Chapter 87: Lupus Erythematosus, Gout, and Fibromyalgia Flashcards
________ is an autoimmune disorder in which an atypical immune response results in chronic inflammation and destruction of healthy tissue.
lupus erythematosus (lupus)
Autoimmune disorders
rheumatoid arthritis vasculitis multiple sclerosis scleroderma (including Raynaud's phenomenon) psoriasis
In autoimmune disorders, small antigens can bond with _______. The body then produces antibodies that attack the healthy tissue.
healthy tissue
These responses can be triggered by toxins, medications, bacteria, and _____.
viruses.
______ 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.
Control
Gout, also known as gouty arthritis, is a systemic disorder caused by _________.
hyperuricemia increase in serum uric acid)
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.
diet
uric crystal
_____ is a chronic pain syndrome that involves stiffness, sleep disturbance, generalized muscle weakness and chronic fatigue.
Fibromyalgia
It is estimated that _______ of people who have fibromyalgia have another form of a rheumatologic disorder, such as RA or SLE.
25% to 65%
The occurrence of autoimmune disorders increases with _____.
age
Lupus varies in severity and _______.
progression
Lupus is generally characterized by periods of exacerbations (flares) and _____.
remissions
______ is classified as discoid or systemic. A temporary form of lupus can be medication-induced.
Lupus
______ only affects the skin.
Discoid lupus erythematosus (DLE)
______ affects the connective tissues of multiple organ systems and can lead to major organ failure.
Systemic lupus erythematosus (SLE)
________ can be caused by medications (procanimide, hydralazine, isoniazid). Findings resolve when the medication is discontinued.
Medication-induced lupus erythematosus
Lupus can be difficult to diagnose because of the _______ of early manifestations.
vague nature
One lupus risk factor is women between the age of ________.
women between the ages of 20 to 40
One lupus risk factor is descent from African American, ____, or Native American.
Asian
The incidence of lupus ______ in women following menopause but remains steady in men.
declines
Diagnosis of lupus can be delayed in older adult clients because they mimic other disorders or can be associated with reports common to the _____.
normal aging process
With older adults a lupus diagnsosis can be delayed. Joint pain and swelling can significantly limit ADLs in older adult clients who have _____.
comorbidities.
With older adults a lupus diagnsosis can be delayed. Older adult clients are at an increased risk for fractures if ______ therapy is used.
corticosteroid
An expected finding of lupus is fatigue/_____.
malaise
Expected findings of lupus include alopecia, blurred vision, and ____.
depression
_____ pain is an expected finding of lupus.
pleuritic
Anorexia/______ are expected findings of lupus.
weight loss
Joint pain, swelling, and ______ are expected findings with lupus.
tenderness
______(also a major indication of exacerbation) with lupus.
fever
Anemia and _________pathy are expected physical findings.
lymphaden-
_____ (presence of a cardiac friction rub or pleural friction rub) is an common physical finding of lupus.
pericarditis
_________ (arteriolar vasospasm in response to cold/stress)
raynaud’s phenomenon
Findings consistent lupus include organ involvement (kidney, heart, lungs, and _______)
vasculature
Erythematous ______ rash over the nose and cheeks (raised, dry, and scaly) is an expected finding
butterfly
A ______ is used to diagnose DLE by confirming the presence of lupus cells and cellular inflammation.
skin biopsy
Immunologic tests are used to diagnose _____.
SLE
Antinuclear antibodies (ANAs): antibodies produced against one’s own DNA; positive titers in _____ of clients who have lupus.
95%
Immunologic Tests
SLE prep SS-A Anti-DNP ssDNA dsDNA (very specific for SLE; assists with differentiation between SLE and medication induced lupus)
With lupus there will be an elevated ______ rate due to systemic inflammation.
ESR
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.
decreased
With lupus BUN and creatinine will be ______ with kidney involvement.
increased
With lupus a urinalysis will show up positive for ______ and RBCs (kidney involvement).
protein
Pancytopenia will be evident through a ____ with lupus.
