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NURS 322 > Arthritis and Autoimmunity Disorders > Flashcards

Arthritis and Autoimmunity Disorders Flashcards

1
Q

What is rheumatology?

A

study of connective tissue diseases

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2
Q

What is rheumatic disease?

A

any disease involving the musculoskeletal system

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3
Q

What is osteoarthritis?

A

non-inflammatory arthritis; it is not systemic or autoimmune

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4
Q

What is the biggest factor in the development of OA? Differentiate between primary and secondary OA?

A

– biggest factor = aging

– primary OA: result of aging

– secondary OA: result of medications

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5
Q

What are osteophytes? What is synovitis? What is subluxation?

A

– osteophytes: bone spurs that form as cartilidge and the bone beneath it begin to errode; this results in crepitus at the joints

– synovitis: inflammation of the synovial tissue; common in advanced OA

– subluxation: partial joint dislocation

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6
Q

What is a major cause for joint degeneration, especially in the knees?

A

obesity

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7
Q

What are 5 physical assessmenets that may indicate OA?

A
  1. joints – tenderness and crepitus
  2. Heberden’s nodes – swelling at distal fingers
  3. Bouchard’s nodes – swelling at proximal fingers
  4. joint effusions – excessive joint fluid, detectable by ballottment
  5. atrophy of skeletal muscle – use it or lose it!
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8
Q

What are 6 ways to nonsurgically manage chronic pain that accompanies OA?

A
  1. analgesics – Tylenol (NSAIDS), topical lidocaine, topical NSAIDS, weak opioids, muscle relaxants
  2. rest immobilization
  3. positioning
  4. thermal – hot or cold
  5. weight control
  6. CAM
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9
Q

What are 3 ways to surgically manage chronic pain that accompanies OA?

A
  1. TJA (total joint arthroplasty)/TJR (total joint replacement) – creation of a joint or replacement of a knee
  2. arthroscopy – removal of damaged cartilidge
  3. osteotomy – bone resection to correct a joint deformity
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10
Q

What condition do most DVTs result in?

A

pulmonary embolism – important to always assess ABCs!

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11
Q

What are the most life-threatening complications after total hip and knee arthroplasty? (2)

A
  1. venous thromboembolism
  2. pulmonary embolism
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12
Q

What are the preventative measures to take for patients after total hip and knee arthroplasties?

A

– PAC:

  • pharmacology – lovenox or another anticoagulant (not a clot buster)
  • ambulation
  • compression – SCDs, TEDs
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13
Q

What is a TNA?

A

total knee arthroplasty

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14
Q

What types of medications do patients receive after TNAs?

A
  • HTN
  • antibiotics
  • pulmonary meds
  • cardiac meds

– NO blood thinners!

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15
Q

What is rheumatoid arthritis?

A

– systemic, autoimmune disease of musculoskeletal system – the body’s immune system attacks cells at synovial joints

  • causes inflammation of synovial membrane
  • synovial thickening
  • cartilage and bone damage
  • lung damage – more affected than other organs – results in toughened up lung tissue
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16
Q

What is a potential indicator of rheumatoid arthritis?

A

rheumatoid factor – present in about 80% of people with RA

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17
Q

What are 4 distinguishing characteristics of RA when compared with OA?

A
  1. RA joint inflammation is symmetrical; OA joint inflammation is not
  2. RA may have extra-articular manifestations like nodules
  3. RA may result in Baker’s cysts – basically an aneurysm of the synovial joint (usually popliteal)
  4. RA pain is worse in the morning; OA pain is worse at night
18
Q

What are 2 associated syndromes with RA?

A
  1. Sjogren’s syndrome – dry eyes, mouth, and vagina
  2. Caplan’s syndrome – RA nodules in the lungs and pneumoconiosis (restricted lung disease)
19
Q

What are 5 diagnostic assessments for RA?

A
  1. rheumatoid factor – measures presence of unusual antibodies of IgM
  2. anticyclic citrullinated peptide (anti-CCP) – specific test in detecting early RA
  3. antinuclear antibody titer (ANA) – measures titers of unusual antibodies that destroy cells and cause tissue death
  4. erythrocyte sed. rate (ESR) – measures inflammation
  5. C-reactive serum protein – measures inflammation
20
Q

What is the primary medication used to manage RA?

A

– methotrexate

  • slow-acting
  • immunosuppressive
  • takes 4 - 6 weeks to work – pt will be on steroids like prednisone in the meantime
  • worry about liver and neutropenia with this medication
21
Q

What is a glucocorticosteroid?

A

– fast-acting, anti-inflammatory, and immunosuppressive medication

  • can be given in high doses for a short duration or low chronic doses
  • most common is prednisone
22
Q

What is one non-pharmacological intervention that should NOT be used to prevent complications of RA, but can be used to prevent complications of OA?

