Chapter 32 Part 6 Flashcards
Is an Inflammatory disease of the joint caused by auto immune response to external trigger
Rheumatoid arthritis
It occurs at any age but most common among older adults the cause is unknown but hormonal, environmental, genetics, or infectious agent can
Trigger an underlying autoimmune
reaction
Rheumatoid arthritis
What happens with rheumatoid arthritis
An abnormal immune response causes in and limitary reaction of the synovial membrane
When An abnormal immune response causes in and limitary reaction of the synovial membrane it causes
Vasodilation,
increase permeability,
formation of Exudate cause red,
swollen joints
Immunoglobulin g appears in the blood and synovial fluid
What appears in the blood with Rheumatoid arthritis
Immunoglobulin g
And synovial fluid
As Rheumatoid arthritis Progresses what forms
Pannus
Is granulation tissue derived from the synovium that spreads over the articular cartilage
Pannus
What do pannus release
What happened to the cartilage
Enzymes and inflammatory mediators that destroy cartilage
It becomes eroded and cuts of nutrition to the cartilage
When pannus is between the bone it causes
The bone to be come fibrotic causing ankylosis
What happened to the joint when you have rheumatoid arthritis
Deformity becomes a parent
Exacerbation causes more damage
Atrophy of muscles around the joints
Tendons and ligaments stretch in the joint becomes unstable
Contracture
Where can the subcutaneous nodules occur
And where do the nodules occur
Over bony prominences
Pleura
Heart ❤️ valve
Eyes
Signs and symptoms of RA
Where are they mostly common signs and symptoms of RA
Joint pain, warmth,
Edema
Limitation of motion, stiffness in multiple joints in the morning lasting more than 1 hour
what are some systemic symptoms
low-grade fever
anorexia= wt loss
malaise
iron deficiency anemia
what do RA or immobility of joints interferes with
self-care activities necessary to lead independent lifestyle
(limitation of ADLs)
how is RA Dx
by history of arthritis pain 3 or more joints that lasts more than 6 weeks
what type of blood test indicates that the pt has RA
positive RF
anti-cyclic peptide/protein
protein antibody test (CCP or CRP)
what does radiographs confirm when you have RA
the cartilage destruction and bone deformities
what is RA pain initially treated with
Nsaid(ibuprofen)
when Dx early what can be started to prevent joint delegation
DMARDs
what is the first line of DMARDs
Methotrexate
other medication for RA
hydroxychloroquine
sulfasalazine
leflunomide
Tumor necrosis factor drugs (TNF inhibitors)
long term of steroid therapy increase the pt for
diabetes mellitus
osteoporosis
hypertension
acne
cataracts and wt gain
what should you test a pt for before starting TNF inhibitor
they need to test for Tuberculosis (TB)
why are opioid not recommended
because Ra is a chronic disease
what should older adult be taught to watch while taking NSAID
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.
what should a pt monitor while taking NSAIDs
gastrointestinal intolerance
liver & kidney
blood
early sign of toxicity
Surgery is used to provide
pain relief and improve mobility for those pt who does not respond god w/ medical therapy
what are the different type of surgery for pt w RA
synovectomy
osteotomy
tendon reconstruction
joint replacement
excision of the synovial membrane of a joint
synovectomy
what is the goal of synovectomy
is interrupt the destructive inflammatory process
why is it good to interrupt the destructive inflammatory process
it can leads tp ankylosis and invasion of surrounding bone and tissue
is performed most commonly on the hand to restore function
tendon reconstruction
what type of surgery should a young pt w/ osteoarthritis
osteotomy
a wedge of bone is removed to allow for realignment
osteotomy
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 ?
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
what type of solution is prescribed for showering no the night before and the morning of surgery to decrease the chance of infection
surgical bacteriostatic
immediately after surgery nursing interventions includes
what the is priority
all measure respiratory and circulatory complications
positioning & repositioning to prevent dislocation and abduction
DVT is a possible complication what should you give to avoid this
blood thinner
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
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
what are some implementation and evaluation of RA
rest and exercise
Application of heat and cold
diet
psychosocial care
resources for pt and family education
