Chapter 88: Rheumatoid Arthritis Flashcards
Rheumatoid arthritis (RA) is a chronic, progressive _______ disease that can affect tissues and organs but principally attacks the joints, producing inflammatory ______.
inflammatory
synovitis
RA involves joints bilaterally and ________, and typically affects several joints at one time.
symmetrically
RA typically affects ______ joints first.
upper
RA is an _______ disease that is precipitated by WBCs attacking synovial tissue.
autoimmune
With RA the______ cause the synovial tissue to become inflamed and thickened.
WBCs
The inflammation can extend to the ______, bone, tendons, and ligaments that surround the joint.
cartilage
Joint _______ and bone erosion can result from these changes, decreasing the joint’s range of motion and function.
deformity
RA is also a systemic disease that can affect any ______ tissue in the body.
connective
Common structures affected are the blood vessels, pleura surrounding the lungs, and ___________.
pericardium
Iritis and _______ can also develop in the eyes as a result of RA.
scleritis
The natural course of RA is one of exacerbations and ______.
remissions.
With RA you use ______ that prevent development of deformity of inflamed joint during ADLs.
adaptive devices
With RA you want to continue using affected joints and ______ to maintain function and range of motion.
ambulating
Rheumatoid Arthritis (RA) Risk Factors
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.
An expected finding of RA is _____ at rest and with movement.
pain
An expected finding of RA is ______ stiffness.
morning
An expected finding of RA is ______ pain (pain upon inspiration).
pleuritic
An expected finding of RA is _____ mouth aka xerostomia
dry
An expected finding of RA is anorexia/weight loss, ______, paresthesias.
fatigue
An expected finding of RA is having occured a _________ illness/stressor.
recent
An expected finding of RA is joint ____.
pain
An expected finding of RA is lack of ______.
function
An expected finding of RA is joint swelling and ______.
deformity
Join deformities are a _____ signs of RA.
late
Joint swelling, _____, and erythema are common with RA.
warmth
Finger, hands, writsts, _____, and foot joints are really affected.
knees
______ joints affected are the proximal interphalangeal and metacarpophalangeal joints.
Finger
Joints can become deformed merely by completing ______ with RA.
ADLs
An expected finding with RA is subcutaneous _____.
nodules
An expected finding of RA is a ____ (generally low grade).
fever
An expected finding of RA is muscle weakness/ ______.
atrophy
An expected finding _____ sclera and/or abnormal shape of the _____.
redness
pupil
An expected finding are enlarged ______.
lymph nodes
Lab tests for RA
Anti - CCP antibodies Rheumatoid Factor Antibodies Erythrocyte sedimentation rate (ESR) C-reactive protein: positive Antinulcear antibody (ANA) titer Elevated WBCs
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.
anti-ccp antibodies
With the ______ test the diagnostic level for RA is 1:40 to 1:60. The expected reference range is 1:20 or less.
Rheumatoid factor antibody
With the Rheumatoid factor antibody test high titers correlate with _____ disease. Other automimmune disease also can increase RF antibody.
severe
Elevated _____ is associated with the inflammation or infection in the body. Other autoimmune disorders can increase levels in this test.
ESR
With ESR _____ to _____ mm/hr is a mild inflammation.
20 to 40 mm/hr
With ESR _____ to _____ mm/hr is a moderate inflammation
40 to 70 mm/hr
With ESR _____ to _____ mm/hr is a severe inflammation.
70 to 150 mm/hr
The ______ test may be done in place of the ESR test.
C-reactive protein: positive
The ______ test is useful for diagnosing disease or monitoring disease activity, and for monitoring the response to anti-inflammatory therapy.
C-reactive protein
an ________ identifies an antibody produced against one’s own DNA.
Antinuclear antibody (ANA) titer
A positive ____ titer is associated with RA. (It is normally negative at 1:20 dilution). Other autoimmune disease also can increase ANA.
ANA
______ count will be elevated during an exacerbation secondary to the the inflammation. The RBCs can be decreased due to ______.
WBC
anemia
Diagnostic Procedures for RA
Arthrocentesis
X-Ray
An _____ is synovial fluid aspiration by needle.
arthrocentesis
With RA, an arthrocentesis will show increased _____ and _____ present in the fluid.
WBC
RF (Rheumatoid Factor)
After an arthrocentesis a nurse should monitor for bleeding or a ______ leak from the needle biopsy site.
synovial fluid
After an arthrocentesis you can educate the client to take _____ for pain.
acetaminophen
____ are used to determine the degree of joint destruction and monitor its progression.
x-rays
Xrays provide adequate visualization and reveal ______ and narrowed joint spaces.
bony erosions
Xrays negate the need for more expensive radiologic tests such as CT scans or ______.
MRIs
With X-rays nurse will help the client into ______ and educate them to minimize movement during the procedures.
position
Apply heat or ____ to the affected areas a indicated based on client response.
cold
For morning stiffness a _____ can be helpful.
hot shower
With pain in hands/fingers you can use _____.
heated paraffin.
