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NURS3313 Adult Health > Chapter 34 Assessment & Management of Patients w/ Inflammatory Rheumatic Disorders > Flashcards

Chapter 34 Assessment & Management of Patients w/ Inflammatory Rheumatic Disorders Flashcards

1
Q

Rheumatic Disorders

A

Numerous disorders affecting skeletal muscles, bones, cartilage, ligaments, tendons, and joints

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2
Q

Examples of Inflammatory Rheumatic Disorders

A

Rheumatoid Arthritis

Spondyloarthropathies

Systemic Lupus Erythematosus

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3
Q

Impact of Rheumatic Disorders

A

Limitations in mobility & ADLs

Pain

Fatigue

Altered self-image

Sleep disturbances

Systemic effects that can lead to organ failure & death

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4
Q

Rheumatic diseases most commonly manifest the clinical features of…

A

…arthritis & pain

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5
Q

Arthritis

A

Inflammation of a joint

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6
Q

Which population is more affected by rheumatic disorders? Women or Men?

A

Generally, women are 2-9 X more commonly affected by rheumatic disorders

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7
Q

These disorders tend to be marked by…

A

… periods of remission & exacerbation

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8
Q

Remission

A

A period when the disease symptoms are reduced or absent

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9
Q

Exacerbation

A

A period when symptoms occur or increase

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10
Q

Inflammation

A

A complex physiologic process mediated by the immune system that occurs in response to harmful stimuli

Meant to protect the body from insult by removing the triggering antigen or event

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11
Q

Steps of Inflammatory Process

A

1) Antigen stimulus

2) Body’s immune system activates & forms antibodies like monocytes & T lymphocytes (T-cells)

3) Immunoglobulin antibodies form immune complexes w/antigens

4) Phagocytosis of the immune complexes is initiated
- Produces chemicals (leukotrienes & prostaglandins)

5) Inflammatory response is generated
- Joint effusion
- Edema
- Pain

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12
Q

Leukotrienes

A

Contribute to the inflammatory process by attracting other WBCs to the area

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13
Q

Prostaglandins

A

Act as modifiers to inflammation
- Can either increase or decrease it

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14
Q

Collagenase

A

Breaks down collagen
- Causes edema & proliferation of the synovial membrane

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15
Q

Pannus

A

The proliferation of newly formed synovial tissue infiltrated w/ inflammatory cells

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16
Q

Autoimmunity

A

Body recognizes own tissue as foreign antigen

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17
Q

Degeneration

A

Secondary response to inflammation

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18
Q

Common Symptoms of Rheumatoid Disease

A

Joint pain & swelling

Limited movement

Stiffness

Weakness

Fatigue

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19
Q

Assessment: Obtaining a Health History

A

Onset of symptoms & how they have evolved

Family hx

Past history

Patient’s perception of the problem

Previous treatments & their effects

Patient’s support system

Patient’s current knowledge base & source of info

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20
Q

Gerontological Considerations for Rheumatoid Disorders

A

Musculoskeletal problems are the most frequently reported conditions in older adults
- Will be seen more frequently by health professionals in the coming years along w/ associated disability
- Especially frail older adults

Comorbid conditions have the ability to mask or alter presenting symptoms

These need to be assessed in older adults:
- Frequency
- Pattern of onset
- Clinical features
- Severity
- Effects on function of the rheumatic disease in older adults

Behavioral clues may aid the nurse in assessing the patient’s pain when cognitive impairment is present:
- Gait patterns
- Guarding
- Flexion

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21
Q

Rheumatoid Arthritis (RA)

A

Chronic Inflammatory Disease that can affect people of all ages

Chronic joint inflammation by a disruption in immune system

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22
Q

Rheumatoid Arthritis (RA) Risk Factors

A

Environmental factors (pollution)

Cigarette smoking: Highly related to RA

Family Hx of 1st-degree relatives

Bacterial & viral illnesses

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23
Q

What does rheumatoid arthritis attack?

