Exam 2 Rheum

Question 1

Rhematoid Arthritis?

Answer 1

Systemic (affects both sides)

• Chronic
• Autoimmune
• Autoantibodies create abnormal complexes in joint and lead to breakdown of joint.

Manifest:

• Inflammation of synovial joint
• Affects other than joint (extra articular manifestations)
• Very disabling!!
• Peak incidence 30-50yrs
• x3 more likely in women
• genetic susceptibility + immune response.
• Often effects smaller joints first and then progresses to larger joints
• Pain gets worse with motion
• Muscular atrophy
• Pleural effusions
• Shogrin (eyes)
• Felty syndrome (spleen and low white counts)
• Low endurance

Risk:
For infection!
Inability to form ADLs

Diagnose:
ESR/ERPs
Citrulinated peptide
*Rheumatoid Factor
*Anti-CCP
*ANA

Question 2

Treatment for RA

Answer 2

Drug/Nutritional Therapy

• No specific diet but they suffer from a lot of fatigue and pain.
• Preparing and eating food will be exhausting d/t lack of endurance.

Acute Care

Ambulatory Care

• Avoid repetitive movements
• Slide things instead of push
• put hands in warm water to loosen joints
• big joints instead of little
• keep things in an area easy to reach.
• lightweight tools…easy to use tools
• Swimming (warm water better)

Fix??
Surgery…replace joint. BUT doesn’t completely fix d/t systemic nature.

Question 3

Gout

Answer 3

Etiology:

• Crystallization in joint.
• Uric acid…purine breakdown in kidneys.
• When someone produces too much uric acid, common etiology.

Risk:

• Hyperuricemia leads to.
• Drink a lot of high-fructose drinks.
• Purine intake…(alcohol/meat/seafood/shellfish/anchovies)
• Prolonged fasting
• Triggered by trauma

Manifest:

• Inflammation of big toe/wrists/knees/ankle…
• Trauma
• Sx start at night
• Sensitive to touch
• Low grade fever
• Can go away on it’s own after 2-3 days
• Can lead to joint deformity

Diagnosis:
-Joint fluid analysis…aspirate fluid and look for crystals.

*Pseudo-gout (calcium instead of uric acid)
*

Interventions:

• Joint aspiration to remove crystals
• Corticosteroids
• Avoid foods with purines
• Take Colchicine (temporarily to fix)
• Allopurinol (To prevent acid production)

Question 4

Lupus

Answer 4

(Systemic Lupus Erythematosus = SLE)
-Multisystem inflammatory autoimmune disease

Etiology:

• genetics (expected)
• hormones (Oral contraceptives)
• immunologic
• effects joints/skin/serous membranes
• Includes series of remission and exacerbation
• Women between 15-45yr.

Manifest:

• Worse postpartum
• Sun/Light exposure can cause exacerbation.
• Stress and viruses can cause exacerbation.
• More than 45

Question 5

Lupus

Answer 5

(Systemic Lupus Erythematosus = SLE)
-Multisystem inflammatory autoimmune disease

Etiology:

• genetics (expected)
• hormones (Oral contraceptives)
• immunologic
• effects joints/skin/serous membranes
• Includes series of remission and exacerbation
• Women between 15-45yr.

Manifest:
-Worse postpartum
-Sun/Light exposure can cause exacerbation.
-Stress and viruses can cause exacerbation.
-More than 45 meds can cause an exacerbation but sx occur months later.
-Immune complexes deposit on capillary membranes.
-Fever/Weight loss/joint pain/fatigue
-Derm: vascular skin lesions in sun-exposed areas.
-Nasopharyngeal or oral ulcers
-Alopecia (losing hair!)
-Avoid sun
-Musculoskeletal (polyalthragia - overal arthritis everywhere)
-Morning stiffness (similar to RA…but diffuse swelling EVERYWHERE in Lupus and RA is just in small joints)
-Increase risk for bone loss and fractures
-Cardiopulmonary (issues with lungs, trouble breathing, inc. resp. rate, inflammation of lungs, pleurocy, cardiac disease)
-Hypercholesteremia
-Anti-phospholipid syndrome = inc. risk for clots = inc. risk for stroke/heart attack
-Raynauds
-Renal Problems: 40% of pt’s with Lupus have kidney problems 5yr after contraction. (**Proteinuria)
-Affects nervous system
(Cognitive deficits - short term memory loss/confusion/seizures/depression)
-Hematologic System (Anemia, thrombocytopenia, neutropenia… risk for bleeding/clotting/infection)
-Pneumonia!!!!

Question 6

What is the leading cause of death in pt’s with Lupus??

Answer 6

Cardiac Disease

Question 7

Diagnose Lupus?

Answer 7

Anti-nucleated A present in blood

Question 8

NANDAS for Lupus

Answer 8

Pain
Difficulty coping
Maintain Independence

Question 9

When someone gets a Lupus flare…

Answer 9

They get ill VERY quickly.

Question 10

Lupus in pregnancy

Answer 10

Most women are of child-bearing age when diagnosed.

• Even if patient gets pregnant, stillborn or spont. abortion is common
• damage to cardio/kidneys/lungs/nervous system
• Women with serious complications should be counseled against pregnancy
• BUT if they choose to become pregnant, they should choose to become pregnant around a time of low disease complications.
• Flare up will be expected during postpartum

Question 11

Psychosocial

Answer 11

-Require support and medical management

Question 12

Lupus Teaching

Answer 12

• Rest w/ Activity
• Avoid physical/emotional stress
• Be aware of soaps and detergents d/t rash risk.
• Sun protection
• Regular medical f/u
• Prego cao

Question 13

Lupus Teaching

Answer 13

-Rest w/ Activity
-Avoid physical/emotional stress
-Be aware of soaps and detergents d/t rash risk.
-Skin integrity
-Sun protection
-Regular medical f/u
-Prego counseling.
-Prevent flare up
-