rheumatoid arthritis (RA). What information should the
nurse include about the disorder during patient teaching?
Answer: The nurse should explain that RA is a chronic, progressive, inflammatory disease and that it is
Question: A patient is diagnosed with gout. How should the nurse instruct him on his diet?
Answer: The nurse should first confirm the diet that has been prescribed by the health care provider. The
_______________________________________________________ Chapter 43Connective Tissue Disorders 5
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 43.1
Instructor Preparation
Textbook Objectives Covered
2. Describe the function of connective tissue.
4. Describe the diagnostic tests and procedures used for assessing connective tissue diseases.
7. Describe the characteristics and prevalence of connective tissue diseases.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying connective tissue disorders, including:
• The characteristics and prevalence of these diseases
• The diagnostic tests and procedures used for assessing connective tissue diseases
• The pathophysiology, signs and symptoms, and complications of these disorders, as well as
diagnostic measures and medical treatment used for patients
• The steps taken in developing a nursing care plan for a patient with a connective tissue
disorder
• Assemble materials and supplies needed for each lesson as indicated below.
Materials and Supplies
• computer and PowerPoint
projector
• thick elbow and knee pads
Key Terms
• vasculitis (p. 957)
• ankylosis (p. 957)
• intraarticular (p. 951)
Student Preparation
Assignments 2 hours
1
READ – Textbook (pp. 939-940)
ANSWER – Study Guide
• Part IA: 2 (p. 277)
• Part IG: A-H (p. 280)
2
READ – Textbook (p. 940)
ANSWER – Text
ANSWER – Study Guide
• Part IIH: 1, 2, 13 (pp. 281-282)
6 Chapter 43Connective Tissue Disorders _______________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 43.1
3
READ – Textbook (pp. 940-941)
REVIEW
• Box 43-1: Nursing Assessment of the Patient with a Connective Tissue Disorder (p. 942)
ANSWER – Study Guide
• Part IA: 1, 8 (p. 277)
• Part IIH: 3 (p. 281)
4
READ – Textbook (pp. 941-945)
REVIEW
• Table 43-1: Diagnostic Tests and Procedures: Connective Tissue Disorders (pp. 943-945)
• Part IC: 1-7 (p. 278)
7
READ – Textbook (p. 939)
50-Minute Lesson Plan
Lecture Outline 20 minutes
Slide 1
Chapter 43
Connective Tissue Disorders
7
Introduction
• More than 50 million people in the US have a condition that affects the joints
Introduction (cont.)
• Most arthritic conditions are chronic, characterized by exacerbations and remissions, with
progressive deterioration
1
&
2
Slide 4
Anatomy and Physiology of Connective Tissues
• Bind structures together, providing support for individual organs and a framework for the
body
• Store fat, transport substances, provide protection, and play a role in repair of damaged
tissue
_______________________________________________________ Chapter 43Connective Tissue Disorders 7
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 43.1
Slide 5
Anatomy and Physiology of Connective Tissues (cont.)
• Types of connective tissue
• Loose (areolar, adipose, reticular)
• Dense (tendons, fascia, dermis, gastrointestinal tract submucosa, fibrous joint
capsules)
• Elastic (aortic walls, vocal cords, parts of trachea and bronchi, some ligaments)
• Hematopoietic (blood)
• Strong supportive (cartilage, bone, ligaments)
Slide 6
Anatomy and Physiology of Connective Tissues (cont.)
• Bone
• Hard tissue: makes up most of skeletal system
• Functions: support, protection, movement, storage of calcium and other ions, and
manufacture of blood cells
Anatomy and Physiology of Connective Tissues (cont.)
• Cartilage
• Specialized fibrous connective tissue
Slide 8
Anatomy and Physiology of Connective Tissues (cont.)
• Ligaments
• Strong and flexible fibrous bands of connective tissue that connect bones and
cartilage and support muscles
• Yellow ligaments, located in the vertebral column, are elastic and allow for stretching
• White ligaments, found in the knee, do not stretch but provide stability
2
Slide 9
Anatomy and Physiology of Connective Tissues (cont.)