CBC
With lupus you need to assess/monitor pain, ______, and fatigue.
mobility
with lupus you need to monitor the vital signs put the _____ especially.
blood pressure
With lupus systemic manifestations such as hypertension, _____ and urine output will demonstrate renal compromise.
edema
With lupus diminished ______ can demonstrate pleural effusion.
breath sounds
With lupus _______ and sharp inspiration chest pain can indicate pericarditis.
tachycardia
With lupus you need to monitor/assess rubor, pallor, and ______ of hands/feet with vascultis/vasospasm and raynaud’s phenomenon.
cyanosis
With lupus you need to assess and monitor arthralgias (joint pain), myalgias (muscle pain), and _______ when there is joint and connective tissue involvement.
polyarthritis (affects more than 4 joints)
With lupus changes in mental status that indicate neurologic involvement such as psychoses, paresis, and _____.
seizures
With lupus _____ and creatinine will be affected by renal involvement.
BUN
With lupus you also need to monitor and assess the patient’s _____ status.
nutritional
With a lupus patient provide ____, _____ meals if anorexia is a concern. Offer between meal supplements.
small, frequent
With lupus encourage the client to limit ____ intake for fluid retention secondary to steroid therapy.
salt
With lupus provide emotional support to the client and ____.
family
______ are used to reduce inflammation and arthritic pain with lupus.
NSAIDs
Do not give NSAIDs to lupus patients who have impaired ____ function.
kidney
For lupus patients monitor for NSAID induced ______..
hepatitis
______ such as predinsone is used for immunosuppression and to reduce inflammation in lupus patients.
corticosteroid
In lupus patients taking corticosteroids monitor for ______, hypertension, and impaired kidney function.
fluid retention
In lupus patients taking corticosteroids do not stop taking them _______. Gradually taper the dosage as prescribed.
abruptly
Immunosuppressant agents such as methotrexate and _____ are used to suppress the immune response in lupus patients.
azathioprine
With Methotrexate or azathioprine (both immunospressants) monitor for toxic effects such as (___________ suppression or increased liver enzymes)
bone marrow suppression
In lupus patients who need suppression of synovitis, fever, or fatigue _______ (hyroxycholorquine) are used.
antimalarials
When a lupus patient is taking antimalarials such as hyroxycholoquine encourage frequent _____.
eye exams
For lupus patients physical and occupational therapy can be used for strengthening exercises and ______ as needed.
adaptive devices
Refer lupus patients to ______ as needed.
support groups
Lupus patient’s should avoid ____ and prolonged sun exposure. Use sunscreen when outside and exposed to sunlgiht.
UV
Lupus patient’s should use _____ protein shampoo and avoid harsh hair treatments.
mild
Lupus patients should use _______ for skin rash.
steroid creams
Lupus patients should report peripheral and _______ promptly.
periorbital edema
Lupus patients should report evidence of _____ related to immunosuppression.
infection
Educate lupus clients of childbearing age regarding risks of _________ and treatment meds.
pregnacy
Complications of lupus include lupus nephritis, pericarditis, and ______.
myocarditis
Clients whose SLE cannot be managed with immunosuppressants and corticosteroids can experience _______ resulting in the possible need for a kidney transplant.
chronic kidney disease
Lupus nephritis is the leading cause of death related to _____.
SLE
With _________ monitor for periorbital and lower extremity swelling and hypertension. Monitor renal status with _____ and _____.
lupus nephritis
BUN and creatinine
With lupus nephritis teach the client the importance of taking immunosuppressants and _____ as prescribed.
corticosteroids
With lupus nephritis teach the client the importance of avoiding ______ and illness.
stress
_______ and myocarditis are complications of lupus.
pericarditis
Pericarditis and myocarditis are an inflammation of the heart, its vessels, and the surrounding sac can occur secondary to ______.
SLE
With the lupus complications of pericarditis and myocarditis you should monitor for chest pain, fatigue, ______, and fever.
arrhythmias
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.
chest pain to the provider
Gout or ______ is the most common inflammatory arthritis.
gouty arthritis
Gout is a ____ disease caused by a disruption in purine metabolism in which uric acid crystals are deposited in joints and body tissues.
systemic
Gout can be classified as either _____ or secondary.
primary
Primary gout is the ______ common.
most
With primary gout uric acid production is _______ than excretion of it by the kidneys.
greater
Primary gout can have a ____ gout.
genetic
Middle and older adult males )peak onset between or and 50), as well as postmenopausal women are commonly affect with _____.
primary gout
_____ gout is caused by another disease or condition (chronic kidney failure, excessive diuretic use) that causes excessive uric acid in the blood.
