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Nurs 343 Adult Health 1 > Exam 1 Material: Rheumatoid Arthritis and Osteoarthritis > Flashcards

Exam 1 Material: Rheumatoid Arthritis and Osteoarthritis Flashcards

1
Q

True or false. Is Osteoarthritis an autoimmune disorder?

A

False

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2
Q

What is Osteoarthritis?

A

Progressive deterioration of the articular cartilage at the joints, creating bone spurs at the joint ends. The body’s ability to repair cartilage eventually cannot keep up with the destruction of OA.

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3
Q

What are the risk factors for Osteoarthritis?

A

Obesity

Age

Sedentary Lifestyle

Joint injury,

Inflammation,

Trauma

Neuropathy

Mechanical stress

Skeletal deformities

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4
Q

When do symptoms and damages from OA appear?

A

Damage from OA starts from young adulthood. Symptoms manifest in middle age and older adulthood.

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5
Q

True or False. Incidence of OA is higher in males after age 50?

A

False. It is females.

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6
Q

True or false. Over half of those 65 years and older have OA?

A

True

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7
Q

How is neuropathy a risk factor for OA?

A

Neuropathy desensitizes pain. If the patient is unaware of joint pain, then the patient may overuse the joint without knowing.

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8
Q

What type of activities would cause mechanical stress which could lead to OA?

A

Any repetitive activities. Examples include sports, high impact exercises, weightlifting, Factory Workers.

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9
Q

How is OA diagnosed?

A

Through X-ray, CT, MRI or Bone scans. There are no Lab tests for OA

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10
Q

What are the Clinical Manifestations of OA?

A

Joint Pain and Stiffness. From mild to severe.

Increased Joint pain with activity but relieved with rest.

Disrupted sleep

Increased Pain as barometric Pressure decreases ( ie: Rainy weather)

Asymmetrical joints are affected

Heberden’s nodes at distal interphalangeal joints

Bouchard’s nodes at proximal interphalangeal joints

Crepitation (grating sensation due to loose cartilage particles in the joint) in one or more affected joints

Referred Pain

Joint stiffness when at rest, relieved once joint is moving. Resolved within 30 minutes.

Deformed joints are Red, swollen, and Tender.

Limping gait due to hip or knee pain

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11
Q

What are the most affected joints for OA?

A

Distal and proximal interphalangeal joints of the fingers, and weight bearing joints such as cervical, vertebrae, lower lumbar vertebrae, Hip, and knee joints.

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12
Q

What medications can be given for OA?

A

Acetaminophen, (first choice) NSAIDs, (Only if acetaminophen didn’t work) Topical Salicylates (Aspercreme), menthol (bengay), glucocorticoids, (Reduce inflammation ) opioids (hydrocodone and oxycodone : For severe pain)

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13
Q

What is the first medication usually given for management of OA?

A

Acetaminophen. For mild to moderate joint pain

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14
Q

What should be monitored for acetaminophen?

A

Liver enzymes.

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15
Q

What should the nurse teach to the patient if they want to NSAIDs for their joint pain?

A

Take food with NSAIDs to prevent GI distress. There is an increased risk for GI bleed with long term use of NSAIDs

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16
Q

What herbal supplements patients might take for their OA joint pain?

A

Ginger (reduce inflammation)

Glucosamine (reduce inflammation)

Topical Capsaicin (block pain impulses)

Chondroitin (Strengthen cartilage)

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17
Q

What are the nonpharmacological care of plans for OA?

A

Balance activity with rest

Good anatomical position

Avoid long periods of standing, kneeling, and squatting.

Start using an assistive devices

Weight loss ROM exercises to alleviate stress on joints

Heat therapy on joints to help with joint tenderness and muscle stiffness

Cold therapy on joints to help reduce inflammation and numb nerve endings.

Tai chi, Massage, Meditation and Yoga

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18
Q

What is glucocorticoids used for OA?

A

immunosuppression in order to treat local inflammation. It is an injection to the affected joint. No more than 4 shots per year.

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19
Q

When should cold and hot therapy not be used for relieving joint pain?

A

IF the patient has neuropathy.

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20
Q

What is the last intervention that can be done for joint pain from OA?

A

Total joint arthroplasty or Replacement. This is done if all other measures fail and the pain is uncontrolled. This is contraindicated with any type of infection, advanced osteoporosis or rapidly progressive inflammation.

21
Q

What should be monitored if the patient is taking NSAIDs for their OA joint pain?

A

Kidney functions. BUN and Creatinine. Watch for GI bleed with signs of black tarry stool, indigestion and SOB

22
Q

How can a patient prevent OA from forming?

A

Avoid joint trauma Use safety measures to prevent injury Avoid smoking Maintain healthy weight Regular low impacting exercise like biking and swimming

23
Q

What are some ways a patient can prevent further damage to their joints? (aka joint protection)

A

Maintain healthy weight Use assistive device if indicated Avoid forceful repetitive movements Good posture and proper body mechanics Seek assistance with tasks when needed Pace tasks and activities

24
Q

Nursing Assessment questions regarding OA?

A

Assess type, location, severity, frequency, and duration of the patient’s joint pain and stiffness

What makes the pain worse or better?

Is the joint pain affecting the patient’s ability to perform ADLs?

What are the patient’s pain management practices?

Were those pain management practices successful?