A

Mostly conjunctive tissue (synovial membrane, tendons, & ligaments)

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24
Q

The effect of RA on the joints

A

Inflammation causes swelling, pain, & burning sensation

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25
Q

Clinical Manifestations of Rheumatoid Arthritis (RA)

A

Symmetric joint pain & morning stiffness (last longer than 1 hr)

Spongy/boggy tissue (fluid may be aspirated)

Symptoms begin in small joints & move to larger joints as disease progress

Symptoms are bilateral & symmetric

Limited func may be present before the presentation of bony changes
- Loss of function due to contractures
Ulnar deviation & swan neck deformity

System Manifestations:
- Fever
- Fatigue
- Weight loss
- Anemia
- Lymph node enlargement
- Raynaud’s phenomenon

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26
Q

Pharmacological Treatment of RA

A

Biologic of Non-Biologic Disease-modifying antirheumatic drug (DMARD)

-Hydroxychloroquine:can cause retinal degeneration -Methotrexate:bone marrow suppression, GI ulcerations, skin rashes

-Infliximab (Remicade): Must have TB test before administration

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27
Q

Gout

A

Most common form of inflammatory arthritis

A type of inflammatory arthritis characterized by deposits of uric acid crystals in the joints

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28
Q

Why does gout mainly affect the big toe?

A

Mainly affects the big toe due to being the most distal part & the coldest part of the body
- Decrease in temperature turns uric acid-> crystals
-> Worsens at night due to this

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29
Q

Tophi

A

Crystalline deposits accumulating in articular tissue, osseous tissue, soft tissue, and cartilage

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30
Q

Primary Hyperuricemia Causes

A

Results from severe dieting or starvation, excessive intake of foods high in purines (shellfish, organ meats) or hereditary

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31
Q

Secondary Hyperuricemia Causes

A

Results from a clinical feature secondary to genetic or acquired processes, including:

  • leukemia

-multiple myeloma

-some types of anemia

-psoriasis

-diuretics (thiazides and furosemide)

-low-dose salicylates, or ethanol

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32
Q

Acute Gouty Arthritis

A

Recurrent attacks of severe articular and periarticular inflammation

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33
Q

What are some triggers for acute gouty arthritis?

A

Triggered by trauma, ETOH ingestion, dieting, meds, surgical stress or illness

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34
Q

Clinical Manifestations of Acute Gouty Arthritis

A

Abrupt onset (often at night)

Severe pain, redness, swelling, and warmth of affected joint

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35
Q

What elements should the nurse assess in a patient with Gout?

A

Lab values (uric acid)
Diet
Gait
Pain
Assess for signs of inflammation, which joints are involved, & extent
Education on disease process, readiness to learn

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36
Q

The 4 Stages of Gout

A

1) Asymptomatic hyperuricemia

2) Acute gouty arthritis
- Triggered by trauma, ETOH ingestion,
dieting, meds, surgical stress or illness
 Abrupt onset often at night
 Severe pain, redness, swelling, and
warmth of affected join

3) Intercritical gout (symptom-free gout)

4) Chronic tophaceous gout

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37
Q

Name 3 priority nursing diagnosis for a patient with gout?

A

Acute Pain
Impaired Mobility
Knowledge deficit

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38
Q

Nursing Interventions for Gout: Medications

A

Colchicine for acute attacks

NSAIDs (indomethacin)

Corticosteroids

Allopurinol - uric acid lowering therapy given post acute attacks

Probenecid - uricosuric agent for patients with frequent attacks

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39
Q

Nursing Interventions for Gout: Patient Education

A

Lifestyle changes

-Avoiding purine-rich foods

-Weight loss

-Decreasing alcohol consumption

-Avoiding certain medications

Pain management and avoidance of factors that increase pain and inflammation, such as trauma, stress, and alcohol

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40
Q

Foods to Avoid in Patients w/ Gout

A

Purine Rich Foods: Anchovies, liver, sardines, lentils, & alcoholic beverages

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41
Q

Osteoarthritis

A

Progressive Mechanical Disease

Degradation of articular cartilage caused by friction causing pain and stiffness (non-inflammatory)

Associated w/ aging & overworked joints

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42
Q

Osteoarthritis Risk Factors

A

65 years or older

Work-related issues

Female

Obesity

Hispanic/African American Descent

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43
Q

What occurs in a joint affected w/ osteoarthritis?

