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MedSurg > Connective Tissue Disorders > Flashcards

Connective Tissue Disorders Flashcards

1
Q

Osteoarthritis risk factors

A
  • Age
  • Female
  • *Obesity- most modifiable risk factor
  • Prev injury/sport activity/muscle weakness
  • Genetics/hx of inflammatory arthritis, joint/bone disorders
  • Occupations with repetitive motions
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2
Q

Osteoarthritis clinical manifestations

A
  • Progressive pain over time
  • Decreased ROM
  • Tenderness to touch around the joint
  • Bony and soft tissue swelling, deformity, and instability
  • *Crepitus (cracling or rubbing sound or feeling due to air or gas under the skin)
  • *Pain with activity that improves with rest = differentiating factor from RA
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3
Q

Morning stiffness osteoarthritis

A

< 30 minutes

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4
Q

Osteoarthritis medical management

A
  • Acetaminophen (mild-moderate pain): up to 4 grams daily, assess for liver disease
  • NSAIDs (severe pain, Acetaminophen refractory)- associated to GI, Cardiac, and Kidney
  • Intraarticular steroid injection (NSAID and Acetaminophen refractory)
  • Opioids: significant side-effects and habit- forming
  • Combination of Acetaminophen, NSAIDs, and Intraarticular injections
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5
Q

Osteoarthritis surgical management

A

Performed in the case of significant disability and severe pain
- Arthroscopic debridement (removes debris)
- Arthroscopic synovectomy (removes excess membrane)
- Surgical fusion
- Total joint replacement

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6
Q

Osteoarthritis complications

A
  • Chronic pain
  • Decreased function
  • Toxic effects of medication (acetaminophen-liver, NSAIDS-look below)
  • Can influence other comorbid conditions like DM and CAD – inability to exercise
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7
Q

Elderly & NSAIDs

A
  • Polypharmacy (interactions)
  • Multiple comorbidities
  • Possible renal insufficiency (NSAIDs can exacerbate)
  • Antiplatelets & anticoags: NSAIDs can cause more bleed
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8
Q

OA nursing assess

A
  • VS, weight, skin integrity,
  • Serum Cr

Joint deformities in hand:
- Bouchard’s nodes: proximal
- Herberden’s nodes: distal hand

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9
Q

OA nursing interventions

A
  • Administer meds (analgesics, anti-inflammatory) as ordered
  • Cold packs for painful joints
  • Heat packs for painful muscles
  • Encourage active ROM
  • Encourage use of assistive devices for ADLs and mobility
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10
Q

OA pt teaching

A
  • *Med adherence
  • *Med risks
  • Regular physical activity
  • Role of PT and OT in patient care
  • Home health aid if patient is alone and significantly disabled
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11
Q

NSAID OA pt medication teaching

A
  • Myocardial infarction (chest pain)
  • GI bleeding and ulcers (abdominal pain, blood in stool, or emesis)
  • Renal insufficiency (edema, weight gain)
  • Abnormal platelet function (bruising, abnormal bleed)
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12
Q

Rheumatoid arthritis

A

Autoimmune inflamm dz
- Unknown antigen triggers immune response –> produce collagenase, enzyme that breaks down collagen –> destruct of cartilage, erosion of bone

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13
Q

RA clinical manifestations - articular

A

WITHIN joint:
- Joint pain, swelling
- Erythema
- Morning stiffness
- Fatigue
- Rheumatoid nodules in SQ tissue over joints

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14
Q

RA diagnosis

A
  • 3 factors: labs, x-ray or ultrasound, clinical manifestation
  • Symmetrical joint pain
  • Morning stiffness > 30 min
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15
Q

RA clinical manifestations

A
  • *Symmetrical peripheral joint pain
  • *Morning stiffness > 30 min
  • Tenderness and synovitis by palpating joints individually
  • Symptoms persist > 6 weeks
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16
Q

RA medical treatment (1st line)

A
  • Analgesics (Acetaminophen or Opioids): pain relief
  • NSAIDs: reduce inflammation, and
  • Glucocorticoids (PO, IM, Joint, IV): reduce inflammation
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17
Q

RA medical treatment (2nd line)