Assess tenderness, swelling, limitation of their ROM and crepitation of affected joints.

Compare affected joint with an opposite, non-affected joint.

25
Q

True or false. OA is a chronic, localized disease. Severe, deforming arthritis is not normal.

A

True

26
Q

What are the expected outcomes with OA patients?

A

Experience adequate rest and activity Achieve satisfactory pain management Maintain joint flexibility and muscle strength through joint protection and therapeutic exercise Verbalize acceptance of OA as a chronic disease, collaborating with HCPs in disease management.

27
Q

True or False. Pain may not correlate with joint damage seen on X ray

A

True

28
Q

An X ray was done on a OA patient. What are some expected findings on the xray?

A

Joint space narrowed

Osteophytes

Subchondral cysts

Sclerosis

29
Q

What is Rheumatoid Arthritis?

A

Chronic, progressive, systemic autoimmune disease that affects tissues and organs. The synovial membranes of the joints are going through inflammation due to Rheumatoid Factor autoantibodies. This results in cartilage destruction and bone erosion.

30
Q

What is the disease progress of RA?

A

Exacerbations and remissions

31
Q

What is the age of diagnosis peak for RA?

A

30-60

32
Q

What are the initial nonspecific symptoms for RA?

A

Fatigue Weight loss anorexia Generalized stiffness

33
Q

What are the specific symptoms to RA?

A

Symmetrical joint stiffness and pain

Morning stiffness that can last for 1 hour.

Increased Pain and stiffness at rest or after immobility

Limited ROM due to pain and joint swelling

Signs of inflammation at affected joints : Redness, swelling, heat, pain and tenderness

Contractures

Joint deformities of bilateral hands and feet (late sign of RA)

34
Q

Match the terms with the Picture

A

A = Ulnar Drift B = Boutonniere deformity C = Hallux Valgus D = Swan Neck deformity

35
Q

What diagnostic tests can be used to diagnosis a patient with RA?

A

Anti-CCP antibodies (shows as positive in patients with RA) = Specific for RA

Rheumatoid Factor Antibody (80 percent of patients with RA shows a high level of RFA)

Erthrocyte Sedmientation Rate (ESR) and C-reactive protein (CRP) = inflammatory markers.. Increased levels just indicate that there is inflammation in the body. Not specific for RA

Antinuclear Antibody (ANA) = Positive ANA can indicate for RA. Specific for RA

Synovial Fluid analysis = Elevated WBC would indicate RA

Tissue Biopsy = Used to confirm inflammatory changes in the synovial membrane

Bone scan = Used for early detection of joint changes and confirming RA diagnosis.

36
Q

What drugs are involved with the medication therapy for RA?

A

NSAIDS

DMARDS

Corticosteroids

Biologic Response Therapy Drugs

37
Q

What are NSAIDs given for RA?

A

To reduce inflammatory effects.

Usually the first medication used to manage RA

38
Q

What are corticosteroids given for in RA?

A

Strong anti-inflammatory effects.

Not given for long term use due to ASE of Hyperglycemia, osteoporosis, immunosuppression

Watch for signs of black, tarry stools, increased blood glucose, impaired healing.

39
Q

What type of corticosteroid is given for an RA patient?

A

Prednisone. Given for a short term use.

40
Q

What drugs are considered as Biologic Response modifiers?

A

Etanercept (enbrel) and adalimumab (Humira)

41
Q

How can Biologic Response Modifiers help patients with RA?

A

Can slow down disease progression in RA.

Inhibits inflammatory Response

Administered through SQ

Can be taken as monotherapy or as combination therapy with DMARD.

42
Q

What are DMARDS?

A

Disease-MOdifing Antirheumatic Drugs

43
Q

How does DMARDS help patients with RA?

A

DMARDS can slow down disease progression and decrease risk of joint erosions and joint deformity.

Earlier DMARDS are given to a newly diagnosed RA patient, the better chance of preventing irreversible damage to the affected joints.

44
Q

What DMARD should you be cautious with?

A

Methotrexate. It is because the ASE of MEthotrexate are Bone marrow suppresion and hepatotoxicity.

45
Q

What lab values should you be monitoring for a patient on Methotrexate?

A

CBC for bone marrow supression. Look for thrombocytopenia.

Liver enzymes AST and ALT for hepatotoxicity.

46
Q

What kind of surgeries can be done to allievate RA?

A

What kind of surgeries can be done to allievate RA?

Total Joint Arthroplasty = Surgicial replacement/repairment of affected joiint.

Synovectomy = Surgical removal of the synovial membrane surrouding the affected joint.

PLasmapheresis = Removing circulating antibodies from plasma, decreasing attacks on client’s tissues. Done only for severe, life threatening exacerbation.

47
Q

True or False. One of the interventions for RA is to provide a high calorie, high protein diet.

A

False. The RA patients usually do not need a special diet. Their goal would be to maintain a healthy weight.

48
Q

What are the non-pharmacological interventions for RA?

A

Hot and Cold Therapy ( 10 minutes on, 10 minutes off)

Soaking in warm water.

Hot showers for morning stiffness

Heated paraffin for pain in hands

Cold therapy for Edema

Rest

Pace activities

Exercise programs and ROM exercises

Avoid heavy lifting

Provide emotional support

Joint protection = Joint splints, rest or using assistive devices.

Nurs 343 Adult Health 1 (14 decks)

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