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Adult ll > Connective Tissue Disease > Flashcards

Connective Tissue Disease Flashcards

1
Q

common trait with connective tissue diseases

A

pain, mainly of the joints

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2
Q

rheumatoid arthritis

A

Autoimmune

inflammation of the connective tissue in synovial joints; triggers formation of the abnormal immunoglobulin G

May be environmental or genetic

*Will have Rheumatoid Factor (RF)

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3
Q

Early Stages of Rheumatoid Arthritis

A

joint stiffness, swelling, pain, morning stiffness

Weakness, weight loss

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4
Q

Late Stages of Rheumatoid Arthritis

A

joint pain and swelling worsens

joint deformities

loss of joint function r/t joint scarring

muscle atrophy r/t nonfunctioning joints

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5
Q

Goal of rheumatoid arthritis

A

for the disease to not progress into the late stage

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6
Q

clinical manifestations of rheumatoid arthritis

A

Slow

insidious, fatigue, weight loss, anorexia, stiffness, low grade fever

joint stiffness after period of inactivity -> worse in the morning

Swelling: symmetrical, impacts small joints of fingers, hands, feet; large peripheral joints, cervical spine, temporomandibular joint (TMJ)

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7
Q

Systemic complications of rheumatoid arthritis

A

Rheumatoid nodule - can be on skin, lungs, retina

Sjorgern’s syndrome - attacks salivary and lacrimal glands (dry mouth and eyes)

cardiopumonary disease

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8
Q

Psychosocial assessment rheumatoid arthritis

A

family support, coping skills, is the pt able to live independently?, job

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9
Q

Dx studies for rheumatoid arthritis

A 
RF (80% positive)
Antinuclear antibody (ANA)

erythrocyte sedimentation rate (ESR) and C-reactive protein test for inflammation

Synovial fluid analysis - checks WBCs

X-rays: initially not detected in early stages

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10
Q

Rheumatoid arthritis Tx

A

pain management, Heat and cold, PT, OT, plasmapheresis, nutrition

Meds: aspirin, NSAIDS, DMARDS, BMRs, corticosteroids

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11
Q

Plasmapheresis

A

taking the blood out, getting rid of the antibodies, replacing donor blood then putting the pt’s blood back

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12
Q

Ankylosing Spondylitits

A

Autoimmune

inflammation of the axial skeleton (next to sacral iliac joint)

white males under 40 y.o most commonly affective

genetic predisposition (HLA-B27 antigen)

*lots of back problems

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13
Q

Ankylosing Sondylitis manifestations

A

low back pain worsening during rest (morning), arthralgia, malaise, weight loss

Later -> pain taking deep breaths causing pulmonary complications

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14
Q

Ankylosing Sondylitis complications

A

severe postural deformities (balance and vision)

aortic insufficiency
pulmonary fibrosis
Lower extremity weakness and bladder dysfunction

spinal fractures

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15
Q

Cauda equina syndrome

A

compression of the spinal nerves (usually from inflammation); needs to be resolved immediately or it can cause permanent paralysis of the lower extremities

lower extremity weakness and bladder dysfunction

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16
Q

Ankylosing Spondylitis dx studies

A

pelvic x-rays, ESR, HLA-B27

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17
Q

Ankylosing Spondylitis Tx

A

Cannot be prevented

maintain mobility (PT/OT)
Maintain respiratory function
correct posture  (firm mattress, legs outright)
decrease pain and inflammation
heat, exercise, surgery

NSAIDS/corticosteroids/DMARDS/BRMs

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18
Q

Lupus Erythematosus

A

Autoimmune; most common in childbearing year females

Discoid lupus erythematosus (DLE) vs Systemic lupus erythematosus (SLE)

overaggressive antibody response r/t B and T cell hyperactivity: immune complexes form in serum and tissues

Genetic and environmental

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19
Q

Discoid lupus erythematosus (DLE)

A

only affects the skin

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20
Q

Systemic lupus erythematosus (SLE)

A

chronic, progressive connective tissue disorder (more severe symptoms)

spontaneous remissions and exacerbations
can be fatal

21
Q

Systemic Lupus Erythematosus assessment findings

A 
malar rash, discoid rash
photosensitivity, oral ulcers, arthritis
pericarditis, raynaud's arthritis, nephritis
fever, fatigue, vasulitis
abdominal pain, headaches

Anti-DNA, Anti-smith, Antinuclear antibody, ESR & CRP, renal/liver/cardiac labs, psychosocial assessment