A
  • Disease-modifying Antirheumatic Medication Therapy (DMARDS)
  • Methotrexate (1st line DMARD): Liver toxicity, oral ulcers, birth control (teratogen), assess for renal impairment
  • Immune system-altering drugs that alter the inflammatory response `
  • Assess TB status prior to therapy
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18
Q

RA medical treatment (3rd line)

A
  • Biologics (Monoclonal antibodies): Act on specific targets in the inflammatory cascade → interrupts the immune response and decreases inflammation
  • Rituximab, Infliximab, Etanercept → given IV
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19
Q

RA nursing assess

A
  • VS (high temp = infection, tachy/tachypnea = pain)
  • Pain assess
  • Mobility assess (gait = decreased range of motion)
  • Resp, cardiac, eyes: pleural effusions, pleurisy, pericarditis, scleritis, episcleritis
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20
Q

RA lab nursing assess

A
  • CRP & ESR (inflamm)
  • Monitor glucose (steroids)
  • Hgb (RA or GI bleed from NSAIDS)
  • Serum albumin (worsen dz)
  • Platelet count (inflamm)
  • Liver & renal function (meds)
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21
Q

RA nursing interventions

A
  • Administer medications as ordered: analgesics, anti-inflammatory, glucocorticioids, DMARD therapy-methotrexate, biologics
  • Nonpharmacological pain management
  • Assist with ROM
  • Maintain safety- fall precautions if unsteady gait
  • Psychosocial support
22
Q

RA pt teaching

A
  • Med adherence
  • Report S&S of infection, active infection = discontinuation of immunosupress meds
  • Refer to PT/OT
  • Atypical/chronic infection shud be addressed w infectious dz specialist
23
Q

Systemic Lupus Erythematous triggers

A
  • Pregnancy
  • Sunlight exposure
  • Illness
  • Major surgery
  • Silica dust
  • Medication allergies
24
Q

SLE clinical manifestations - mucocutaneous

A
  • Malar rash (“butterfly rash”) over cheeks
  • Erythematous plaques covered by scale appearing in sun-exposed areas
  • Oral ulcers
  • Urticaria (hives)
25
Q

SLE clinical manifestations - musculoskeletal

A
  • Joint paint w or w/o synovitis
  • Muscle pain and weakness
26
Q

SLE clinical manifestation - renal

A
  • Lupus nephritis (glomerulonephritis)
27
Q

SLE diagnosis

A
  • Positive ANA
  • Must have 4/17 (at least 1 clinical and 1 immunological) criteria to support a diagnosis of SLE
28
Q

SLE medical management

A

Plaquenil, NSAIDS, Glucocorticoids, Immunosuppressants (Methotrexate)

29
Q

SLE non-pharmacological management

A
  • Avoid prolonged sun exposure – use sunscreen daily (SPF >50)
  • Well-balanced diet
  • Frequent rest periods, regular sleep
  • Regular exercise to improve strength and maintain ROM
30
Q

SLE complications

A
  • Renal failure from lupus nephritis
  • Premature heart disease
  • Interstitial lung disease
  • Hypercoagulation
  • Stroke
  • Avascular necrosis of joints
  • Increased risk for infection
  • Complication from pharmacological therapy
31
Q

SLE nursing assess

A
  • VS (temp = infection, HTN = renal/cardiac dz)
  • Past health hx & head-toe assess
  • Labs: CRP & ESR, BUN/Cr, Urinalysis, Coag studies
32
Q

Plaquenil

A
  • Med for SLE
  • Block immune complex –> reduce constitutional symptoms
  • Prevent dz flares and organ dz
  • SE: abd pain & nausea
  • *Baseline eye exam & biannual/annual eye exams d/t renal toxicity
33
Q

SLE nursing intervention

A
  • Administer medications as ordered: NSAIDs, Analgesics, Glucocorticoids, Plaquenil, Biologics
  • Psychosocial Support
  • Daily weights, intake, and output, sodium restriction, of Lupus nephritis
34
Q

SLE pt teaching

A
  • *Dz process education
  • *Avoid live vaccines (immunosuppression) + vaccines up-to-date
  • *Avoid oral contraceptives in patients with raynaud’s phenomenon & hx of phlebitis (oral contraceptions could cause a hypercoaguable states)
  • Daily sunscreen use
  • Energy conservation and activity prioritization
35
Q

