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musculoskeletal part 2 chapter 32 > Chapter 32 Part 6 > Flashcards

Chapter 32 Part 6 Flashcards

1
Q

Is an Inflammatory disease of the joint caused by auto immune response to external trigger

A

Rheumatoid arthritis

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2
Q

It occurs at any age but most common among older adults the cause is unknown but hormonal, environmental, genetics, or infectious agent can

A

Trigger an underlying autoimmune
reaction

Rheumatoid arthritis

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3
Q

What happens with rheumatoid arthritis

A

An abnormal immune response causes in and limitary reaction of the synovial membrane

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4
Q

When An abnormal immune response causes in and limitary reaction of the synovial membrane it causes

A

Vasodilation,

increase permeability,

formation of Exudate cause red,

swollen joints

Immunoglobulin g appears in the blood and synovial fluid

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5
Q

What appears in the blood with Rheumatoid arthritis

A

Immunoglobulin g

And synovial fluid

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6
Q

As Rheumatoid arthritis Progresses what forms

A

Pannus

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7
Q

Is granulation tissue derived from the synovium that spreads over the articular cartilage

A

Pannus

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8
Q

What do pannus release

What happened to the cartilage

A

Enzymes and inflammatory mediators that destroy cartilage

It becomes eroded and cuts of nutrition to the cartilage

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9
Q

When pannus is between the bone it causes

A

The bone to be come fibrotic causing ankylosis

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10
Q

What happened to the joint when you have rheumatoid arthritis

A

Deformity becomes a parent

Exacerbation causes more damage

Atrophy of muscles around the joints

Tendons and ligaments stretch in the joint becomes unstable

Contracture

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11
Q

Where can the subcutaneous nodules occur

And where do the nodules occur

A

Over bony prominences

Pleura
Heart ❤️ valve
Eyes

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12
Q

Signs and symptoms of RA

Where are they mostly common signs and symptoms of RA

A

Joint pain, warmth,

Edema

Limitation of motion, stiffness in multiple joints in the morning lasting more than 1 hour

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13
Q

what are some systemic symptoms

A

low-grade fever

anorexia= wt loss

malaise

iron deficiency anemia

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14
Q

what do RA or immobility of joints interferes with

A

self-care activities necessary to lead independent lifestyle

(limitation of ADLs)

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15
Q

how is RA Dx

A

by history of arthritis pain 3 or more joints that lasts more than 6 weeks

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16
Q

what type of blood test indicates that the pt has RA

A

positive RF

anti-cyclic peptide/protein

protein antibody test (CCP or CRP)

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17
Q

what does radiographs confirm when you have RA

A

the cartilage destruction and bone deformities

18
Q

what is RA pain initially treated with

A

Nsaid(ibuprofen)

19
Q

when Dx early what can be started to prevent joint delegation

A

DMARDs

20
Q

what is the first line of DMARDs

A

Methotrexate

21
Q

other medication for RA

A

hydroxychloroquine

sulfasalazine

leflunomide

Tumor necrosis factor drugs (TNF inhibitors)

22
Q

long term of steroid therapy increase the pt for

A

diabetes mellitus

osteoporosis

hypertension

acne

cataracts and wt gain

23
Q

what should you test a pt for before starting TNF inhibitor

A

they need to test for Tuberculosis (TB)

24
Q

why are opioid not recommended

A

because Ra is a chronic disease

25
Q

what should older adult be taught to watch while taking NSAID

A

Dizziness

falls,

can occur with analgesics for arthritis pain, particularly if the medication contains codeine.

Advise patients to arise slowly, hold on to furniture until steady, and wait until dizziness passes before trying to walk.
Assistive devices for ambulation can also prevent falls.

26
Q

what should a pt monitor while taking NSAIDs

A

gastrointestinal intolerance

liver & kidney
blood

early sign of toxicity

27
Q

Surgery is used to provide

A

pain relief and improve mobility for those pt who does not respond god w/ medical therapy

28
Q

what are the different type of surgery for pt w RA

A

synovectomy

osteotomy

tendon reconstruction

joint replacement

29
Q

excision of the synovial membrane of a joint

A

synovectomy

30
Q

what is the goal of synovectomy

A

is interrupt the destructive inflammatory process

31
Q

why is it good to interrupt the destructive inflammatory process

A

it can leads tp ankylosis and invasion of surrounding bone and tissue

32
Q

is performed most commonly on the hand to restore function

A

tendon reconstruction

33
Q

what type of surgery should a young pt w/ osteoarthritis

A

osteotomy

34
Q

a wedge of bone is removed to allow for realignment

A

osteotomy

35
Q

what should you teach your pt after a hip replacement?

how many months should the pt not cross their leg?

what should the pt put between their leg while rolling over?

a pt should not bend their leg beyond?

a pt should avoid sitting in ?

A

it is OK to lie on the operated

for 3 months they should not cross their leg

put a pillow between your leg when rolling over

it ok to bend your knee but not beyond 90 degree

avoid sitting in low chairs

36
Q

what type of solution is prescribed for showering no the night before and the morning of surgery to decrease the chance of infection

A

surgical bacteriostatic

37
Q

immediately after surgery nursing interventions includes

what the is priority

A

all measure respiratory and circulatory complications

positioning & repositioning to prevent dislocation and abduction

38
Q

DVT is a possible complication what should you give to avoid this

A

blood thinner

39
Q

what are the expected outcome for RA

how would the pt pain be controlled

how should the pt mobility improve

what should the pt demonstrate w/in 1 month

A

w/ medication, heat and exercise for 2wks

w/ the use of assistive devices and PT w/in 3wks

less disturbance of body image by participating in more social activities

40
Q

what are some implementation and evaluation of RA

A

rest and exercise

Application of heat and cold

diet

psychosocial care

resources for pt and family education

musculoskeletal part 2 chapter 32 (10 decks)

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