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MS II > Chapter 88: Rheumatoid Arthritis > Flashcards

Chapter 88: Rheumatoid Arthritis Flashcards

1
Q

Rheumatoid arthritis (RA) is a chronic, progressive _______ disease that can affect tissues and organs but principally attacks the joints, producing inflammatory ______.

A

inflammatory

synovitis

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2
Q

RA involves joints bilaterally and ________, and typically affects several joints at one time.

A

symmetrically

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3
Q

RA typically affects ______ joints first.

A

upper

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4
Q

RA is an _______ disease that is precipitated by WBCs attacking synovial tissue.

A

autoimmune

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5
Q

With RA the______ cause the synovial tissue to become inflamed and thickened.

A

WBCs

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6
Q

The inflammation can extend to the ______, bone, tendons, and ligaments that surround the joint.

A

cartilage

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7
Q

Joint _______ and bone erosion can result from these changes, decreasing the joint’s range of motion and function.

A

deformity

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8
Q

RA is also a systemic disease that can affect any ______ tissue in the body.

A

connective

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9
Q

Common structures affected are the blood vessels, pleura surrounding the lungs, and ___________.

A

pericardium

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10
Q

Iritis and _______ can also develop in the eyes as a result of RA.

A

scleritis

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11
Q

The natural course of RA is one of exacerbations and ______.

A

remissions.

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12
Q

With RA you use ______ that prevent development of deformity of inflamed joint during ADLs.

A

adaptive devices

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13
Q

With RA you want to continue using affected joints and ______ to maintain function and range of motion.

A

ambulating

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14
Q

Rheumatoid Arthritis (RA) Risk Factors

A

Female gender (3:1 compared to males)
Age 20-50 years
Genetic predisposition
Epstein-Barr virus
Stress
Environmental factors
Older age
- Early signs of RA (fatigue, joint discomfort) are vague and can be attributed to other disorders in older adult clients.
- Joint pain and dysfunction can have a greater effect on older adult clients than younger ones due to the presence of other chronic conditions.
- Older adult clients can be less able to overcome and/or cope with joint pain/deformity.

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15
Q

An expected finding of RA is _____ at rest and with movement.

A

pain

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16
Q

An expected finding of RA is ______ stiffness.

A

morning

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17
Q

An expected finding of RA is ______ pain (pain upon inspiration).

A

pleuritic

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18
Q

An expected finding of RA is _____ mouth aka xerostomia

A

dry

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19
Q

An expected finding of RA is anorexia/weight loss, ______, paresthesias.

A

fatigue

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20
Q

An expected finding of RA is having occured a _________ illness/stressor.

A

recent

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21
Q

An expected finding of RA is joint ____.

A

pain

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22
Q

An expected finding of RA is lack of ______.

A

function

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23
Q

An expected finding of RA is joint swelling and ______.

A

deformity

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24
Q

Join deformities are a _____ signs of RA.

A

late

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25
Q

Joint swelling, _____, and erythema are common with RA.

A

warmth

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26
Q

Finger, hands, writsts, _____, and foot joints are really affected.

A

knees

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27
Q

______ joints affected are the proximal interphalangeal and metacarpophalangeal joints.

A

Finger

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28
Q

Joints can become deformed merely by completing ______ with RA.

A

ADLs

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29
Q

An expected finding with RA is subcutaneous _____.

A

nodules

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30
Q

An expected finding of RA is a ____ (generally low grade).

A

fever

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31
Q

An expected finding of RA is muscle weakness/ ______.

A

atrophy

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32
Q

An expected finding _____ sclera and/or abnormal shape of the _____.

A

redness

pupil

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33
Q

An expected finding are enlarged ______.

A

lymph nodes

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34
Q

Lab tests for RA

A 
Anti - CCP antibodies
Rheumatoid Factor Antibodies
Erythrocyte sedimentation rate (ESR)
C-reactive protein: positive
Antinulcear antibody (ANA) titer
Elevated WBCs
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35
Q

The _____ test detects antibodies to cyclic citrullinated peptide. The result is positive in most people who have rheumatoid arthritis, even years before symptoms develop. The test is more sensitive for RA than rehumatoid factor (RF) antibodies.

A

anti-ccp antibodies

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36
Q

With the ______ test the diagnostic level for RA is 1:40 to 1:60. The expected reference range is 1:20 or less.

A

Rheumatoid factor antibody

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37
Q

With the Rheumatoid factor antibody test high titers correlate with _____ disease. Other automimmune disease also can increase RF antibody.