Gout risk factors

A
  • *Eating large amounts of meat and seafood (purine- rich foods increase uric acid production)
  • *Consuming large amounts of alcohol (purine-rich)
  • Obesity
  • HTN
  • Thiazide diuretics increase urate reabsorption (which increases serum uric acid levels)
36
Q

Gout clinical manifestations

A

-*Usually affects a lower extremity joint - typically the first metatarsophalangeal (MTP) joint called Podagra Last 12-24 hours
- Acute gout: involves one join, acute onset of pain, redness, and swelling
- Intercortical gout: asymptomatic between gout attacks
- Chronic tophaceous gout: repeated attacks over years leading to tophi (uric acid deposit in the joint) and joint destruction

37
Q

Gout kidney stones

A

High UA leads to kidney stones

38
Q

Acute gout meds

A

Pain relief and reducing inflammation
- NSAIDs, (indomethacin and colchicine reduce uric acid crystals from building up in the joint)
- Glucocorticoids reduce inflammation and pain relief
- Never treated with uric acid lowering agents (Allopurinol) as it could worsen gout attacks

39
Q

Chronic gout meds

A
  • Uric-acid lowering agents
  • Allopurinol or Febuxostat reduces serum uric acid by inhibiting its production
40
Q

Gout nursing assess

A
  • Monitor uric acid levels
  • Tophi (bumps, hard masses) under the skin or around joints
  • Red and painful joints indicative of a gout flare
  • Pain levels
  • Urinary symptoms or flank pain
41
Q

Gout nursing intervention

A

Administer medications as ordered in the appropriate situations:
- Analgesics
- Anti-inflammatory agents
- Uric acid lowering agents (chronic gout)
- Glucocorticoids

42
Q

Gout pt teaching

A
  • Avoid purine-rich food and alcohol
  • Medication adherence for UA lowering agents
  • Report gout flares immediately as prompt treatment decreases flare severity and pain
  • Weight reduction through exercise and diet modification
43
Q

Osteoarthritis

A

Degenerative dz of joints

44
Q

RA clinical manifestations - extra-articular

A
  • Osteopenia
  • Muscle weakness
  • Episcleritis
  • Scleritis
  • Pleuritis
  • Pleural effusion
  • Pericarditis
  • Enlarged spleen
  • Anemia
45
Q

Amputation nurse assess

A
  • VS for infection
  • Pulses, temp, color, movement of affected extremity
  • Pain: phantom pain
  • Wound incision site
  • Hgb and Hct for hemorrhage
46
Q

Amputation nursing intervention

A
  • Insert large bore IV: IV blood & fluid resuscitate
  • Transfusions as ordered
  • Analgesic meds as ordered
  • Alternative pain management technqiue: CAM
  • No pillow under portion of lower extremity d/t flexion contraction
  • Apply ice
  • Nutrition, ROM, application of rigid splint
47
Q

Amputation pt teaching

A
  • Meds, nutrition & hydration
  • Wrap limb w compression dressing: figure 8 technique
  • Wound care
  • S&S of infection
  • ROM exercise
  • Community support
48
Q

Phantom limb pain

A
  • Numbness, tingling, and sharp burning are perceived in the removed limb or distal remaining limb
  • Exacerbated by weather changes, stress, nervousness, exhaustion
49
Q

Neuroma

A

Regeneration of clumps of nerve axons in the distal end of the residual limb after amputation (inevitable)
- *Mostly in UE but can be in any limb
- Cause problems with prosthesis fitting

50
Q

Amputation complications

A

Neuromas, phantom limb pain

51
Q

Medical intervention before elective amputation

A
  • Hyperbaric therapy: 100% O2 under pressure in a hyperbaric chamber
  • Percutaneous transluminal angioplasty: to open the artery and restore blood flow
  • Anticoagulant therapy
  • Resection of the tumor and bone grafting (neoplasms)
52
Q

Immediate concerns in traumatic amputation

A
  • Achieving hemostasis (stop bleed)
  • Fluid resuscitation (blood prods, IV fluids to correct hypovolemia)

MedSurg (15 decks)

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