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Nursing Semester 3 > Cyndi - Week 16 - Exam 7 > Flashcards

Cyndi - Week 16 - Exam 7 Flashcards

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1
Q

what is scleroderma?

A
  • autoimmune affects connective tissue - inflammation, sclerosis, and fibrosis
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2
Q

what is arthritis?

A

progressive deterioration of synovial joints

  • osteoarthritis
  • rheumatoid arthritis
  • gout
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3
Q

what are the characteristics of osteoarthritis?

A

Occurs in synovial joints:
• Not normal aging process
• Stress on joints – excessive load or damaged joint
• Excessive pressure breaks down cartilage
• Inflammatory response further degrades cartilage
• Chondrocytes (cartilage producing cells) repair
damage, but over time there is erosion of
cartilage, and bone beneath becomes exposed
• Osteocytes deposited – bony spurs
• Heberden’s and Bouchard’s nodes
• Usually asymmetrical

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4
Q

what are the risk factors of OA?

A
  • Age
  • Gender
  • Obesity
  • Sedentary lifestyle
  • Occupational
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5
Q

what are the causes of OA?

A
  • Trauma
  • Mechanical stress
  • Inflammation
  • Joint instability
  • Neurological disorders
  • Skeletal deformities
  • Hematologic/endocrine
  • Medications
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6
Q

what are the clinical manifestations of OA?

A

No systemic involvement – symptoms are joint‐specific
• Pain – from bone against bone, bone spurs, nerve impingement
• Especially after exercise or weight bearing, relieved with rest
• Sleep disturbances from pain
• Crepitation
• Asymmetrical
• Fingers, hip, knee, spine, and cervical joints most common
• Bouchards and/or Heberden’s nodes
• Movement increases pain
• Joint stiffness, decreased ROM in joint

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7
Q

what are the labs used for OA?

A 
**Biochemical markers
• Serum osteocalcin
• Hyaluronic acid levels (component of syn. fluid)
**Rule out rheumatoid arthritis
• Rheumatic Factor  ‐ negative
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8
Q

what are the radiology used for OA?

A

• X‐ray ‐– confirmation and staging
• Degree of disease seen may not correspond to degree of symptoms
Bone scan, CT, MRI – for diagnosis

**Synovial Fluid Analysis ‐ differentiate OA from RA

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9
Q

TEACHING POINT: what are the goals for OA tx?

A

Goals –manage pain, prevent disability, improve joint use

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10
Q

what are the different methods of pain control for OA?

A
  • Salicylates
  • NSAIDs
  • Hyaluronic acid
  • Glucosamine, chondroitin, MSM
  • Topical
  • Cortisone
  • Heat and ice
  • Alternative therapies
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11
Q

what is the pt education for OA?

A
  • Balance of rest and joint protection
  • Nutrition
  • Weight reduction
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12
Q

is surgery possible for OA?

A

yes!

- replacement of degenerative joint and arthroscopy

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13
Q

what are the complications of OA?

A

usually just local joint breakdown causing

decreased mobility

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14
Q

what is rheumatoid arthritis?

A

Chronic autoimmune, inflammatory disorder that affects the joints and may have systemic affects

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15
Q

what are the characteristics of RA?

A
  • Inflamed connective tissue in synovial joints
  • Extra‐articular (systemic) symptoms may occur
  • Process of destruction
  • Exacerbations and remissions
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16
Q

what are the risk factors for RA?

A
  • Any age
  • Women 2‐3x more
  • Cause unknown
  • Genetic – 50% of risk?
  • Hormones?
  • Infection?
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17
Q

what are the 4 stages of RA?

A

Stage 1 - mild; early, beginning, not ID’d on XRay
Stage 2 - moderate, joint stiffness, swelling
Stage 3 - severe; subluxation (stretching), risk for infection d/t bump
Stage 4 - terminal; bony growth, results in fusion of joint, immobility

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18
Q

what are the RA joint specific symptoms? TP*

A

• Symmetrical
• Inactivity causes stiffness
• Pain lessens with movement (but
worsens with overuse)
• Pain, stiffness, limited motion, heat, swelling
• Frequently small joints, but can include large joints and
cervical spine
• Severe results in distortion, subluxation,
dislocation
• Sometimes have “swan neck” deformity TP

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19
Q

what are the RA non-joint specific symptoms?

A

Fatigue, anorexia, wt. loss, stiffness – insidious onset
• Rheumatoid nodules
• Cardiopulmonary effects (pericarditis → late stages)
• Sjogren’s syndrome (↓ lacrimal/saliva secretion → dry)
• Felty syndrome (severe nodules → splenacromegy → leukopenia)
• Cataracts
• Depression

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20
Q

what are the complications of RA?

A
  • Increased deformity, infection/sore from nodules
  • Dec ability to perform ADLs
  • Visual changes/loss
  • Cardiovascular disease, vasculitis
  • Pulmonary changes – Pulmonary HTN, pleural effusion
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21
Q

what are the diagnostics for RA?

A 
• X‐ray – can be inconclusive, but if seen:
- Joint narrowing, erosion
- Baseline comparison
- Subluxation, dislocation
• Labs
• Synovial fluid analysis
• Biopsy of synovium
• Bone scan
• Diagnostic criteria for RA
22
Q

what labs are used for RA?

A
  • WBC, ESR, CRP
  • RF positive (80%)
  • ANA
  • Biomarkers – ACPA positive (70%)
23
Q

TP: if an RA med is given and there is improvement, which lab would go down?

