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2024DM Med Surg > connective tissue disorders part 1 > Flashcards

connective tissue disorders part 1 Flashcards

1
Q

Osteoporosis, osteoarthritis, rheumatoid arthritis, gout, or scoliosis may have some

A

genetic basis

Autoimmune diseases, e.g., thyroid disorders

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2
Q

is aproteinfound in the blood, the levels of which rise in response toinflammation

A

C-reactive protein(CRP)

i.e., C-reactive protein is an acute-phase protein

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3
Q

is produced by the liver. The level ofrises when there is inflammation throughout the body

A

C-reactive protein

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4
Q

Drug therapy

A

Anti-inflammatory drugs:

* * Glucocorticoids
* * Nonsteroidal anti-inflammatory drugs (NSAIDs)
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5
Q

work like NSAIDs without the side effects of GI

distress, but may  risk of MI or CVA

A

Cyclooxygenase-2 (COX-2) inhibition

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6
Q 
Most common
  Non-inflammatory condition
  Primary cause– aging
  Secondary – trauma, infection
  Affects joints under pressure (knees, spine, hips)
A

Osteoarthritis

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7
Q

Drug therapy

Osteoarthritis

A

Acetaminophen for pain

NSAIDs, DMARDs (disease-modifying anti-rheumaticdrugs), COX-2 inhibitors, or low dose of salicylates (aspirin)

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8
Q

Surgery

Osteoarthritis

A

Arthroscopic

Arthroplasty

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9
Q

Nursing Assessment

Osteoarthritis

A

Joint pain or tenderness
Examine joints for crepitus, enlargement, deformity, and decreased range of motion
Compare affected and unaffected joints to detect abnormalities
Determine how the disease affects the patient’s mobility and ability to perform activities of daily living
** 8 Critical Characteristics
Support joint during assessment

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10
Q

Nursing Care following Total Joint Replacement Surgeries

Assessment

A

Vital signs, level of consciousness, intake and output, respiratory and neuro-vascular status, urinary function, bowel elimination, wound condition, dressing intact, and comfort
Circulation and sensation in the affected extremity

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11
Q

Signs and symptoms

Rheumatoid Arthritis

A

Pain in affected joints aggravated by movement
Morning stiffness lasting more than 1 hour
Weakness, easy fatigability, anorexia, weight loss, muscle aches and tenderness
Warmth and swelling of the affected joints
Joint changes are usually symmetric
Rheumatoid nodules (subcutaneous, over bony prominences)
Any organ may be affected
Inflammation in tissues of heart, lungs, kidneys, eyes
blood vessels can be affected causing vasculitis
May develop a cluster of symptoms
Sjögren (show-gren): dryness of mouth, eyes and vagina
Felty: (less common) liver and speen enlargement, neutropenia
Caplan: rhuematoid nodules in the lungs

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12
Q

Medical diagnosis

Rheumatoid Arthritis

A

Laboratory studies
RF (rheumatoid factor), ESR (erythrocyte sedimentation rate), and CRP (C-reactive protein)
MRI, bone scans, and DEXA scans (Dual-energy X-ray absorptiometry
Ulnar drift
Boutonniere deformity
swan neck deformity
rheumatoid deformity

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13
Q

Drug therapy

Rheumatoid Arthritis

A

Aspirin and other NSAIDs for several months, with the addition of gold compounds, d-penicillamine, antimalarials, or sulfasalazine if needed

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14
Q

Surgery

Rheumatoid Arthritis

A

Arthroplasty, synovectomy, tenosynovectomy (to release the tightened tendon sheath), and arthrodesis (joint fusion)

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15
Q

Medical treatment

Rheumatoid Arthritis

A

Cortisone injections
Rest
Splinting joints
Orthotic devices

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16
Q

Nursing Assessment

Rheumatoid Arthritis

A

Pain, joint swelling, tenderness
joint deformities and limitation of movement
fatigue and decreased ability to perform activities of daily living

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17
Q

Bone is constantly formed and absorbed
Until adolescence, bone formation exceeds bone absorption so that bones grow and strengthen
Around age 30, bone absorption surpasses formation
Loss of trabecular bone, innermost layer, occurs first
Loss of cortical bone, hard outer shell, begins later
Begins earlier and progresses faster in women than in men
Result is loss of bone mass

A

Osteoporosis

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18
Q

1° Osteoporosis =

A

aging w/o etiology; 2° Osteoporosis due to factors other than aging (e.g. long term steroid use)

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19
Q

Risk factors

Osteoporosis

A

Older women who have small frames, who are white or of
northern European heritage

Have fair skin and blond or red hair
Estrogen deficiency or have had bilateral oophorectomy
Physical inactivity or immobility
Low body weight, inadequate calcium, protein, or vitamin
D intake
Corticosteroid therapy over more than 6 months
Excessive use of cigarettes, caffeine, and alcohol

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20
Q

Signs and symptoms

Osteoporosis

A

Back pain, fractures, loss of height due to vertebral compression, and kyphosis
Bone deterioration in the jaw can cause dentures to fit poorly
Collapsed vertebrae can cause chronic pain