A

Degradation of articular cartilage caused by friction causing pain and stiffness (non-inflammatory)

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44
Q

The effect of osteoarthritis on tendons & ligaments

A

Tendons and ligaments lose their elasticity and wear out, reducing their mobility

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45
Q

Clinical Manifestations of Osteoarthritis

A

Pain and brief morning stiffness, lasting < 30mins

Functional impairment

Joints aggravated by movement or exercise

-Relieved by rest

Affected joints may be enlarged w/ decreased ROM

Crepitus may be palpated, especially over the knee Mild joint effusion, a sign of inflammation

Heberden’s and Bouchard’s nodes
Herberden’s: Distal interphalangeal
Bouchard’s: Proximal interphalangeal

No systemic manifestations

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46
Q

Pharmacological Treatment of Osteoarthritis

A

Acetaminophen: Initial therapy

NSAIDS: Cox-2 enzyme blockers for those at risk for GI complications

Opioids and Corticosteroids:Topical diclofenac sodium gel (Voltarengel)

Glucosamine and chondroitin

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47
Q

Surgical Treatments for both RA & OA

A

Osteotomy or Arthroplasty

Rehab with physical therapy w/in 1st 24hrs

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48
Q

Arthroplasty

A

Surgical removal of an unhealthy joint removal & replacement of joint surfaces w/metal or synthetic materials

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49
Q

Common Conditions that May Require Arthroplasty

A

Osteoarthritis (OA), RA, congenital deformities

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50
Q

Frequently Replaced Joints

A

Hips, knees, & fingers

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51
Q

Total Hip Arthroplasty

A

Replacement of a severely damaged hip w/ an artificial
joint

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52
Q

Total Hip Arthroplasty Indications

A

Osteoarthritis or Rheumatoid arthritis

Femoral neck fractures,

Failure of previous reconstructive surgeries

Conditions resulting from developmental dysplasia
(avascular necrosis of the hip in childhood)

*Prostheses chosen based on skeletal structure and activity level

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53
Q

Complications of Total Hip Arthroplasty

A

Dislocation of hip prothesis

Excessive wound drainage

VTE

Infection

Heel pressure injury

Long-Term Complications:
- Heterotopic ossification
- Avascular necrosis
- Loosening of the prosthesis

54
Q

Heterotopic Ossification

A

Formation of bone in periprosthetic space

55
Q

Signs & Symptoms of Hip Dislocation

A

Increased pain, swelling, and immobilization

Acute groin pain in the affected hip or increased discomfort

Shortening of the affected extremity

Abnormal external or internal rotation of the affected extremity

Restricted ability or inability to move the leg

Reported “popping” sensation in the hip

56
Q

Hip Dislocation Prevention

A

Always maintain correct position
- Supine, head slightly elevated, affected leg in neutral position

Use abductor splints or pillows to support extremity

Support leg and place pillows between the affected legs when patient is turning. Always turn to the unaffected side.

Avoid acute flexion of the hip (head of the bed 90 degrees or less) or crossing legs

Assess for dislocation (notify surgeon immediately if suspected)

57
Q

Which position does the performed hip need to be in?

A

Abduction

58
Q

Abduction

A

Movement away from the center or median line

59
Q

Adduction

A

Movement towards the center or median line
- The affected hip needs to be protected from this

60
Q

Gerontological Considerations for Total Hip Arthroplasty (THA)

A

Early THA surgery is recommended for hip fractures w/in a 24- 36 hrs after patient’s condition has been stabilized properly

If there are no contraindications (bleeding disorder) low-molecular-weight heparin is recommended for VTE prevention
- In the case of contraindications, mechanical devices should be used

Consult w/ pain management specialist would be helpful due to altered LOC, medical co-morbidities, & polypharmacy

ALL older adults who are post-THA they are put on a higher-specification, foam pressure-relieving mattress vs regular mattress

