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MS II > Chapter 87: Lupus Erythematosus, Gout, and Fibromyalgia > Flashcards

Chapter 87: Lupus Erythematosus, Gout, and Fibromyalgia Flashcards

1
Q

________ is an autoimmune disorder in which an atypical immune response results in chronic inflammation and destruction of healthy tissue.

A

lupus erythematosus (lupus)

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2
Q

Autoimmune disorders

A 
rheumatoid arthritis
vasculitis
multiple sclerosis
scleroderma (including Raynaud's phenomenon)
psoriasis
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3
Q

In autoimmune disorders, small antigens can bond with _______. The body then produces antibodies that attack the healthy tissue.

A

healthy tissue

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4
Q

These responses can be triggered by toxins, medications, bacteria, and _____.

A

viruses.

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5
Q

______ of manifestations and a decrease in the number and frequency of exacerbations is the goal of treatment, because there is no cure for autoimmune disorders.

A

Control

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6
Q

Gout, also known as gouty arthritis, is a systemic disorder caused by _________.

A

hyperuricemia increase in serum uric acid)

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7
Q

Urate levels can be affected by medications, ____, and overproduction in the body. This can cause _____ deposits to form in the joints, and a gout attack can occur.

A

diet

uric crystal

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8
Q

_____ is a chronic pain syndrome that involves stiffness, sleep disturbance, generalized muscle weakness and chronic fatigue.

A

Fibromyalgia

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9
Q

It is estimated that _______ of people who have fibromyalgia have another form of a rheumatologic disorder, such as RA or SLE.

A

25% to 65%

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10
Q

The occurrence of autoimmune disorders increases with _____.

A

age

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11
Q

Lupus varies in severity and _______.

A

progression

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12
Q

Lupus is generally characterized by periods of exacerbations (flares) and _____.

A

remissions

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13
Q

______ is classified as discoid or systemic. A temporary form of lupus can be medication-induced.

A

Lupus

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14
Q

______ only affects the skin.

A

Discoid lupus erythematosus (DLE)

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15
Q

______ affects the connective tissues of multiple organ systems and can lead to major organ failure.

A

Systemic lupus erythematosus (SLE)

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16
Q

________ can be caused by medications (procanimide, hydralazine, isoniazid). Findings resolve when the medication is discontinued.

A

Medication-induced lupus erythematosus

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17
Q

Lupus can be difficult to diagnose because of the _______ of early manifestations.

A

vague nature

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18
Q

One lupus risk factor is women between the age of ________.

A

women between the ages of 20 to 40

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19
Q

One lupus risk factor is descent from African American, ____, or Native American.

A

Asian

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20
Q

The incidence of lupus ______ in women following menopause but remains steady in men.

A

declines

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21
Q

Diagnosis of lupus can be delayed in older adult clients because they mimic other disorders or can be associated with reports common to the _____.

A

normal aging process

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22
Q

With older adults a lupus diagnsosis can be delayed. Joint pain and swelling can significantly limit ADLs in older adult clients who have _____.

A

comorbidities.

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23
Q

With older adults a lupus diagnsosis can be delayed. Older adult clients are at an increased risk for fractures if ______ therapy is used.

A

corticosteroid

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24
Q

An expected finding of lupus is fatigue/_____.

A

malaise

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25
Q

Expected findings of lupus include alopecia, blurred vision, and ____.

A

depression

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26
Q

_____ pain is an expected finding of lupus.

A

pleuritic

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27
Q

Anorexia/______ are expected findings of lupus.

A

weight loss

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28
Q

Joint pain, swelling, and ______ are expected findings with lupus.

A

tenderness

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29
Q

______(also a major indication of exacerbation) with lupus.

A

fever

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30
Q

Anemia and _________pathy are expected physical findings.

A

lymphaden-

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31
Q

_____ (presence of a cardiac friction rub or pleural friction rub) is an common physical finding of lupus.

A

pericarditis

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32
Q

_________ (arteriolar vasospasm in response to cold/stress)

A

raynaud’s phenomenon

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33
Q

Findings consistent lupus include organ involvement (kidney, heart, lungs, and _______)

A

vasculature

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34
Q

Erythematous ______ rash over the nose and cheeks (raised, dry, and scaly) is an expected finding

A

butterfly

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35
Q

A ______ is used to diagnose DLE by confirming the presence of lupus cells and cellular inflammation.