• Tendons
• Composed of very strong and dense fibrous connective tissue
• They are in the shape of heavy cords and anchor muscles firmly to bones
Slide 10
Joint Structure and Function
• Connective tissue disorders: manifested as joint disorders since joint mobility depends on
functional connective tissue
• Joint: site where two or more bones are joined; permit motion and flexibility of the rigid
skeleton
• Classification
• Synarthroses (fixed joints)
• Amphiarthroses (slightly movable joints)
• Diarthroses (freely movable joints)
• Encased in a fibrous capsule made of strong cartilage and lined with synovial membrane
TALKING POINTS:
• What bone in the body does not articulate with at least one other bone?
8 Chapter 43Connective Tissue Disorders _______________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 43.1
Slide 11
Age-Related Changes
• Loss of bone mass and bone strength
• Osteoporosis common in women but affects men
• Put the older patient at risk for fractures
• Cartilage gradually loses elasticity; becomes soft and frayed
TALKING POINTS:
• What is caused by the progressive loss of bone density?
3
Slide 12
Chief Complaint and History of Present Illness
• Complaints that suggest possible problems related to connective tissue disorders are
aches, pain, joint swelling or stiffness, generalized weakness, a change in ability to work
or to enjoy leisure activities, a change in appearance that is significant to the patient, and
a change in ability to carry out activities of daily living
Slide 13
Medical History
• Major childhood and adult illnesses, operations, and current medications and allergies
• History of tuberculosis, poliomyelitis, diabetes mellitus, gout, arthritis, rickets, infection of
bones or joints, autoimmune diseases, and neuromuscular disabilities
• Accidents and injuries
• Current medications
TALKING POINTS:
• Accidents and injuries, even in the distant past, may be significant because they could be
related to the patient’s current problem.
Slide 14
Family History
• Osteoporosis, osteoarthritis, rheumatoid arthritis, gout, or scoliosis may have some
genetic basis
• Autoimmune diseases; e.g., thyroid disorders
• Review of systems
_______________________________________________________ Chapter 43Connective Tissue Disorders 9
LESSON 43.1
Slide 15
Physical Examination
• Vital signs, height, and weight
• Skin color, rashes, lesions, scars, or any signs of injuries
• Palpate skin for warmth, edema, and moisture
• Palpate lymph nodes for enlargement and tenderness
• Inspect joints for swelling and deformity, and palpate for warmth, swelling, and tenderness
• Joint pain and range of motion
• Measure limb length and muscle strength
TALKING POINTS:
• What is crepitus?
• A goniometer measures the range of movement of the joints.
4
Slide 16
Diagnostic Tests and Procedures
• Blood studies
• Complete blood cell count, erythrocyte sedimentation rate (ESR), and C-reactive protein
determination
TALKING POINTS:
• What tests may be done on fluid aspirated from the joints?
• Most laboratory tests are not diagnostic for a single condition—that is, many factors could
cause measures of inflammation to increase.
Slide 17
Diagnostic Tests and Procedures (cont.)
• Radiologic imaging
• Radiography, arthrography, nuclear scintigraphy, MRI, discography, tomography, CT
• Biopsy, arthroscopy
TALKING POINTS:
• What is the appropriate nursing care for a patient who has undergone an arthroscopy?
Common Therapeutic Measures
• Requires the services of a team
Slide 19
• What effect does the patient’s attitude have on the outcome of the disease?
Common Therapeutic Measures (cont.)
• Physical and occupational therapy
• Helps preserve functional capability and minimize disability
• Braces and splints support inflamed joints, protect from further injury, relieve discomfort
• Helps to make adaptations in work, personal life to allow maximal function
• Education and support
Introduction to Medical-Surgical Nursing, 6th ed.
Slide 20
Question 1
• Which of the following is not part of the elastic connective tissue?
A. Aortic walls
B. Bronchi
C. Tendons
D. Vocal cords
TALKING POINTS:
Slide 21
Question 2
• Which of the following is not an age-related change in connective tissue?
A. Cartilage increases in elasticity
B. Loss of bone mass
C. Loss of bone strength
D. Cartilage may ulcerate
TALKING POINTS:
Activities
Classroom Choose from below to make 30 minutes
Online
1
ASSESS BASELINE
• Have the class complete the Pretest. Collect
their work and use the results to guide how
you teach the class.
DISCUSS
• Discuss the types of connective tissue and
their structures and composition.
PRACTICE
• Divide the class into four groups. Assign
ASSESS BASELINE
• Post the Pretest and the Background
Assessment online and have your class
complete them. Use the results to guide how
you teach the class.