Early assisted mobilization is key

61
Q

Total Knee Arthroplasty

A

A surgical procedure in which parts of the knee joint are replaced with artificial (prosthetic) parts

62
Q

Total Knee Arthroplasty Indications

A

Considered for patients:
- Joint pain cannot be managed w/ nonsurgical treatment
- Has severe pain
- Functional disability related to destruction of joint surfaces

63
Q

Benefits of Total Knee Arthroplasty

A

Successful, cost-effective, low-risk
therapy

Offers significant pain relief

Restores of quality of life and function

64
Q

Nursing Management of Total Knee Arthroplasty

A

Knee is dressed w/ compression bandage

Cold/ice packs may be applied to reduce postop swelling & bleeding

Assess the neurovascular status of the surgical extremity & compare it w/ contralateral extremity every 2-4hrs

Wound suction drain is used to remove fluid accumulating around the knee
- Usually left in place 24-48hrs to prevent infection

Acute rehab usually takes between 1-2 weeks
- Total recovery takes 6 weeks or longer (especially those 65 yrs or older)

65
Q

Osteolysis

A

Lysis of bone from an inflammatory reaction against polyethylene particulate debris

66
Q

Nursing Management of Post-Arthroplasty Care: Managing Blood Loss

A

Assess dressing (saturation, color change) multiple times per protocol
-> Draw around area of bleed
-> DO NOT remove aqua-seal dressing (decreases risk for bleeding & infection-> has antibiotic properties)
-> Anything over 250 mL of blood loss is EXCESSIVE

Monitor H & H (baseline & watch for anemia)

Administer fluids & blood products (donor blood, autologous blood, plasma) as ordered

Assess for signs of bleeding

67
Q

Nursing Management of Post-Arthroplasty Care: Managing Pain

A

Pre & Post-op Pain assessment

OLDCARTS pain assessment

Early ambulation

Administer pain meds as ordered

Compression therapy

Numeric Pain Scale to assess current pain level

PQRST Pain assessment

Imagery

Provide education on expectations of pain ( meds may not completely make pain go away but, make it tolerable)

Assess for cultural influence

68
Q

Nursing Management of Post-Arthroplasty Care: Monitoring Wound Drainage

A

Assess bandage
- Assess drainage characteristics: color, smell, & amount
- Trend documentation of drainage

Assess pulses, cap refill, color, temp, motion, strength, & sensation of extremity

Assess for signs of shock: hypotension, tachycardia, diaphoresis, fever, tachypnea

Acceptable drainage: Lower than 250 mL
- 25 to 30 mL drainage level to remove drain

69
Q

Nursing Management of Post-Arthroplasty Care: Promoting Ambulation

A

Set distance goals

Educate on benefits

Pain management

Assess for fall risk, assistive devices, orthostatic hypotension

Make short term goals

Assess for tolerance, medicate before ambulation

Avoid flexion contractures (do not bend leg for extended periods of time)

70
Q

Nursing Management of Post-Arthroplasty Care: Preventing Venous Thromboembolism (VTE)

A

Assess for unilateral calf pain/ tenderness every 8 hrs

Avoid pressure on popliteal blood vessels from equipment (pillows, abductor splint straps, sequential compression stockings)

Compression devices

Assess pulses, cap refill

Early ambulation

Anticoagulants: Heparin, Lovenox

Routine nuerovascular checks q8 hrs (initially q 15mins)
- Take SCDs off for at least 20 mins 2X every shift

71
Q

Nursing Management of Post-Arthroplasty Care: Preventing Infection

A

Proper wound care
- Aseptic technique

Assess for s/s of infection
- Monitor CBC panel

Employ hand hygiene

Admin antibiotics prophylactically 30 mins- 1hr before surgery

Note date & time of dressing

72
Q

Nursing Management of Post-Arthroplasty Care: Providing Patient Education & Support

A

Positioning

Physical limitations per PT recommendations

How to use assistive devices

Ambulate per provider orders

Pain management

S/s of post-op complications

Avoid flexion contractures

Gradually progress

Teach back for post-op instructions & follow-up care

73
Q

Which disease is associated w/aging or overworked joints (Osteoarthritis/Rheumatoid arthritis)?