With edema you can treat with _____.
cold therapy
Assist with and encourage physical activity to ______ joint mobility (within the capabilities of the client).
maintain
Monitor the patient for signs of _____.
fatigue
Teach the client the measures to (6)
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
Provide a ______ environment for clients.
safe
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 _________.
occupational therapy
physical therapy
Using ______ muscle relaxation can help a patient.
progressive
Administer medication and ______ as prescribed.
proper positioning
Monitor for medication effectiveness such as __________ and increased mobility.
reduced pain
Teach the client regarding signs/symptoms that need to be reported immediately (fever, infection, pain upon _____, pain in the _______ area of the chest.
inspiration
substernal area
With RA encourage foods high in vitamins, protein, and ______.
iron
With RA they should eat ____, _____ meals.
small, frequent
Medication options for RA (4)
NSAIDS
COX-2 enzyme blockers
corticosteroids
DMARDs (disease modifyingg anti-rheumatic drugs)
Treatment with RA begins with ________.
NSAIDS
The use of NSAIDS for RA provide analgesic, antipyretic, and ________ effects.
anti-inflammatory
When using NSAIDs the patient could have considerable ______ distress.
gastrointestinal (GI)
When NSAIDs are prescribed request a concurrent prescription for a ________ (histamine-receptor antagonist, proton pump inhibitor) if GI distress is reported
GI-acid lowering agent
When taking NSAIDS for RA monitor for fluid retention, hypertension, and ____ dysfunction.
renal
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.
food
When taking NSAIDs advise the client to observe for GI bleeding visible such as (______ emesis, dark, tarry stool).
coffee-ground
Instruct the client to avoid _____ when taking NSAIDs which can increase the risk of GI complications.
alcohol
COX-2 enzyme blockers cause less GI distress but carry a risk of _____.
cardiac disease
______ (predinsone) are strong anti-inflammatory meds that can be given for acute exacerbation or advanced forms of the disease.
corticosteroids
Corticosteroids (predinsone) are not given for ____ therapy due to significant adverse effects (osteoporosis, hyperglycemia, immunosuppression, cataracts).
long-term
With corticosteroids you need to monitor weight and ______. Also observe for ______ changes.
BP
Cushingoid *changes in mood, headaches, and a chronic feeling of tiredness
When taking corticosteroids instruct the client to observe for changes in vision, blood glucose, and _____.
impaired healing
Instruct a client taking corticosteroids to avoid ______.
crowds
Instruct a client takings corticosteroids to follow the prescription, such as alternate day dosing, tapering, and ______.
discontinuation of medication
_______ 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 ______.
DMARDS
several weeks
DMARDS (5)
Antimalarial agent : hydorxychoroquine
Antibiotic: Minocycline
Sulfonamide: Sulfasalzine
Biologic response modifiers: Etranercept, infliximab
Cytotoxic meds: Methotrexate, leflunomide, clycophosphamide, azathioprine (can cause severe a/e)
Therapeutic procedures (2)
plasmapheresis
total join arthroplasty
_______ removes circulating antibodies from plasma, decreasing attacks on the client’s tissues.
plasmapheresis
Plasmapheresis may be done for a _____, ________ exacerbations.
severe, life-threatening
_____ 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.
total joint arthroplasty
A patient with RA should be referred to groups as appropriate, occupational therapy for _______ that can facilitate carrying out ADLs and prevent deformities.
adaptive devices
A home _____ can be necessary for assistance with ADLs.
health aide
Complications of RA is ______.
Sjogren’s syndrome, secondary osteoporosis, vasculitis
Sjorgren’s syndrome has a triad of symptoms _______, _______, and vagina which is caused by obstruction of secretory ducts and glands.
dry eyes, mouth
For a patient with Sjogren’s syndrome provide ______ and artificial saliva, and recommend vaginal lubricants as needed.
eye drops
For a patient with Sjorgren’s syndrome provide _____ with meals.
fluids
______ is another complication of RA that is immobilization caused by arthritis can contribute to the development of osteoporosis.
secondary osteoporosis
With the complication of secondary osteoporosis nurses encourage _____ exercises as tolerated.
weight-bearing
______ (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.
Vascultiis
With vascultiis a complication of RA you should monitor for skin lesions, decrease in vision, and symptoms of _______.
cognitive dysfunction
Exacerbating factors for RA include a _______ illness.
recent
A ____ in ROM is indicative in clients who have RA.
decrease
Clients who have RA can experieince _____, but not hypersalivation.
xerostomia (dry mouth)
Increased BP is ____ indicative of RA.
not
Pain at _____ is indicative of RA.
rest
The nurse should include in the teaching that the client who has RA can experience ____ in their joints upon rising.
stiffness
The client who has RA can experience ____, not weight gain.
weight loss
The client who has RA does not experience a low _____.
blood sugar
The client who has RA can experience _______ upon inspiration, not abdominal pain.
pleuritic