A

skin biopsy

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36
Q

Immunologic tests are used to diagnose _____.

A

SLE

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37
Q

Antinuclear antibodies (ANAs): antibodies produced against one’s own DNA; positive titers in _____ of clients who have lupus.

A

95%

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38
Q

Immunologic Tests

A 
SLE prep
SS-A
Anti-DNP
ssDNA
dsDNA (very specific for SLE; assists with differentiation between SLE and medication induced lupus)
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39
Q

With lupus there will be an elevated ______ rate due to systemic inflammation.

A

ESR

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40
Q

Serum complement C3 and C4 will be _______ as a result of lupus. C3 and C4 are diagnostic for SLE because they decrease due to depletion secondary to an exaggerated inflammatory response.

A

decreased

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41
Q

With lupus BUN and creatinine will be ______ with kidney involvement.

A

increased

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42
Q

With lupus a urinalysis will show up positive for ______ and RBCs (kidney involvement).

A

protein

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43
Q

Pancytopenia will be evident through a ____ with lupus.

A

CBC

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44
Q

With lupus you need to assess/monitor pain, ______, and fatigue.

A

mobility

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45
Q

with lupus you need to monitor the vital signs put the _____ especially.

A

blood pressure

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46
Q

With lupus systemic manifestations such as hypertension, _____ and urine output will demonstrate renal compromise.

A

edema

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47
Q

With lupus diminished ______ can demonstrate pleural effusion.

A

breath sounds

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48
Q

With lupus _______ and sharp inspiration chest pain can indicate pericarditis.

A

tachycardia

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49
Q

With lupus you need to monitor/assess rubor, pallor, and ______ of hands/feet with vascultis/vasospasm and raynaud’s phenomenon.

A

cyanosis

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50
Q

With lupus you need to assess and monitor arthralgias (joint pain), myalgias (muscle pain), and _______ when there is joint and connective tissue involvement.

A

polyarthritis (affects more than 4 joints)

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51
Q

With lupus changes in mental status that indicate neurologic involvement such as psychoses, paresis, and _____.

A

seizures

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52
Q

With lupus _____ and creatinine will be affected by renal involvement.

A

BUN

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53
Q

With lupus you also need to monitor and assess the patient’s _____ status.

A

nutritional

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54
Q

With a lupus patient provide ____, _____ meals if anorexia is a concern. Offer between meal supplements.

A

small, frequent

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55
Q

With lupus encourage the client to limit ____ intake for fluid retention secondary to steroid therapy.

A

salt

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56
Q

With lupus provide emotional support to the client and ____.

A

family

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57
Q

______ are used to reduce inflammation and arthritic pain with lupus.

A

NSAIDs

58
Q

Do not give NSAIDs to lupus patients who have impaired ____ function.

A

kidney

59
Q

For lupus patients monitor for NSAID induced ______..

A

hepatitis

60
Q

______ such as predinsone is used for immunosuppression and to reduce inflammation in lupus patients.

A

corticosteroid

61
Q

In lupus patients taking corticosteroids monitor for ______, hypertension, and impaired kidney function.

A

fluid retention

62
Q

In lupus patients taking corticosteroids do not stop taking them _______. Gradually taper the dosage as prescribed.

A

abruptly

63
Q

Immunosuppressant agents such as methotrexate and _____ are used to suppress the immune response in lupus patients.

A

azathioprine

64
Q

With Methotrexate or azathioprine (both immunospressants) monitor for toxic effects such as (___________ suppression or increased liver enzymes)

A

bone marrow suppression

65
Q

In lupus patients who need suppression of synovitis, fever, or fatigue _______ (hyroxycholorquine) are used.

A

antimalarials

66
Q

When a lupus patient is taking antimalarials such as hyroxycholoquine encourage frequent _____.

A

eye exams

67
Q

For lupus patients physical and occupational therapy can be used for strengthening exercises and ______ as needed.

A

adaptive devices

68
Q

Refer lupus patients to ______ as needed.

A

support groups

69
Q

Lupus patient’s should avoid ____ and prolonged sun exposure. Use sunscreen when outside and exposed to sunlgiht.

A

UV

70
Q

Lupus patient’s should use _____ protein shampoo and avoid harsh hair treatments.