_______________________________________________________ Chapter 43Connective Tissue Disorders 11
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 43.1
2
DISCUSS
• Discuss the roles of the various types of
connective tissue in binding structures
together, supporting individual organs, and
providing a framework for the body as a
whole.
• Discuss the age-related alterations in the
ability of connective tissues to support the
body, and their impact on level of
functioning.
PRACTICE
• Have students don thick work gloves and
thick elbow and knee pads. Ask students to
perform tasks such as picking up a coin from
• Divide the class into three groups. Assign
each group one of the following connective
tissue types:
• Loose
• Dense
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 43.1
3
DISCUSS
• Discuss the key elements of an assessment
for a patient with diagnosed or suspected
connective tissue disease.
• Discuss the importance of conducting a
functional assessment of the patient with
connective tissue disease in order to
describe the extent of the patient’s disease.
PRACTICE
• Have pairs of students take turns role–
playing a nurse-patient interaction in which
the nurse is collecting data from a patient
presenting with severe hip and knee joint
pain. Each student should be sure to collect
the following data:
• Chief complaint and history of present
illness
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Ask students
to prepare and post a video of a nurse
interacting with a patient who has a
connective tissue disorder. The conversation
should center around the patient’s functional
ability and the patient’s frustration with being
unable to perform simple tasks. Ask
students to provide constructive comments
on each other’s videos.
4
DISCUSS
• Discuss the importance of proper
preparation of the patient for diagnostic
testing to ensure accurate results.
PRACTICE
• As a class, discuss the diagnostic tests and
procedures for connective tissue disorders
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Discuss three
diagnostic tests and the care of the patient
7
DISCUSS
• Discuss your perception of how a connective
disorder would affect everyday function.
What activities would you NOT be able to do
if you had a connective tissue disorder? Ask
students to provide constructive comments
on each other’s posts.
_______________________________________________________ Chapter 43Connective Tissue Disorders 13
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 43.1
Critical Thinking Question
A 58-year-old patient has been diagnosed with osteoarthritis and osteoporosis and has
limited joint mobility. What should the nurse teach the patient about her diseases?
Discussion Guidelines: The nurse should explain to the patient that osteoarthritis is the most
common form of arthritis. Osteoarthritis is classified as a noninflammatory condition; however,
Instructor Notes/Student Feedback
14 Chapter 43Connective Tissue Disorders _______________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 43.2
Instructor Preparation
Textbook Objectives Covered
6. Describe the pathologic basis for osteoarthritis (degenerative joint disease), rheumatoid
8. Assist in developing a nursing care plan for a patient whose life has been affected by a
connective tissue disease.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying connective tissue disorders, including:
• The characteristics and prevalence of these diseases
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• arthroplasty (p. 951)
• rheumatoid nodule (p. 957)
• ankylosis (p. 957)
• intraarticular (p. 951)
• vasculitis (p. 957)
Assignments 2 hours
5
READ – Textbook (pp. 942, 945-949)
REVIEW
• Table 43-2: Drugs Used to Treat Connective Tissue Disorders (pp. 946-949)
ANSWER – Text
• Review Questions for the NCLEX Examination: 5 (p. 970)
ANSWER – Study Guide
• Part ID: 1-15 (pp. 278-279)
_______________________________________________________ Chapter 43Connective Tissue Disorders 15
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 43.2
6
READ – Textbook (pp. 949-969)
REVIEW
• Figure 43-1: Diarthrodial joint (p. 950)
• Figure 43-2: Osteoarthritis (p. 950)
• Figure 43-7: Tophi on an index finger (p. 963)
• Box 43-3: Purine Content of Selected Foods (p. 964)
• Figure 43-8: Late-stage skin changes in progressive systemic sclerosis (p. 966)
• Table 43-3: Other Connective Tissue Disorders (pp. 968-969)
ANSWER – Text
• Review Questions for the NCLEX Examination: 3, 4, 5 (p. 970)
ANSWER – Study Guide
• Part IA: 3-7, 9, 10 (p. 277)
8
READ – Textbook (p. 952)
REVIEW
• Nursing Care Plan 43-1: Patient with a Total Hip Replacement (p. 952)
ANSWER – Text
• Review Questions for the NCLEX Examination: 6, 7, 9, 10 (p. 970)
ANSWER – Study Guide
• Part IIH: 8-11, 14–16 (p. 281)