5.1 Chronic Degenerative Disease Disorders

Question 1

Rheumatoid Arthritis

Answer 1

• Systemic condition
• Autoimmune disease of unknown origin
• Affects joints/muscles/soft tissue
• Females 2.5x more likely to get it
• Onset common between 30-60
• Can be monoarticular or polyarticular (can affect one or multiple joints)

Question 2

Osteoarthritis

Answer 2

• Most common joint disorder

Question 3

Osteoperosis

Answer 3

• Most prevalent bone disease

Question 4

Rheumatoid Arthritis Risk Factors

Answer 4

• Pollution
• Smoking
• Family history
• Bacterial/viral illnesses can be a trigger

Question 5

Distinctions of Rheumatoid Arthritis

Answer 5

• Inflammation
• Autoimmunity (Chief distinction. Body recognizes its own tissue as foreign and attacks it)
• Degeneration (Secondary process of inflammation)

Question 6

Rheumatoid Arthritis Pannus

Answer 6

• Inflammation leads to damage which leads to pannus
• Abnormal layer of tissue or granulation tissue.
• Destroys cartilage and erodes bone
• Related to degeneration in rheumatoid arthritis
• Commonly found on joints or surface of joints

Question 7

Clinical Manifestations of Rheumatoid Arthritis

Answer 7

• Symmetric joint pain
• Swelling of joints
• Pain in joints
• Warmth to the touch
• Stiffness
• Systemic issues like fever, fatigue, weakness.
• Onset is acute, bilateral, symmetric
• Morning stiffness that lasts longer than an hour
• Symptoms vary depending on the stage of RA

Question 8

Rheumatoid Arthritis and Cardiac

Answer 8

• Implicated in diseases like atherosclerosis because it interferes with HDL production (High Density Lipoprotein) which leads to arterial wall stiffness
• Related to cardiac issues

Question 9

Rheumatoid Arthritis and Nervous System

Answer 9

• Synovial joint inflammation and swelling can compress adjacent nerves. This can cause paresthesia (pins and needles) or numbness/decrease in sensation

Question 10

Assessment of Rheumatoid Arthritis

Answer 10

• Onset/evaluation of symptoms
• Is there family history
• Health and physical exam focuses on manifestations
• Stiffness of joints, temperature, swelling, tenderness of joints, articular changes
• Systemic can be weight loss or sensory changes, lymph node enlargement, fatigue, anorexia, loss of appetite.
• Assess articular changes in the joints
• Spongy/boggy tissue when palpating joints

Question 11

Criteria for Rheumatoid Arthritis

Answer 11

• Number of joints affected
• Based on urology results
• Inflammatory markers
• Lasted greater than 6 weeks

Question 12

Diagnostic Tests for Rheumatoid Arthritis

Answer 12

• x-rays or ultrasounds at the hand and feet are useful for establishing a baseline for joint evaluation
• MRI can detect small erosions
• Arthrocentesis to remove fluid from affected joint and look for infection
• If the fluid is cloudy we can look at WBC or culture of the fluid joint

Question 13

Nursing Priorities for Rheumatoid Arthritis

Answer 13

• Acute/chronic pain (comfort/anti-inflammatory analgesics)
• Fatigue (energy conservation techniques, development of activity rest schedule)
• Impaired physical mobility (Assessing and encouraging independence)

Question 14

Nursing Priorities for RA

Answer 14

• Self-care deficits (provide assistive devices, assessing use of devices, consulting with community agencies)
• Disturbed body image (identify elements of control over the disease, encourage verbalization of their feelings)
• Ineffective coping (Identify areas of life affected by the disease, develop plan to manage symptoms, family support)

Question 15

Nursing Priorities for RA

Answer 15

• Complications secondary to medication
  Preform periodic clinical assessments, lab evaluations.
  Educate correct way to take medication and side effects
  Importance of monitoring
  Counsel methods to reduce side effects
  Administer medication in modified doses if prescriber complications occur

Question 16

Systemic Effects of RA

Answer 16

• Fever, fatigue, anemia, lymph node enlargement
• Cardiac system, atherosclerosis, neuropathies from compression of joints from synovial joint swelling
• Sclerites (Inflammation of sclera eye)
• Pericarditis (Swelling of the heart)
• Pleural effusion
• Spleen enlargement
• Renal issues
• Skin/mucosal issues

Question 17

Osteoarthritis

Answer 17

• Not an autoimmune disorder
• Non-inflammatory degenerative type disorder
• Wear and tear
• Not related to normal aging
• By age 40 90% have some degenerative disorder or breakdown of bone
  Primary - Idiopathic with no prior injury or disease
  Secondary - Results from previous injury

Question 18

Osteoarthritis

Answer 18

• Breakdown of cartilage between bones that can lead to progressive damage of underlying bone. This causes formation of osteophytes or bone spurs (bone lumps)

Question 19

Risk factors of Osteoarthritis

Answer 19

• Female at risk
• Labor intensive jobs
• Sports and previous injuries
• Most prominent risk factor is obesity

Question 20

Signs/Symptoms of Osteoarthritis

Answer 20

• Joint pain/stiffness
• Functional impairment
• Blood tests can be done to rule out rheumatoid arthritis
• X-rays that show bone-spurs confirm OA
• History of physical, S&S, X-ray are used to confirm OA

Question 21

Treatment of Osteoarthritis

Answer 21

• OTC meds
• Braces of affected joints (typically weight bearing joints like hips and knees)
• Massage, yoga, acupuncture, joint replacement

Question 22

Osteoperosis

Answer 22

• Most prevalent bone disease in the world

- Alteration of rate of bone formation and reabsorption with the rate.