A

Osteoarthritis is associated

74
Q

Which disease is chronic and affects all ages (Osteoarthritis/Rheumatoid arthritis)?

A

Rheumatoid arthritis is associated

75
Q

Common Blood Studies: Erythrocyte Count

A

Measures circulating erythrocytes

76
Q

Clinical Significance of Erythrocyte Count

A

Decrease can be seen in RA due to inflammation

77
Q

Common Blood Studies: Erythrocyte Sedimentation Rate (ESR)

A

Measures the rate at which RBCs settle out of unclotted blood in 1 hour

78
Q

Clinical Significance of ESR

A

Increase is usually seen in inflammatory connective tissue diseases.
-RBCs become more thick & heavy-> quickly fall to the bottom

An increase indicates rising inflammation, resulting in clustering of RBCs, which makes them heavier than normal.

The higher the ESR, the greater the inflammatory activity

79
Q

Common Blood Studies: Hematocrit

A

Measures the size, capacity, and number of cells present
in blood

80
Q

Clinical Significance of Hematocrit

A

Decrease can be seen in chronic inflammation
- Anemia in chronic disease
- Blood loss via GI bleed

81
Q

Common Blood Studies: Uric Acid

A

Measures level of uric acid in serum

82
Q

Clinical Significance of Uric Acid

A

An increase in this substance is seen w/ gout

During acute flare, levels may be normal

After flare has subsided, levels will be elevated in gout

83
Q

Common Blood Studies: Antinuclear Antibody (ANA)

A

Measures antibodies that react with a variety of nuclear antigens

84
Q

Clinical Significance of ANA

A

Positive test may be associated with RA, Raynaud’s disease, and necrotizing arteritis.
- The higher the titer, the greater the inflammation

85
Q

Common Blood Studies: Uric Acid

A

Measures level of uric acid in serum

86
Q

Common Blood Studies: C-Reactive Protein (CRP)

A

Shows presence of abnormal glycoprotein due to inflammatory process

87
Q

Clinical Significance of CRP

A

A positive reading indicates active inflammation

88
Q

Common Blood Studies: Rheumatoid Factor (RF)

A

Determines the presence of abnormal antibodies seen in connective tissue disease

89
Q

Clinical Significance of RF

A

Positive titer >1:80
- - Every 1 part of blood, there is 80 rheumatoid factors in the solution
Present in 80% of those with RA

The higher the titer (number at right of colon), the greater the inflammation

90
Q

Nursing Considerations for Salicylates (Aspirin)

A

Administer w/ food, milk, antacids or large glass of water to reduce GI effects.

Assess for tinnitus, gastric intolerance, GI bleeding, and purpura.

Administer enteric coated or extended-release whole, do not crush

91
Q

Examples of Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)

A

Diclofenac

Naproxen

Meloxicam

Ibuprofen

COX-2 enzyme blockers

92
Q

Nursings Considerations for NSAIDs

A

Administer NSAIDs w/ food

Monitor for GI, CNS, cardiovascular, renal, hematologic, and dermatologic adverse effects

Avoid salicylates; use acetaminophen for additional analgesia

Watch for possible confusion in older adults

93
Q

Example of COX-2 Enzyme Blockers

A

Celecoxib

94
Q

Nursing Considerations for COX-2 Enzyme Blockers

A

Monitoring is the same as for other NSAIDs

Indications: Those at risk for GI complications

Increased risk of cardiovascular events, including MI and stroke

Appropriate for older adults & patients who are at high risk for gastric ulcers

95
Q

Examples of Disease-Modifying Antirheumatic Drugs (DMARDs)

A

Hydroxychloroquine & chloroquine

96
Q

Nursing Considerations for DMARDs

A

May be administered concurrently w/ NSAIDs

Assess for visual changes (retinal degeneration), GI upset, skin rash, headaches, photosensitivity, bleaching of hair