A

CRP → inflammation is ↓

24
Q

look at tx for RA

A

READ

25
Q

look at differences between OA and RA

A

READ

26
Q

what is gout?

A

Joint disorder of recurrent inflammation
that is triggered by hyperuricemia
• Uric acid comes from purine catabolism, and is
excreted by the kidneys • 5% of those with hyperuricemia develop gout

27
Q

what are the causes of gout?

A
  • Increase in uric acid production
  • Decrease in uric acid excretion (80‐90%)
  • Increase in uric acid consumption (food)
28
Q

what are the causes of the joint inflammation?

A

Joint inflammation:
• Uric acid crystals deposited within joint
• 1 to 4 joints in acute attacks – especially great toe
**Primary versus secondary gout

29
Q

what are the risk factors of primary gout?

A
  • Obese
  • Middle‐aged male
  • AfricanAmerican men 2 x Caucasian men
  • Rare in premenopausal females
  • HTN
  • Prolonged fasting
  • Excessive alcohol drinking
  • Heavy purine intake (diet of meat, seafood)
  • Long term thiazide diuretic use – side effect
30
Q

what are the risk factors of secondary gout?

A

– due to complications of other
problems
• Chemo, medications, trauma, chronic illness

31
Q

what are the diagnostic tests used for gout?

A
  • Serum uric acid levels above 6 mg/dL
  • 24 hour urine uric acid
  • X‐ray
  • Synovial fluid aspiration – urate crystals
  • Rule out other causes, ie:“pseudo gout”
32
Q

what are the sxs of gout?

A
  • Sudden onset of pain in affected joints
  • Especially the joint of the great toe
  • Swelling
  • Tophi (stone, other growth of joint space)
  • Dusky or reddened appearance (looks like infection)
33
Q

what is the tx for acute attacks of gout?

A
  • NSAIDS
  • Colchicine + NSAIDs
  • Corticosteroids
34
Q

what is the ongoing tx for gout and the patient education?

A

• Dietary changes and avoidance of alcohol
• Allopurinol: xanthine oxidase inhibitor (blocks uric
acid production)
• Probalan: improves uric acid removal
• Heat or cold treatment
• Immobilization of joint
• Treat pain

35
Q

what is systemic lupus erythematosus? SLE

A

Multi‐system auto‐immune disease characterized

by autoantibodies

36
Q

what are the characteristics of SLE?

A
  • Sudden or insidious onset
  • Chronic and unpredictable
  • Exacerbations and remissions
  • Symptoms and severity varies
  • Large variety of antibodies involved
  • Human Leukocyte Antigen positive
  • Increased risk of infection
37
Q

what are the risk factors of lupus (SLE)?

A
  • Genetically linked
  • Women 10 x men, esp. in the childbearing years
  • Ethnicity – African and native American, Asian, Hispanic
  • Others:
  • Hormones
  • Environment
38
Q

what are the complications of lupus (SLE)?

A
  • Kidney failure
  • Brain and nervous system problems
  • Anemia, vasculitis
  • Pleurisy, pneumonia
  • Pericarditis, cardiovascular disease
  • Pregnancy complications
  • Psychosocial issues
39
Q

what are the exacerbation and remission pattern of lupus?

A
  • Fever, fatigue, anorexia & wt loss

* Arthralgia – swollen, reddened joints

40
Q

what are the skin sxs of lupus?

A
  • Red rash, often on face, sun‐sensitivity, often butterfly rash TP*
  • Mouth ulcers, patchy hair loss w/rash on scalp
41
Q

what are the musculoskeletal sxs of lupus?

A

– Arthritis 90%, bone deformities

42
Q

what are the cardiopulmonary sxs of lupus

A

advanced disease – dysrhythmia, HTN, cough, tachypnea,

cholesterol elevation

43
Q

what are the renal sxs of lupus?

A

nephritis – 40% progress to renal failure

44
Q

what are the hematologic sxs of lupus?

A

anemia, coagulopathies, leukopenia

45
Q

what are the nervous system sxs of lupus?

A

seizures, headaches, neuropathy,
cognitive dysfunction, mood disorders, anxiety,
psychosis, memory deficits, disordered thoughts

46
Q

what are the diagnostic tests of SLE?

A
  • No specific test ‐ Diagnostic Criteria
  • Clinical picture
  • Labs:
47
Q

what are the labs for Lupus?

A
  • ANA – Anti‐nuclear antibodies (97%)
  • ESR
  • CRP
  • LE cell prep test
  • Anti‐Smith antibodies (30‐40%)
  • Anti‐DNA antibodies (HLA attack “self”)
  • CBC shows anemia, leukopenia, thrombocytopenia
  • Serum creatinine to monitor renal function
48
Q

what are the ACR diagnostic criteria?

A
  • skin criteria (butterfly rash, discoid rash, photosensitivity, oral ulcers)
  • systemic criteria (arthritis, serositis, kidney disorder, neuro disorder)
  • lab criteria (hematologic abnormalities, immunologic disorder, antinuclear antibody)
49
Q

what is the tx for SLE?

A

• NSAIDS – joint pain, inflammation
• Antimalarial drugs ‐ hydroxychoroquine
• Corticosteroids – limited to exacerbations
• Immunosuppressants ‐ methotrexate
• Topical immunomodulators for skin conditions
• Combinations of medications
• Other supportive care for goals of pain relief,
maintaining independent functioning and quality of life

50
Q

what is the pt education for SLE?

A

– identify triggers, compliance with

plan of care, support system

Nursing Semester 3 (29 decks)

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