Exam 1: Module 2 Flashcards
What is RA
- it is the inflammation of what
a chronic progressive autoimmune disorder
- inflammation of connective tissues and gradually affects joints producing synovitis
What is the pathophysiology of RA
- Synotivitis
- inflammation of the synovium
- synovial membranes become inflamed and thickens - Pannus formation
- Abnormal layer of vascula fibrous tissue that forms
- Inflammation extends into the cartilage and bones - Fibrous Ankylosis
- Joint begins to be invaded by fibrous connective tissue
- Joint deformity and bone erosion occurs - Bony Ankylosis
- Bones become fused together decresaing the joints ROM and function
what is the cause of RA
unknown
what is the most common form of arthritis in older adults
Osteoarthritis
What is the most ommon form of autoimmune arthritis
RA
does RA affect women or men more
Women, 3x more
Children <16 years of age but have arthritis is called what type of arthritis?
Juvenile Idiopathic Arthritis
What are the risk factors for RA (What makes people more prone to RA?)
Female
- age 30-60 yrs old
- Family Hx of RA
- smoking
- environmental factors
What are the clinical manifestations of RA
- does it happen fast or gradual?
- what are the 4 S’s
- what are other complaints and symptoms of RA?
Gradual onset
- 4 S’s
- symmetric joint pain discomfort (EARLY)
- Symptoms are typically BILATERAL
-Stiffness in the morning
- Swelling of the joints
Other complaints:
- Loss of mobility in joint
- Joint deofrmities (LATE DISEASE)
- early affects fingers, thumbs, toes, wrists
Other symptoms:
- Fatigue (early)
- low-grade fever
- weight loss
- depression
If a patient has RA, what other diseases have an increased risk for developing it?
- chronic inflammation accelerates the progressin of what cholesterol issue?
- Coronary Heart Disease
- Atherosclerosis
Because RA have an increased complication with CHD, what do they have an increased risk for?
- low HDL
- High LDL and triglycerides
- HTN
What diagnostic Tests show RA
Rheumatoid Factor (Obvious)
- Anti-Cyclic Citrullinated Peptide
- C-reactive protein (CRP)
- CBC
What pharmacological are used with RA?
What do DMARDS do?
- NSAIDS
- Corticosteroids
- DMARD’s
- slow the progression of RA and suppress the immune systems reaction to RA that causes pain & inflammation
- takes weeks for results
When taking Hydrochloroquine, what needs to be examined every 6 months?
An antimalarial rug, Eye exams need to be done every 6 months
What are the 3 surgical treatments for RA?
Synovectomy: Performed early in the disease process
- Removal of inflamed synovial membrane
Arthrodesis: Joint fusion to stabilize joints in the cervical vertebrae, writs, and ankles
Arthroplasty: Complete joint replacement may be needed if severe deformity or joint destruction not responded to medication
What are 2 complimentary health alternatives to surgery for RA
Acupuncture or Hydrotherapy
What are the 3 types of Juvenile Idiopathic Arthritis?
Pauciarticular arthritis:
- occurs more freq. in females
- affects primarily the knees, ankles, and elbows
- affects < 4 joints within 6 months
Systemic Arthritis:
- Symptoms of high fever, poly arthritis, and rheumatoid rash
- can affecet internal organs and joints
Polyarticular arthritis:
- Involves multiple joints (5 or more) within the first 6 months
- Typically affeects the SMALL JOINTS of hands and fingers, but can also affect other joints
What are the risk factors for JIA (What would increase the likelihood of developing JIA?)
- Immune susecptibility
- Environmental Triggers
- Genetic/Family Hx
- Female Gender
What are the. JIA symptoms
- Fever
- Rash
- Joint swelling and stifness
- mobility limitations
- Slow growth/uneven growth of extremities
- abnormal gait
- eye pain (Uveitis)
Just like RA patients are at risk for Cadiac complications, are JIA at the same risks?
Yes
Complication with JIA
- with there be changes in growth?
- can some joints be longer than others
yes and yes
What diagnostic tests would show JIA in children?
- CRP
- ESR
- CBC
- ANA
- Rheumatoid Factor
All increased levels would show
Is JIA treatment similar to RA patients?
Yes, use aspirin, NSAIDS, DMARDS, and monitor labs regularly
- Interprofessional collab. (PT, OT, Opthalmologist)
Discharge education for JIA
(PPATE)
provide - extra time or the child to complete ADL’s
Perform - ROM exercises are presribed
Apply - warm moist heat to affected joints
Take - meds as prescribed
Even - during exacerbation child should continue usual activities
What type of first dose is given immediatelty at birth
Hep B
Hep B has a series of 3 immunizations, when are they given
birth
- 1-2 months
- 6-18 months
How does Hep B spread
It spreads through bodily fluids and affects the liver
What vaccine is ONLY given orally?
What virus has the most common symptoms of diarrhea resulting in dehydration?
Rotavirus
what ages is rotavirus administered
orally at 2 and 4 months (Rotarix)
- 2,4, and 6 months (RotaTeq)
Which Diphtheria vaccine is for young children
DTaP
Which Diphtheria vaccine is for young for adults
Td or Tdap
Which Diphtheria vaccine is for young for preteens (11-12 yrs)
Tdap
Diptheria bacteria is spread through…
Coughing, sneezing, and touch
How is tetanus spread
found in soil and spreads through bloodstream such as a wound
How is pertrussis spread?
Coughing (aka whooping cough)
DTaP is a series of 5 immunizations. When are they scheduled?