A

severe

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38
Q

Elevated _____ is associated with the inflammation or infection in the body. Other autoimmune disorders can increase levels in this test.

A

ESR

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39
Q

With ESR _____ to _____ mm/hr is a mild inflammation.

A

20 to 40 mm/hr

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40
Q

With ESR _____ to _____ mm/hr is a moderate inflammation

A

40 to 70 mm/hr

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41
Q

With ESR _____ to _____ mm/hr is a severe inflammation.

A

70 to 150 mm/hr

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42
Q

The ______ test may be done in place of the ESR test.

A

C-reactive protein: positive

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43
Q

The ______ test is useful for diagnosing disease or monitoring disease activity, and for monitoring the response to anti-inflammatory therapy.

A

C-reactive protein

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44
Q

an ________ identifies an antibody produced against one’s own DNA.

A

Antinuclear antibody (ANA) titer

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45
Q

A positive ____ titer is associated with RA. (It is normally negative at 1:20 dilution). Other autoimmune disease also can increase ANA.

A

ANA

46
Q

______ count will be elevated during an exacerbation secondary to the the inflammation. The RBCs can be decreased due to ______.

A

WBC

anemia

47
Q

Diagnostic Procedures for RA

A

Arthrocentesis

X-Ray

48
Q

An _____ is synovial fluid aspiration by needle.

A

arthrocentesis

49
Q

With RA, an arthrocentesis will show increased _____ and _____ present in the fluid.

A

WBC

RF (Rheumatoid Factor)

50
Q

After an arthrocentesis a nurse should monitor for bleeding or a ______ leak from the needle biopsy site.

A

synovial fluid

51
Q

After an arthrocentesis you can educate the client to take _____ for pain.

A

acetaminophen

52
Q

____ are used to determine the degree of joint destruction and monitor its progression.

A

x-rays

53
Q

Xrays provide adequate visualization and reveal ______ and narrowed joint spaces.

A

bony erosions

54
Q

Xrays negate the need for more expensive radiologic tests such as CT scans or ______.

A

MRIs

55
Q

With X-rays nurse will help the client into ______ and educate them to minimize movement during the procedures.

A

position

56
Q

Apply heat or ____ to the affected areas a indicated based on client response.

A

cold

57
Q

For morning stiffness a _____ can be helpful.

A

hot shower

58
Q

With pain in hands/fingers you can use _____.

A

heated paraffin.

59
Q

With edema you can treat with _____.

A

cold therapy

60
Q

Assist with and encourage physical activity to ______ joint mobility (within the capabilities of the client).

A

maintain

61
Q

Monitor the patient for signs of _____.

A

fatigue

62
Q

Teach the client the measures to (6)

A 
maximize functional activity
minimize pain
monitor skin closely
conserve energy (space out activities, take rest periods, ask for additional assistance when needed).
promote coping strategies
encourage routine health screenings
63
Q

Provide a ______ environment for clients.

A

safe

64
Q

To provide a safe environment remove unnecessary equipment and supplies, facilitate the use of assistive devices, provide information for support organizations and provide referrals for __________ and _________.

A

occupational therapy

physical therapy

65
Q

Using ______ muscle relaxation can help a patient.

A

progressive

66
Q

Administer medication and ______ as prescribed.

A

proper positioning

67
Q

Monitor for medication effectiveness such as __________ and increased mobility.

A

reduced pain

68
Q

Teach the client regarding signs/symptoms that need to be reported immediately (fever, infection, pain upon _____, pain in the _______ area of the chest.

A

inspiration

substernal area

69
Q

With RA encourage foods high in vitamins, protein, and ______.

A

iron

70
Q

With RA they should eat ____, _____ meals.

A

small, frequent

71
Q

Medication options for RA (4)

A

NSAIDS
COX-2 enzyme blockers
corticosteroids
DMARDs (disease modifyingg anti-rheumatic drugs)

72
Q

Treatment with RA begins with ________.

A

NSAIDS

73
Q

The use of NSAIDS for RA provide analgesic, antipyretic, and ________ effects.

A

anti-inflammatory

74
Q

When using NSAIDs the patient could have considerable ______ distress.

A

gastrointestinal (GI)

75
Q

When NSAIDs are prescribed request a concurrent prescription for a ________ (histamine-receptor antagonist, proton pump inhibitor) if GI distress is reported

A

GI-acid lowering agent

76
Q

When taking NSAIDS for RA monitor for fluid retention, hypertension, and ____ dysfunction.

A

renal

77
Q

When taking NSAIDs instruct the client to take the medication with _____ or with a full glass of water or milk. If taking routinely, an H2-receptor antagonist can also be prescribed.