21
Q

Medical treatment

A 
Calcium supplementation (1500mg/day postmenopausal w/o estrogen replacement) with Vitamin D
Calcium supplementation (1000mg/day postmenopausal with estrogen replacement) with Vitamin D
Bisphosphonates and selective estrogen receptor modulators (Fosamax or Actonel) 
Regular exercise 
Percutaneous vertebroplasty (cement injected to vertebrae)
22
Q

Nursing Assessment

A

Diet, calcium intake, and exercise plan
Note whether the patient is menopausal or has had an oophorectomy
Compare height with previous measurements
Posture; note the presence and degree of deformity, pain level

23
Q

Characterized by hyperuricemia

Related to excessive uric acid production or decreased uric acid excretion by the kidneys

A

Gout

24
Q

Four stages

Gout

A

Asymptomatic hyperuricemia
Acute gouty arthritis
Asymptomatic intercritical period
Chronic tophaceous gout

25
Q

Signs and symptoms
Asymptomatic hyperuricemia
Gout

A

Blood uric acid level is elevated, but no other symptoms

Many people with asymptomatic hyperuricemia never progress to the next stage

26
Q

Signs and symptoms
Acute gouty arthritis
Gout

A

Onset is abrupt, usually occurs at night
The patient is suddenly afflicted with severe, crushing pain and cannot bear even the light touch of bed sheets on the affected joint
Joint commonly affected is the great toe
Symptoms usually disappear within a few days

27
Q

Signs and symptoms
Asymptomatic inter-critical period
Gout

A

No symptoms

28
Q

Chronic tophaceous gout

A

Advanced gout

Tophi: deposits of sodium urate crystals that are visible as small white nodules under the skin

29
Q

Medical treatment

gout

A

Asymptomatic hyperuricemia requires no medical treatment
NSAID alone or with colchicine for acute gouty arthritis (give q hour until pain eases or N/V starts)
For subsequent attacks: indomethacin (an NSAID), corticosteroids, and corticotrophin
Prednisone may be injected into single joint
Avoid foods high in purines
Allopurinol to inhibit uric acid synthesis

30
Q

Nursing Assessment

gout

A 
Pain and joint swelling 
P/A tophi, uric acid stones 
Fever  
History of trauma, injury, or surgery
When taking colchicine, monitor labs for abnomalities in blood cell counts…. Fatal blood dyscrasia have occured
31
Q

Multi-system autoimmune disease of unknown origin, thought to be the result of 1° vessel injury or dysfunction of immune system
Term came from symptom of hardening of skin
Other organs affected include: Primary vessel, GI tract, lungs, heart and kidneys
Progressive manifestations: from inflammation to degeneration of tissues, that results in decreased elasticity, stenosis, and occlusion of vessels
onset between age 30-50

A

Progressive Systemic Sclerosisalso called Scleroderma

Term Scleroderma came from symptom of hardening of skin

32
Q

– thickening of skin and systemic effects

A

Progressively fatal sclerosis

33
Q

calcium deposit in tissues

CREST Syndrome:

A

Calcinosis:

34
Q

vascular spasms

CREST Syndrome:

A

Raynaud’s phenomenon:

35
Q

scleroderma of the digits

CREST Syndrome:

A

Sclerodactyly:

36
Q

dilated superficial blood vessels

CREST Syndrome:

A

Telangiectasis:

37
Q

Progressive Systemic
Sclerosis
Signs and symptoms

A 
Raynaud’s phenomenon 
 Symmetric painless swelling or 
  thickening of the skin
 Taut and shiny skin 
 Morning stiffness
 Frequent reflux of gastric acid
 Difficulty swallowing, 
 Weight loss, 
 Dyspnea, 
 Pericarditis
 Renal insufficiency
38
Q

Medical treatment

Progressive Systemic Sclerosis

A

No cure
High doses of steroids or other immunosuppressants may bring about remission
Physical therapy
Antihypertensives; d-Penicillamine (chelator drug: the process of removing a heavy metal from the bloodstream by means of a chelate as in treating lead or mercury poisoning)

39
Q

Assessment

Progressive Systemic Sclerosis

A

Pain and stiffness in the fingers; intolerance for cold
Signs and symptoms suggestive of cardiovascular, respiratory, renal, and gastrointestinal problems
Skin rash, loss of wrinkles on the face, limitations of joint range of motion, muscle weakness, and dry mucous membranes
Examine the hands for contractures of the fingers and for color changes or lesions on the fingertips
Palpate the fingers to determine warmth

40
Q

chronic disorder of spine and surrounding cartilaginous joints

A

Ankylosing Spondylitis

41
Q

multi-system antibody destructive disorder

A

Systemic Lupus Erythematosus:

42
Q

inflammation of the bursa sac

A

Bursitis:

43
Q

chronic syndrome of muscle pain

A

Fibromyalgia:

44
Q

: infection of the bone

A

Osteomyelitis:

45
Q

bacterial tick bite

A

Lyme Disease

46
Q

: loss of bone density

A

Osteoporosis:

47
Q

metabolic disease (softening re low Vit. D)

A

Osteomalacia:

48
Q

deformity of the great toe

A

Bunions (Hallux Valgus):

2024DM Med Surg (35 decks)

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