A

mild

71
Q

Lupus patients should use _______ for skin rash.

A

steroid creams

72
Q

Lupus patients should report peripheral and _______ promptly.

A

periorbital edema

73
Q

Lupus patients should report evidence of _____ related to immunosuppression.

A

infection

74
Q

Educate lupus clients of childbearing age regarding risks of _________ and treatment meds.

A

pregnacy

75
Q

Complications of lupus include lupus nephritis, pericarditis, and ______.

A

myocarditis

76
Q

Clients whose SLE cannot be managed with immunosuppressants and corticosteroids can experience _______ resulting in the possible need for a kidney transplant.

A

chronic kidney disease

77
Q

Lupus nephritis is the leading cause of death related to _____.

A

SLE

78
Q

With _________ monitor for periorbital and lower extremity swelling and hypertension. Monitor renal status with _____ and _____.

A

lupus nephritis

BUN and creatinine

79
Q

With lupus nephritis teach the client the importance of taking immunosuppressants and _____ as prescribed.

A

corticosteroids

80
Q

With lupus nephritis teach the client the importance of avoiding ______ and illness.

A

stress

81
Q

_______ and myocarditis are complications of lupus.

A

pericarditis

82
Q

Pericarditis and myocarditis are an inflammation of the heart, its vessels, and the surrounding sac can occur secondary to ______.

A

SLE

83
Q

With the lupus complications of pericarditis and myocarditis you should monitor for chest pain, fatigue, ______, and fever.

A

arrhythmias

84
Q

With the complications of pericarditis and myocarditis of lupus instruct the client to report _____, take drugs as prescribed, and try to avoid stress and illness.

A

chest pain to the provider

85
Q

Gout or ______ is the most common inflammatory arthritis.

A

gouty arthritis

86
Q

Gout is a ____ disease caused by a disruption in purine metabolism in which uric acid crystals are deposited in joints and body tissues.

A

systemic

87
Q

Gout can be classified as either _____ or secondary.

A

primary

88
Q

Primary gout is the ______ common.

A

most

89
Q

With primary gout uric acid production is _______ than excretion of it by the kidneys.

A

greater

90
Q

Primary gout can have a ____ gout.

A

genetic

91
Q

Middle and older adult males )peak onset between or and 50), as well as postmenopausal women are commonly affect with _____.

A

primary gout

92
Q

_____ gout is caused by another disease or condition (chronic kidney failure, excessive diuretic use) that causes excessive uric acid in the blood.

A

Secondary

93
Q

With secondary gout treatment is based on treating the _____.

A

underlying condition

94
Q

Secondary gout can affect people of any ____.

A

age

95
Q

Risk factors for gout

A 
obesity
cardiovascular disease
trauma
alcohol ingestion
starvation dieting
diuretic use
some chemotherapy agents
chronic kidney failure
96
Q

Expected findings of gout include

A 
sever joint pain
especially in the metatarsophalangeal joint of the great toe
redness
swelling
warmth of affected joint
97
Q

Expected physical findings of gout

A

painful, swollen joint that is very painful if touched or moved
appearance of tophi (chronic gout)

98
Q

Lab Tests for Gout

A

ESR - elevated
Urinary uric acid - elevated
BUN and Creatinine - elevated
Serum uric acid: consistent elevation above 6.5 mg/dL - repeated measurements are needed due to the effect of dietary intake on results.

99
Q

With gout you need to assess/monitor pain, redness/swelling of affected joints and the _____.

A

serum uric acid levels

100
Q

With acute gout there are 3 med options

A

antigout agent
NSAIDs
Corticosteroids

101
Q

An antigout agent such as ______ (PO or parenteral) is used to decrease pain and inflammation for acute gout.

A

colchicine

102
Q

Antigout agents such as colchicine should be used cautiously in clients who have impaired _____.

A

kidney functions

103
Q

NSAIDS such as indomethacin or ibuprofen is used to decrease pain and _____ with acute gout.

A

inflammation

104
Q

NSAIDS should not be given to clients who have impaired _____.

A

kidney function

105
Q

Do not take NSAIDs on an ______.

A

empty stomach

106
Q

Corticosteroids such as predinsone is used to treat ______.