Emphasize need for ophthalmologic examinations (every 6-12 mo)

97
Q

Examples of Tumor Necrosis Factor (TNF)-blocking agents

A

Enbrel, Remicade, & Humira

98
Q

Nursing Considerations for TNF-blocking Agents

A

Patient should be tested for tuberculosis before beginning this med
- It can re-activate TB in patients that actively have it

Educate patient about SQ self-injection

Monitor for injection site reactions

Educate patient about increased risk for infection and to wi/hold med if fever occurs

Notify provider if any illness or infection occurs & med is held

99
Q

Examples of Corticosteroids

A

Prednisone, prednisolone, & hydrocortisone

100
Q

Nursing Considerations for Corticosteroids

A

Assess for toxicity: Cataracts, GI irritation, hyperglycemia, hypertension, fractures, avascular necrosis, hirsutism, psychosis

Repeated injections can cause joint damage

Use caution in patients diagnosed with diabetes, due to effects causing elevation in blood sugar

101
Q

What elements should the nurse consider w/self-management programs of RA & OA?

A

Medication adherence
Lab work
Exercise
Nutrition
Educate on adverse effects of meds
Assistive equipment & personnel
Educate on limitations of ADLs, resting in between activities, modifications to ADLs to promote independence
Address body-image distortion secondary to deformities, support

102
Q

Identify effects of the disorder that can impact the patient’s lifestyle, independence, & psychological status

A

Social isolation
Body dysmorphia & decreased self-esteem
Limited ROM & ADLs
Depression & grief over loss of independence
Dependence on assistive devices
Watch for association of debilitating joint pain w/ signs of aging
Pain meds can alter LOC, hearing, & vision
Risk of providers under & over-prescribing meds

103
Q

What is the nurse specifically looking for in a functional assessment in RA & OA?

A

Muscle size & contour
Symmetry
ROM (limitations)
Abnormal Movements
Combination of history & observation
Assess for joint deformities
Posture, gait

104
Q

The goal of nursing care is to decrease pain & stiffness & improve joint mobility. How can this be achieved?

A

Exercise
Knee braces & insoles
Weight management (decrease stress on joints)
Ice & heat therapy
Physical & nutritional therapies
Alternative & integrative therapies
- Yoga
- Acupuncture
- Massage
- TENS units
- Copper bracelets

105
Q

Additional Issues to Consider w/ RA & OA

A

Limited access to resources
Muscle atrophy & contractures
Decreased movement due to movement
Immobility/ decreased movement due to pain
Limitations in job performance-> decreases financial resources
Assess the impact RA/OA may have on co-morbidities
Lack of support
Can affect rest & sleep

106
Q

Systemic Lupus Erythematosus (SLE)

A

Inflammatory autoimmune disorder that affects nearly every organ in the body

107
Q

Clinical Manifestations of Systemic Lupus Erythematosus (SLE)

A

Baldness

CNS symptoms

Butterfly rash

Oral ulcers

Pleuritis Pneumonitis

Anemia

Thrombocytopenia

Neutropenia

Splenomegaly

Lupus glomerulonephritis

Osteoporosis

Fingertip lesions

Myositis

Polyarthritis

Lymphadenopathy

108
Q

Tell-tale Sign of SLE

A

“Butterfly” rash

109
Q

Lab Studies to Order for SLE

A

Antinuclear antibody (ANA)

Anti-DNA

Anti-dsDNA

Anti-Sm

CBC

110
Q

Goal of SLE Treatment

A

Prevent progressive loss of organ func

Reduce acute disease

Minim disease-related disability

Prevent complications from therapy

111
Q

Nursing Interventions for Patients w/ SLE

A

Nursing management of fatigue, impaired skin integrity, body image disturbances, and lack of knowledge for self-management decisions

Encourage patient participation in support groups
Educate patient to avoid sun and UV light exposure or protect themselves w/ sunscreen and appropriate clothing

Routine periodic screenings and health promotion activities

-Smoking cessation programs

-Continuing prescribed medications and addressing changes and potential side effects