Secondary
With secondary gout treatment is based on treating the _____.
underlying condition
Secondary gout can affect people of any ____.
age
Risk factors for gout
obesity cardiovascular disease trauma alcohol ingestion starvation dieting diuretic use some chemotherapy agents chronic kidney failure
Expected findings of gout include
sever joint pain especially in the metatarsophalangeal joint of the great toe redness swelling warmth of affected joint
Expected physical findings of gout
painful, swollen joint that is very painful if touched or moved
appearance of tophi (chronic gout)
Lab Tests for Gout
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.
With gout you need to assess/monitor pain, redness/swelling of affected joints and the _____.
serum uric acid levels
With acute gout there are 3 med options
antigout agent
NSAIDs
Corticosteroids
An antigout agent such as ______ (PO or parenteral) is used to decrease pain and inflammation for acute gout.
colchicine
Antigout agents such as colchicine should be used cautiously in clients who have impaired _____.
kidney functions
NSAIDS such as indomethacin or ibuprofen is used to decrease pain and _____ with acute gout.
inflammation
NSAIDS should not be given to clients who have impaired _____.
kidney function
Do not take NSAIDs on an ______.
empty stomach
Corticosteroids such as predinsone is used to treat ______.
inflammation
With corticosteroids monitor for fluid retention, hypertension, and impaired _____,
kidney dysfunction
Do not stop taking _____ abruptly. Gradually taper dosage as prescribed.
corticosteroids
For chronic gout what two meds are prescribed.
xanthine oxidase inhibitor
uricosuric
Xanthine oxidase inhibitor such as _____ is used as a maintenance medication to promote uric acid excretion and decrease its production.
allopurinol
With allopurinol you need to ______ fluid intake.
increase
Allopurinol should be taken ____ meals and with a full glass of water.
after
Uricosuric (probenecid) is used as a maintenance medication to promote uric acid _______.
excretion
With uricosuric you need to monitor _____ levels.
uric acid
When taking uricosuric do not use ______ because it will decrease the effectiveness of the medication.
aspirin
Gout patients should remind the client to stay on a ______ diet, which includes no organ meats or shellfish.
low-purine
Gout patients should limit _____.
alcohol intake
Gout patients should avoid starvation diets, aspirin, and ______.
diuretics
Gout patients should limit physical or _______.
emotional stress
Gout patients should have ____ fluids.
increased
Gout patients should _____ medications.
adhere to their
Fibromyalgia also known as fibromyalgia syndrome is a chronic pain syndrome which manifests as pain, stiffness, and tenderness at certain _______ in the body.
“trigger points”
The pain experienced with Fibromyalgia is typically described as a _____ a gnawing pain that can be elicited by palpating “trigger points.”
burning
Fibromyalgia patients can experience chronic fatigue, sleep disturbances, and ___________
functional impairment.
Fibromyalgia Risk Factors
Female between 30-50
Hx of rheumatolgoic condition, chronic fatigue syndrome, or Lyme disease
Deep sleep deprivation
Expected findings of Fibromyalgia
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
With Fibromyalgia assess/monitor pain, mobility, and _____.
fatigue
With fibromyalgia provide ____ support to the client and family.
emotional
Medications for fibromyalgia
serotonin-nonrepinephrine reuptake inhibitors (SNRIs) and anticonvulsants
NSAIDS
Tricyclic antidepressants
Pregabalin (anticonvulsant) and duloxetine (SNRI) are used to increase the release of serotonin and norepinephrine, resulting in decreased ______ pain.
nerve
SNRIs and anticonvulsants can cause drowsiness/_______.
sleepiness
When taking SNRIs and anticonvulsants dont’ drink _____.
alcohol
NSAIDs are used to decrease pain and _____.
inflammation
NSAIDs are contraindicated for clients who have impaired _______. Don’t take on an empty stomach.
kidney function
Tricyclic antidepressants (amtitriptyline, nortriptylline and trazodone are used to help induce _____ and decrease pain.
sleep
______ and nortiptyline can cause confusion and orthostatic hypotension in older adult clients.
amitriptyline
Trazodone is often the medication of choice for the older adult clients due to ______ adverse effects.
decreased
Physical therapy can be helpful with ______ to decrease pain.
fibromyalgia
Complementary and alternative therapies can be helpful with ______. (acupuncture, stress management)
fibromyalgia
Teach the client to limit the intake of _____, alcohol, and other substances that interfere with sleep with fibromyalgia.
caffeine
A client suffering from ______ should teach the client to develop a routine for sleep.
fibromyalgia