A

Ambulation

does not alleviate symptoms of RA since it is autoimmune

23
Q

What is plasmapheresis, and how is it used to treat RA?

A

– process by which a cell separator removes plasma from blood

  • cells are returned to the individual, but the plasma (which contains the antibodies which attack the self cells) are discarded and replaced with other fluids
24
Q

What is lupus erythematosus?

A

– chronic, progressive autoimmune disorder

  • results in inflammation and damage to organs
  • results in vasculitis – compromises blood flow and oxygenation
25
Q

What are the 2 forms of lupus erythematosus?

A
  1. cutaneous lupus erythematosus (CLE)/discoid lupus
    • chronic inflammatory skin condition of sores – inflammation and scarring of areas of the head and sometimes other parts of the body
    • 70 - 80% of these pts will develop systemic lupus
  2. systemic lupus erythematosus (SLE)
    • chronic, progressive inflammatory condition of connective tissue
    • results in failure of major body organs and systems
26
Q

Which organ is mainly affected in patients with lupus erythematosus?

A

kidneys (specifically, glomeruli)

SLE pts tend to have some degree of kidney failure

27
Q

What are the 4 major clinical manifestations of SLE?

A
  1. skin
    • dry, scaly butterfly rash on face
    • round skin lesions
    • alopecia
    • mouth ulcers
  2. intermittent fevers
  3. fatigue
  4. kidney changes
    • usually kidneys but could be other organs
      • heart
      • lungs – pleural effusions
    • Raynaud’s phenomenon – numbness/coolness in areas of the body
28
Q

What is osteonecrosis, and how does it relate to lupus erythematosus?

A

– osteonecrosis: bone necrosis due to prolonged steroid use from constriction of blood vessels

  • pts with lupus erythematosus are often on chronic steroid use and may suffer osteonecrosis
29
Q

What are the 3 types of diagnostic tests for lupus erythematosus?

A
  1. skin biopsy – the only significant test to confirm diagnosis for CLE
  2. immunologic-based lab tests – same tests to diagnose RA
  3. body system function tests
    • ESR/CRP – inflammation tests
    • creatinine tests
    • BUN tests
30
Q

What are the 4 types of drugs that patients can take for treatment of lupus erythematosus?

A
  1. corticosteroids (like prednisone) – for acute exacerbations
  2. plaquenil – antimalaria med that decreases inflammatory response
  3. DMARDS (like Cytoxan or methotrexate)
  4. monoclonal antibodies – these aren’t as common
31
Q

What is scleroderma?

A

– AKA systemic sclerosis

– chronic, inflammatory, autoimmune connective tissue disease

  • not always progressive
  • hardening of the skin
  • similar to SLE but higher mortality rate
    • scleroderma doesn’t respond well to meds
    • scleroderma pts don’t live for very long after diagnosis
32
Q

What is the major organ/system affected by scleroderma?

A

GI system – first thing to demonstrate symptoms

33
Q

What are the symptoms of scleroderma? (CREST)

A
  • Calcinosis – calcium deposits in skin
  • Raynaud’s phenomenon – spasms of BVs in response to cold or stress
  • Esophageal dysfunction – acid reflux; decrease in esophageal motility
  • Sclerodactyly – thickening and tightening of skin on fingers and hands
    • in later stages of scleroderma, if it’s progressive, sclerodactyly can advance to the face
  • Telangiectasias – dilation of capillaries = red marks on skin
34
Q

What are 3 major clinical manifestations of scleroderma?

A
  1. arthralgia – joint pain without inflammation or deformities
  2. GI tract problems (especially esophageal) – dysphagia, reflux, malabsorption
  3. pulmonary problems – fibrosis, pulmonary arterial hypertension
35
Q

What is gout?

A

– AKA gouty arthritis

– systemic disease in which urate crystals deposit in the joints and body tissues, causing inflammation

36
Q

What are the 2 forms of gout?

A
  1. primary gout
    • most common
    • uric acid builds up from inability of the kidneys to excrete it
    • genetic – often affects middle aged - older males and post-menopausal women
  2. secondary gout
    • possibly caused by renal insufficiency, diuretics, chemo, crash diets
37
Q

What are the types of drug therapies used to treat gout?

A

– acute gout

  • colchicine
  • NSAIDs 4 - 7 days

– chronic gout

  • allopurinol – reduces production of uric acid
38
Q

What nutritional diet is recommended for patients with gout?

A

– low purine diet

  • avoiding meats – especially organ meats and high protein meats
  • avoiding seafood
39
Q

What is lyme disease?

A

systemic infectious disease caused by Borrelia burgdorferi, transferred to humans by a bite from an infected deer tick

40
Q

What are the most common and sometimes first and only signs of lyme disease?

A

bulls-eye rash and arthritis

41
Q

What is important to note about OA?

A
  • everyone will develop
  • caused by wear and tear to the joints
  • caused by age, weight, overuse

NURS 322 (19 decks)

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