2 months
4 month
6 months
15-18 months
4-6 years
Tdap is given how many times at what age? (Teen age, not infant)
1 time immunization at 11-12 yrs old, then booster every 10 years
HIB, what is it and what does it cause (clinical manifestations)
Causes invasive, life-threatening disease
- Blood infection
- Pneumonia
- Meningitis (inflammatin o membranes covering the brain and spinal cord
For HIB vaccine, how many doses and when
3 doses or 4 doses
3 doses
- 2 months
- 4 months
- 12-15 months
4 dose schedule
- 2 months
- 4 months
- 6 months
- 12-15 months
What is PCV and what is the dose schedule?
Pneumococcal conjugate
- prevent strep
- spread through resp. droplets
4 doses:
- 2 months
- 4 months
- 6 months
- 12-15 months
how does Polio spread?
- what is the vaccine schedule for IPV (Inactivated Polio Vaccine)
- Polio spreads mostly through exposure to feces
4 dose schedule:
- 2 months
- 4 months
- 6-18 months
- 4-6 years
How early can first dose of infuenza be given
- how often given after that?
- nasal spray is available for over what age
WARNING WARNING**
as early as 6 months of age
- given yearly
- nasal flu spray available for over 2 years old (***its not a live virus and should NOT be given to certain individuals)
What is MMR, what type of vaccine is it and what are the immunization schedules?
What are two common side effects?
MMR is measles, mumps, rubella
- Attenuated live vaccine
2 dose schedule
- 12-15 months
- 4-6 years
- common side effects are fever and rash
What is Varicella aka?
- if you had this disease what are you at risk for?
- what type of vaccine is it
- how many doses and what is the dose schedule
Chicken pox
- at risk for shingles
- attenuated live vaccine
2 dose schedule:
- 12-18 months
- 4-6 years
Hep A, how does it spread and how many doses and at what age?
- spreads when virus from an infected persons feces somehow gets into food/water
2 Dose schedule:
- 12-23 months
- 6-18 months following initial
HPV, how many doses
2-3 doses series
2 dose schedule:
- First Dose: 11-12 yrs old
- Second Dose administer 6-12 months after first
3 dose schedule:
2nd dose: 1-2 months after 1st
3rd dose: within 6 months of 2nd
What is meningococcal disease and what are the dose schedules?
Uncommon disease that can cause serious illness and death in people of all ages (meningitis)
2 dose schedule
- 11-12 years old
- 16 years old
What are some complications/contraindications/precautions for immunizations?
- allergic reaction possible
- moderate illness with no fever is precaution for immunization
- common cold is not a contraindication to immunizations
- no live viruses (aka varicella/MMR) to child with immunosuppression, pregnant or acquired passive immunity (blood products) within 11 months
3 common reactions to
Vaccines
- Tenderness/Redness at injection site
- Low grade fever
- Irritable
a bundle of what vaccines to take at 2 months
- Hep B (2nd dose)
- DTaP
- Hib
- Polio (IPV)
- Pneumococcal (PCV13)
- Rotavirus (RV)
a bundle of what vaccines to take at 4 months
- DTaP (2nd dose)
- Hib (2nd Dose)
- Polio - IPV (2nd Dose)
- PCV13 (2nd dose)
- Rotavirus (2nd dose)
a bundle of what vaccines to take at 6 months
KEY: same as 2 months
- DTaP (3rd dose)
- Hep B (3rd dose) 6-18 months
- Hib (3nd Dose)
- Polio - IPV (3nd Dose)
- PCV13 (3nd dose)
- Rotavirus (3nd dose)
- Influenza (Yearly)
A bundle of what vaccines to take at 12-23 months
KEY same as 2(6) months but with 3 more immunizations
- MMR (1st dose) 12-18 months
- Hep A (1st Dose) 12-23 months
- DTaP (4rd dose)
- Hib (4nd Dose) 12-18 months
- Polio - IPV (3nd Dose) 6-19 months
- PCV13 (4th dose) 12-18 months
- Influenza (Yearly)
A bundle of what vaccines to take at 4-6 years
- DTaP (5th dose)
- Polio (IPV) 4th dose
- MMR (2nd dose)
- Varicella (2nd Dose)
- Influenza (FLu)
A bundle of what vaccines to take at 11-12 years
- Meningococcal
- HPV (2 doses o vaccine)
- Tetanus, diptheria and whooping cough
- Influenza
2 vaccines to take at 11-12 years
- Influenza every year
- Meningococcal
What is Hypersensitivity?
Altered immune response to an antigen
anaphylaxis and transfusion reactions are exmples of what
Immediste hypersensitivity reactions
hypersensitivity accounts for more than ___ million outpatient visitis per year
17 million
Type I hypersensitivity reaction is what?
IgE Medicated Hypersensitivity
(allergic asthma, allergic rhinitis, hives)
Can hypersensitivity be localized or systemic
They can be BOTH!
What is Anaphylaxis
an acute systemic type I response that can result in shock and death
- reaction begins within minutes of allergin exposure
What are three comon allergens that can trigger anaphylaxis?
- Foods: Peanuts, shellfish, eggs, etc.
- Insect bites/stings: Bees, wasps, etc.
- Medications: Antibiotics, immunizations, etc.
What are clinical manifestations of anaphylaxis?
- Hives
- Angioedema of eyelids, tongue, throat
- sense of fear/doom
- imcreased work of breathing
What to do if patient is experiencing anaphylaxis?
Administer epipen, csll 911, administer albuterol
for how many seconds do you hold down epipen to thigh?
3 full seconds
Common side effects of epinephrine
- pounding heartbeat
- sweating
- headache
- weakness
- NV
- pale appearance
what to do for severe allergy and anaphylaxis vs mild allergy reaction?
Severe: Give epinephrine
Mild: Monitor child
