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6200 Adult /Older Adult II > Arthritis and connective Tissue Disease > Flashcards

Arthritis and connective Tissue Disease Flashcards

1
Q

Affects of Osteoarthritis on cartilage?

A
  • cartilage becomes:
    • Dull, yellow, and granular
    • Soft and less elastic
    • Less able to resist wear with heavy use
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2
Q

Risk factors for Osteoarthritis?

A

females, obese, frequent bending or stooping, older patients, genetic predisposition

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3
Q

Early joint changes of osteoarthritis?

A

articular cartilage degeneration

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4
Q

Later joint changes of osteoarthritis?

A

bone thickening

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5
Q

Osteoarthritis Clinical Manifestations in the joints?

A

Pain, stiffness and deformity

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6
Q

Osteoarthritis Clinical Manifestations- joint pain?

A
  • mild pain to disabling
  • worse with joint use
  • Early stages:
    • rest relieves pain
  • Later stages:
    • pain with rest
    • sleep disturbed
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7
Q

Osteoarthritis Clinical Manifestations- joint stiffness?

A
  • Occurs with rest

- Early morning

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8
Q

Osteoarthritis Clinical Manifestations- joint deformity?

A

not loss of function, swelling and crepitation

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9
Q

Osteoarthritis Nursing Management - Assessment?

A
  • Joint pain, stiffness
  • Affect on daily life
  • Prior treatment
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10
Q

Osteoarthritis Nursing Management - joint examination?

A
  • assess the good side first for baseline

- tenderness, swelling, decreased ROM,

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11
Q

Nonpharmacologic pain management - Osteoarthritis

A
  • Rest/Exercise
  • Heat/Cold
  • CAM-acupuncture, yoga, massage,
  • Nutrition supplements-glucosamine, chondroitin
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12
Q

What effect does glucosamine, chondroitin have when used to tx osteoarthritis?

A

increases collagen and decreases pain

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13
Q

Osteoarthritis Drug therapy for mild to moderate joint pain?

A
  • Acetaminophen (1000 mg every 6 hours)
  • Topical agent (e.g., capsaicin cream [Zostrix])
  • Topical salicylates (e.g., Aspercreme)
  • Hyaluronic acid (HA)
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14
Q

Osteoarthritis Drug therapy for moderate to severe joint pain?

A

Nonsteroidal anti-inflammatory drug (NSAID)

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15
Q

Rheumatoid Arthritis Pathophysiology?

A
  • Chronic, systemic autoimmune disease
  • Symmetrical
  • Inflammation in synovial joints
  • Periods of remission and exacerbation
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16
Q

Nonspecific manifestations of RA?

A
  • precede onset of arthritic complaints.

- Fatigue, anorexia, weight loss, generalized stiffness

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17
Q

Rheumatoid Arthritis (RA) Clinical Manifestations: Pain and Stiffness?

A
  • Joint pain
    • ↑ with motion
    • Varies in intensity
    • May not be proportional to degree of inflammation
  • Stiffness after periods of inactivity
    • Morning stiffness 60 mins to several hrs
18
Q

Two most common Rheumatoid Arthritis (RA) Extraarticular Manifestations?

A

Rheumatoid nodules and Sjogren’s syndrome

19
Q

What are Rheumatoid nodules?

A
  • firm, non-tender mass on surface

- not removed because they recur or may burst and cause infection

20
Q

Characteristics of Sjogrens’ Syndrome?

A
  • decrease in lacrimal and salivary gland secretions

- dry mouth, burning/itching eyes, and photosensitivity

21
Q

Complications of RA?

A
  • Flexion contractures and hand deformities
  • Cause diminished grasp strength
  • Affect patient’s ability to perform self-care tasks
22
Q

Comparison of RA and Osteoarthritis - Age at onset?

A

RA: young to middle age
Osteoarthritis: usually > 40

23
Q

Comparison of RA and Osteoarthritis - Gender?