22
Q

main cause of death in systemic lupus erythematosus

A

cardiac, renal failure, infection r/t altered immunity

23
Q

systemic lupus erythematosus complications

A 
dermatoligic
musculoskeletal
cardiopulmonary
renal
neurological
hematological disease
infection
24
Q

Systemic Lupus Erythematosus Tx

A

prevention of complications

Drug therapy: NSAIDS, DMARDS (plaquenil, methotrexate), corticosteroids, plasmaphoresis, immunosuppressive drugs

skin protection, carefully watch renal function!, pregnancy concerns, psychosocial concerns

25
Q

Scleroderma

A

autoimmune
AKA systemic sclerosis

chronic, inflammatory, autoimmune connective tissue disease

results in hardening of skin; proliferation of collagen disrupts function of internal organs

more common in women

environmental or genetic

26
Q

scleroderma clinical manifestations

A

arthalgia
edema of hands/fingers, upper/lower extremities
skiny, taut skin
joint contractures

CREST syndrome

27
Q

CREST syndrome

A

Calcinosis - decreased Ca deposits under skin

Raynaud’s Syndrome - worsens in the cold

Esophageal Dysfunction - difficulty swallowing

Sclerodactyly - tightening of the skin of hands

Telangiectasia - red spots on the hands and feet

28
Q

scleroderma organ dysfunction

A

GI tract (constipation)
Cardiovascular system
Pulmonary system
Kidneys

29
Q

scleroderma dx studies

A

similar to SLE

30
Q

scleroderma tx

A

prevent or treat secondary complications

PT/OT - ROM exercises

Drug therapy: immunosuppressants, corticosteroids, NSAIDS

skin protection

31
Q

Fibromyalgia

A

chronic widespread musculoskeletal pain and fatigue

32
Q

Fibromyalgia clinical manifestations

A 
widespread burning
pain/tenderness on palpation
difficulty concentrating
memory lapse
peripheral numbness/tingling
headaches
depression
33
Q

Fibromyalgia Dx studies

A

exam findings
rule out other disorders
often not properly diagnosed

pain and tenderness on palpation

34
Q

Fibromyalgia collaborative care

A

massage w/ ultrasound
restrict foods that are muscle irritants
relaxation techniques

meds: analgesias (AVOID OPIOIDS), Lyrics (prevents nerve firing), tricyclic antidepressants and SSRIs, skeletal muscle relaxants, benzos

35
Q

Lyme Disease

A

infectious disease

Infection transmitted by a deer tick

36
Q

Lyme Disease clinical manifestations

A

erythema migraines: “bulls eye appearance”

Carditis (inflammation around heart)

Acute viral symptoms
Arthritis
severe headaches
facial paralysis (bell's palsy)
poor motor coordination
37
Q

Lyme Disease late manifestations

A

arthritis pain, swelling

neurological disorders (fatigue, memory/thinking problems)

38
Q

Lyme Disease dx

A

hx of exposure
lyme disease AB screening
Western Blot IgG, IgM
Lyme diseae C6 peptide by ELISA

39
Q

Lyme Disease tx

A

doxycycline, ceftriaxone

40
Q

Lyme Disease education

A

wear long pants, light color
spray insect repellent on skin/clothing
provide pets w/ tick collars, check frequently

remove tick w. tweezers, flush down toilet
wash bitten area with soap and water, apply antibx ointment

report flu-like s/s

41
Q

Gout

A

Not autoimmune or infectious

Crystal precipitate in a joint and subcutaneous tissue causing an inflammatory rxn

usually affects the big toe

42
Q

Primary Gout

A

error of purine metabolism

foods high in purine: liver, sardines, kidney meat, pork, chicken, beef

43
Q

Secondary Gout

A

hyperuricemia from a secondary cause: renal disease, diuretics, crash dieting, chemo

–cannot get rid of uric acid

44
Q

Acute gouty arthritis “Attack”

A

pain/inflammation of 1 or more joints -> horrible pain

joint tenderness, swelling, warmth

45
Q

asymptomatic hyperuricemic stage

A

no s/s

46
Q

Chronic tophaceous gout

A

after multiple “attacks”

urate crystals (tophi) deposit under skin and kidneys

arthritis, renal calculi, 3-40yrs after initial s/s

47
Q

Gout dx tests

A

serum uric acid, 24 hr urine uric acid levels, BUN and creatinine
synovial fluid aspiration
x-rays

48
Q

Gout management

A 
eliminate alcohol
decrease foods high in purine
increase fluids
Avoid ASA and diuretics
immbolization

drug therapy: NSAIDS (except ASA), colchicine, allopurinol, probenecid

Adult ll (11 decks)

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