Chapter 32 Part 6

Question 1

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

Answer 1

Rheumatoid arthritis

Question 2

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

Answer 2

Trigger an underlying autoimmune
reaction

Rheumatoid arthritis

Question 3

What happens with rheumatoid arthritis

Answer 3

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

Question 4

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

Answer 4

Vasodilation,

increase permeability,

formation of Exudate cause red,

swollen joints

Immunoglobulin g appears in the blood and synovial fluid

Question 5

What appears in the blood with Rheumatoid arthritis

Answer 5

Immunoglobulin g

And synovial fluid

Question 6

As Rheumatoid arthritis Progresses what forms

Answer 6

Pannus

Question 7

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

Answer 7

Pannus

Question 8

What do pannus release

What happened to the cartilage

Answer 8

Enzymes and inflammatory mediators that destroy cartilage

It becomes eroded and cuts of nutrition to the cartilage

Question 9

When pannus is between the bone it causes

Answer 9

The bone to be come fibrotic causing ankylosis

Question 10

What happened to the joint when you have rheumatoid arthritis

Answer 10

Deformity becomes a parent

Exacerbation causes more damage

Atrophy of muscles around the joints

Tendons and ligaments stretch in the joint becomes unstable

Contracture

Question 11

Where can the subcutaneous nodules occur

And where do the nodules occur

Answer 11

Over bony prominences

Pleura
Heart ❤️ valve
Eyes

Question 12

Signs and symptoms of RA

Where are they mostly common signs and symptoms of RA

Answer 12

Joint pain, warmth,

Edema

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

Question 13

what are some systemic symptoms

Answer 13

low-grade fever

anorexia= wt loss

malaise

iron deficiency anemia

Question 14

what do RA or immobility of joints interferes with

Answer 14

self-care activities necessary to lead independent lifestyle

(limitation of ADLs)

Question 15

how is RA Dx

Answer 15

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

Question 16

what type of blood test indicates that the pt has RA

Answer 16

positive RF

anti-cyclic peptide/protein

protein antibody test (CCP or CRP)

Question 17

what does radiographs confirm when you have RA

Answer 17

the cartilage destruction and bone deformities

Question 18

what is RA pain initially treated with

Answer 18

Nsaid(ibuprofen)

Question 19

when Dx early what can be started to prevent joint delegation

Answer 19

DMARDs

Question 20

what is the first line of DMARDs

Answer 20

Methotrexate

Question 21

other medication for RA

Answer 21

hydroxychloroquine

sulfasalazine

leflunomide

Tumor necrosis factor drugs (TNF inhibitors)

Question 22

long term of steroid therapy increase the pt for

Answer 22

diabetes mellitus

osteoporosis

hypertension

acne

cataracts and wt gain

Question 23

what should you test a pt for before starting TNF inhibitor

Answer 23

they need to test for Tuberculosis (TB)

Question 24

why are opioid not recommended

Answer 24

because Ra is a chronic disease

Question 25

what should older adult be taught to watch while taking NSAID

Answer 25

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.

Question 26

what should a pt monitor while taking NSAIDs

Answer 26

gastrointestinal intolerance liver & kidney blood early sign of toxicity

Question 27

Surgery is used to provide

Answer 27

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

Question 28

what are the different type of surgery for pt w RA

Answer 28

synovectomy osteotomy tendon reconstruction joint replacement

Question 29

excision of the synovial membrane of a joint

Answer 29

synovectomy

Question 30

what is the goal of synovectomy

Answer 30

is interrupt the destructive inflammatory process

Question 31

why is it good to interrupt the destructive inflammatory process

Answer 31

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

Question 32

is performed most commonly on the hand to restore function

Answer 32

tendon reconstruction

Question 33

what type of surgery should a young pt w/ osteoarthritis

Answer 33

osteotomy

Question 34

a wedge of bone is removed to allow for realignment

Answer 34

osteotomy

Question 35

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 ?

Answer 35

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

Question 36

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

Answer 36

surgical bacteriostatic

Question 37

immediately after surgery nursing interventions includes what the is priority

Answer 37

all measure respiratory and circulatory complications positioning & repositioning to prevent dislocation and abduction

Question 38

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

Answer 38

blood thinner

Question 39

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

Answer 39

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

Question 40

what are some implementation and evaluation of RA

Answer 40

rest and exercise Application of heat and cold diet psychosocial care resources for pt and family education