-Screen for osteoporosis

Monitor for s/s of infection

112
Q

Examples of Spondyloarthropathies (3)

A

Ankylosing Spondylitis (AS)

Reactive Arthritis (Formerly known as Reiter’s Syndrome)

Psoriatic Arthritis

113
Q

Ankylosing Spondylitis (AS)

A

Chronic inflammatory disease of the spine

114
Q

Ankylosing Spondylitis (AS) Prevalence

A

More prevalent in males than females

115
Q

Joints/Systems affected in Ankylosing Spondylitis (AS)

A

Cartilaginous joints of the spine & surrounding tissues

Large synovial joints, such as the hips, knees, or shoulders

116
Q

Clinical Manifestations of Ankylosing Spondylitis (AS)

A

Rigid joints, decreasing mobility, leading to kyphosis (a stooped position), decreased stability & balance

Back pain is the characteristic feature which may mask symptoms of a cervical fracture, leading to neurologic problems if left untreated

117
Q

Systemic Effects/Complications of Ankylosing Spondylitis

A

Increased risk for CV disease

Pulmonary fibrosis, respiratory compromise w/ disease progression

Osteoporosis

118
Q

Reacting Arthritis

A

The arthritis occurs after an infection

119
Q

Reactive Arthritis Prevalence

A

Mostly affects young adult males

120
Q

Joints/Systems Affected by Reactive Arthritis

A

GI & GU

121
Q

Clinical Manifestations of Reactive Arthritis

A

Primarily characterized by urethritis, arthritis, & conjunctivitis

Dermatitis and ulcerations of the mouth and penis may be present

Low back pain is common

122
Q

Psoriatic Arthritis

A

Inflammatory arthritis associated with the skin disease psoriasis

123
Q

Psoriatic Arthritis Prevalence

A

Most common autoimmune disease in the US

Onset between 30-50 years of age, equally affecting men & women

124
Q

Joints/Systems Affected by Psoriatic Arthritis

A

Spine, Achilles tendon, plantar fascia, or tibial tuberosity areas

125
Q

Clinical Manifestations of Psoriatic Arthritis

A

Synovitis, polyarthritis, and spondylitis

Inflammatory back pain is a common symptom

Differentiated from other back pain by symptoms presenting at a young age, pain improving w/activity, & pain occurring at night

126
Q

Systemic Effects/Complications of Psoriatic Arthritis

A

Infections

127
Q

Nursing Management of Sponkyloarthropathies

A

Symptom management: Focuses on treating pain & maintaining mobility by suppressing inflammation

Good body position for AS patients

Maintenance of optimal functioning
-Maintaining ROM with regular exercise and muscle-strengthening program

Address psychological changes
-Depression
-Emotional stress

128
Q

Pharmacological Management of Sponkyloarthropathies

A

NSAIDS as 1st line of treatment

-Methotrexate, sulfasalazine, and leflunomide

-Help w/ skin and peripheral joint disease but may not prevent spinal changes

Corticosteroid injections for periodic flares

Anti-TNF therapies, such as Enbrel, Remicade, Humira Additional agents include apremilast(Otezla) and ustekinumab (Stelara)

129
Q

Surgical Management of Sponkyloarthropathies

A

Osteotomy of the spine for advanced AS and debilitating kyphosis

Total joint replacement

130
Q

Fibromyalgia

A

Autoimmune condition w/ widespread aching and pain in the muscles and fibrous soft tissue

131
Q

Predisposing Factors of Fibromyalgia-Associated Pain

A

Anxiety

Depression

Physical trauma

Emotional stress

Sleep disorders

Viral infection

132
Q

Nursing Interventions for Fibromyalgia

A

Treatment of symptoms:
-NSAIDs
-Tricyclic antidepressants (amitriptyline and nortriptyline)
-Muscle relaxants (cyclobenzaprine)

Cognitive behavioral therapy to improve sleep and attentional dysfunction

Pay special attention to patient’s concerns and symptoms
-Provide support and encouragement during program of therapy

NURS3313 Adult Health (27 decks)

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