A

inflammation

107
Q

With corticosteroids monitor for fluid retention, hypertension, and impaired _____,

A

kidney dysfunction

108
Q

Do not stop taking _____ abruptly. Gradually taper dosage as prescribed.

A

corticosteroids

109
Q

For chronic gout what two meds are prescribed.

A

xanthine oxidase inhibitor

uricosuric

110
Q

Xanthine oxidase inhibitor such as _____ is used as a maintenance medication to promote uric acid excretion and decrease its production.

A

allopurinol

111
Q

With allopurinol you need to ______ fluid intake.

A

increase

112
Q

Allopurinol should be taken ____ meals and with a full glass of water.

A

after

113
Q

Uricosuric (probenecid) is used as a maintenance medication to promote uric acid _______.

A

excretion

114
Q

With uricosuric you need to monitor _____ levels.

A

uric acid

115
Q

When taking uricosuric do not use ______ because it will decrease the effectiveness of the medication.

A

aspirin

116
Q

Gout patients should remind the client to stay on a ______ diet, which includes no organ meats or shellfish.

A

low-purine

117
Q

Gout patients should limit _____.

A

alcohol intake

118
Q

Gout patients should avoid starvation diets, aspirin, and ______.

A

diuretics

119
Q

Gout patients should limit physical or _______.

A

emotional stress

120
Q

Gout patients should have ____ fluids.

A

increased

121
Q

Gout patients should _____ medications.

A

adhere to their

122
Q

Fibromyalgia also known as fibromyalgia syndrome is a chronic pain syndrome which manifests as pain, stiffness, and tenderness at certain _______ in the body.

A

“trigger points”

123
Q

The pain experienced with Fibromyalgia is typically described as a _____ a gnawing pain that can be elicited by palpating “trigger points.”

A

burning

124
Q

Fibromyalgia patients can experience chronic fatigue, sleep disturbances, and ___________

A

functional impairment.

125
Q

Fibromyalgia Risk Factors

A

Female between 30-50
Hx of rheumatolgoic condition, chronic fatigue syndrome, or Lyme disease
Deep sleep deprivation

126
Q

Expected findings of Fibromyalgia

A

mild to severe fatigue
sleep disturbances
numbness/tingling of extremities
sensitivity to noxious smells, loud noises, and bright lights
headaches
jaw pain
depression
concentration and memory difficulties
GI manifestations: abdominal pain, heartburn, constipation, diarrhea
Genitourinary manifestations: frequency, urgency, dysuria, pelvic pain
visual changes

127
Q

With Fibromyalgia assess/monitor pain, mobility, and _____.

A

fatigue

128
Q

With fibromyalgia provide ____ support to the client and family.

A

emotional

129
Q

Medications for fibromyalgia

A

serotonin-nonrepinephrine reuptake inhibitors (SNRIs) and anticonvulsants
NSAIDS
Tricyclic antidepressants

130
Q

Pregabalin (anticonvulsant) and duloxetine (SNRI) are used to increase the release of serotonin and norepinephrine, resulting in decreased ______ pain.

A

nerve

131
Q

SNRIs and anticonvulsants can cause drowsiness/_______.

A

sleepiness

132
Q

When taking SNRIs and anticonvulsants dont’ drink _____.

A

alcohol

133
Q

NSAIDs are used to decrease pain and _____.

A

inflammation

134
Q

NSAIDs are contraindicated for clients who have impaired _______. Don’t take on an empty stomach.

A

kidney function

135
Q

Tricyclic antidepressants (amtitriptyline, nortriptylline and trazodone are used to help induce _____ and decrease pain.

A

sleep

136
Q

______ and nortiptyline can cause confusion and orthostatic hypotension in older adult clients.

A

amitriptyline

137
Q

Trazodone is often the medication of choice for the older adult clients due to ______ adverse effects.

A

decreased

138
Q

Physical therapy can be helpful with ______ to decrease pain.

A

fibromyalgia

139
Q

Complementary and alternative therapies can be helpful with ______. (acupuncture, stress management)

A

fibromyalgia

140
Q

Teach the client to limit the intake of _____, alcohol, and other substances that interfere with sleep with fibromyalgia.

A

caffeine

141
Q

A client suffering from ______ should teach the client to develop a routine for sleep.

A

fibromyalgia

MS II (10 decks)

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