A

food

78
Q

When taking NSAIDs advise the client to observe for GI bleeding visible such as (______ emesis, dark, tarry stool).

A

coffee-ground

79
Q

Instruct the client to avoid _____ when taking NSAIDs which can increase the risk of GI complications.

A

alcohol

80
Q

COX-2 enzyme blockers cause less GI distress but carry a risk of _____.

A

cardiac disease

81
Q

______ (predinsone) are strong anti-inflammatory meds that can be given for acute exacerbation or advanced forms of the disease.

A

corticosteroids

82
Q

Corticosteroids (predinsone) are not given for ____ therapy due to significant adverse effects (osteoporosis, hyperglycemia, immunosuppression, cataracts).

A

long-term

83
Q

With corticosteroids you need to monitor weight and ______. Also observe for ______ changes.

A

BP

Cushingoid *changes in mood, headaches, and a chronic feeling of tiredness

84
Q

When taking corticosteroids instruct the client to observe for changes in vision, blood glucose, and _____.

A

impaired healing

85
Q

Instruct a client taking corticosteroids to avoid ______.

A

crowds

86
Q

Instruct a client takings corticosteroids to follow the prescription, such as alternate day dosing, tapering, and ______.

A

discontinuation of medication

87
Q

_______ work in a variety of ways to slow the progression of RA and suppress the immune system’s reaction to RA that causes pain and inflammation. Relief of symptoms may not occur for ______.

A

DMARDS

several weeks

88
Q

DMARDS (5)

A

Antimalarial agent : hydorxychoroquine
Antibiotic: Minocycline
Sulfonamide: Sulfasalzine
Biologic response modifiers: Etranercept, infliximab
Cytotoxic meds: Methotrexate, leflunomide, clycophosphamide, azathioprine (can cause severe a/e)

89
Q

Therapeutic procedures (2)

A

plasmapheresis

total join arthroplasty

90
Q

_______ removes circulating antibodies from plasma, decreasing attacks on the client’s tissues.

A

plasmapheresis

91
Q

Plasmapheresis may be done for a _____, ________ exacerbations.

A

severe, life-threatening

92
Q

_____ is the surgical repair and replacement of a joint which may be done for a severely deformed joint that has not responded to medication therapy.

A

total joint arthroplasty

93
Q

A patient with RA should be referred to groups as appropriate, occupational therapy for _______ that can facilitate carrying out ADLs and prevent deformities.

A

adaptive devices

94
Q

A home _____ can be necessary for assistance with ADLs.

A

health aide

95
Q

Complications of RA is ______.

A

Sjogren’s syndrome, secondary osteoporosis, vasculitis

96
Q

Sjorgren’s syndrome has a triad of symptoms _______, _______, and vagina which is caused by obstruction of secretory ducts and glands.

A

dry eyes, mouth

97
Q

For a patient with Sjogren’s syndrome provide ______ and artificial saliva, and recommend vaginal lubricants as needed.

A

eye drops

98
Q

For a patient with Sjorgren’s syndrome provide _____ with meals.

A

fluids

99
Q

______ is another complication of RA that is immobilization caused by arthritis can contribute to the development of osteoporosis.

A

secondary osteoporosis

100
Q

With the complication of secondary osteoporosis nurses encourage _____ exercises as tolerated.

A

weight-bearing

101
Q

______ (organ ischemia) is another complication of RA when inflammation of arteries can disrupt blood flow, causing ischemia. Smaller artieries in the skin, eyes, and brain are most commonly affected in RA.

A

Vascultiis

102
Q

With vascultiis a complication of RA you should monitor for skin lesions, decrease in vision, and symptoms of _______.

A

cognitive dysfunction

103
Q

Exacerbating factors for RA include a _______ illness.

A

recent

104
Q

A ____ in ROM is indicative in clients who have RA.

A

decrease

105
Q

Clients who have RA can experieince _____, but not hypersalivation.

A

xerostomia (dry mouth)

106
Q

Increased BP is ____ indicative of RA.

A

not

107
Q

Pain at _____ is indicative of RA.

A

rest

108
Q

The nurse should include in the teaching that the client who has RA can experience ____ in their joints upon rising.

A

stiffness

109
Q

The client who has RA can experience ____, not weight gain.

A

weight loss

110
Q

The client who has RA does not experience a low _____.

A

blood sugar

111
Q

The client who has RA can experience _______ upon inspiration, not abdominal pain.

A

pleuritic

MS II (10 decks)

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