A 
RA:
- female > male, > 60 no difference
OA:
- < 50, men > female, 
- > 50, female > male
24
Q

Comparison of RA and Osteoarthritis - Weight?

A

RA: lost or maintained wt
OA: often overweight

25
Q

Comparison of RA and Osteoarthritis - affected joinits?

A

RA: small joints affected first, usually bilateral, symmetrical joint involvment
OA: weight bearing joints, often asymmetrical

26
Q

Comparison of RA and Osteoarthritis - Disease?

A

RA: systemic disease w/ exacerbations and remissions
OA: localized disease w/ variable, progressive course

27
Q

Comparison of RA and Osteoarthritis - pain characteristics?

A

RA: stiffness lasts 1hr to a day and may decrease with use
OA: stiffness occurs on arsing but usually subsides after 30 mins. pain gradually worsens with joint use and disease progression, relieved by rest

28
Q

RA Acute Intervention-Primary Management Goals?

A
  • Decrease inflammation/Manage pain

- Maintain joint function/prevent deformity

29
Q

Acute interventions to maintain joint function/prevent deformity?

A
  • Medications
  • Nonpharmacologic pain relief measures
  • Heat/cold therapy
  • Rest/exercise
  • Splints
  • Morning stiffness
  • Joint protection
  • Psychologic support
30
Q

Rheumatoid Arthritis Drug Therapy for mild to moderate disease - DMARDs?

A
  • Methotrexate (Rheumatrex)-CBC and chem panel monitoring
  • Sulfasalazine (Azulfidine)
  • Hydroxychloroquine (Plaquenil)
  • Leflunomide (Arava)
31
Q

Rheumatoid Arthritis Drug Therapy for mild to moderate disease - Biologics?

A
  • Tumor necrosis factor inhibitors
    • Etanercept (Enbrel)
    • Infliximab (Remicade)
    • Monitor for infection, avoid live vaccinations
  • Rituximab (Rituxan)-monoclonocal antibody-targets B cells
32
Q

Rheumatoid Arthritis Drug Therapy - Corticosteroid therapy?

A
  • Often used until DMARDs effective
    • Intraarticular injections-relieve pain/inflammation
    • Long-term use should not be a mainstay, there is a risk of osteoporosis, avascular necrosis
33
Q

What is Gout?

A
  • a form of arthritis caused by the accumulation of uric acid in the joints
  • usually in the big toe
34
Q

Characteristics

A
  • Joint Inflammation
    • Swollen, red, painful
    • Motion limited
    • Deformity-tophi
35
Q

Gout Interprofessional Care?

A
  • Rest
  • Drug therapy
    • NSAIDs
    • Antiinflammatory-colchicine
    • Recurrent gout-allopurinol, probenecid
  • Nutritional therapy
    • Eliminate purine (if needed)
    • Low-purine Diet
    • Mayo clinic gout diet
36
Q

What is Systemic Lupus Erythematosus?

A
  • Chronic, multisystem, inflammatory autoimmune disease
  • Etiology unknown
  • Variability within and among persons
37
Q

Which disease is called “the rich mans’ disease” and why?

A
  • Gout

- comes from a diet high in protein and alcohol

38
Q

Systemic Lupus Erythematosus Drug Therapy?

A
  • NSAIDs
  • Hydroxychloroquine (Plaquenil)
  • Corticosteroids (for acute flares)
  • Immunosuppressive drugs
39
Q

What is important for a nurse to assess in Systemic Lupus Erythematosus?

A

pain and fatigue daily

40
Q

Which disease is known as the “disease of 1000 faces”?

A

Systemic Lupus Erythematosus

41
Q

S/S of Systemic Lupus Erythematosus?

A

joint pain/swelling, rash (butterfly rash on face), sun sensitivity, finger changes color in the cold, hair loss, mouth sores, dyspnea, chest pain, blood clots miscarriages

42
Q

Risk factors for Systemic Lupus Erythematosus?

A

women, 20-30 yrs of age

6200 Adult /Older Adult II (17 decks)

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