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NRSG 102: Med Surg 1 > Exam 3: Chapter 38 - Assessment and Management of Patietns with Rheumatic Disorders > Flashcards

Exam 3: Chapter 38 - Assessment and Management of Patietns with Rheumatic Disorders Flashcards

1
Q

What is a Rheumatic Disease?

A

Numerous disorders afecting skeletal muscles, bones, cartilage, ligaments, tendons, and jointsH

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2
Q

Rheumatic Disease most commonly manifest the clinical features of

A

arthritis (inflammation of a joint) and pain

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3
Q

Rheumatic Diseases encompass

A

autoimmune, degenerative, inflammatory, and systemic conditions

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4
Q

How many types of Rheumatic Diseases are there?

A

Over 100 types

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5
Q

Problems caused by rheumatic diseases?

A 
Limitations in mobility and ADL
Pain
Fatigue
Altered Self-Image
Sleep Disturbances
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6
Q

How can Rheumatic Diseases be classified?

A

Monoarticular (Affecting a Single Joint) / Polyarticular (Affecting Multiple Joints)
Inflammatory / NonInflammatory

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7
Q

Common symptoms of Rheumatic Disease

A 
Pain
Joint Swelling
Limited Movement
Stiffness
WEakness
Fatigue
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8
Q

Three distinct characteristics of pathophysiology include

A

inflammation, autoimmunity, and degeneration

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9
Q

Phagocytosis produces chemicals such as

A

leukortrienes and prostaglandins

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10
Q

Leukotrienes contribute to the inflammatory process by

A

attracting other white blood cells to the area

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11
Q

Prostaglandins act as

A

modifiers to inflammation

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12
Q

Instead of resolution of swelling and joint pain once the trigger has subsided,

A

Pannus (prolifieration of newly formed synovial tissue infiltrated with inflammatory cells) formation occurs. Destruction of the joints cartilage and erosion of bone soon follow

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13
Q

Joints become swollen because

A

T and B Cell Proliferation

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14
Q

What is Autoimmunity?

A

The body mistakenly recognizes its own tissue as a foreignn antigen

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15
Q

Autoimmunity leads to

A

the destruction of tissue via the same inflammatory seen with inflammation.

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16
Q

What may be affected by autoimmunity?

A

Blood Vessels, Lungs, Heart, and Kdineys may be affected

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17
Q

What occurs in Degeneration?

A

Inflammation also occurs but as a secondary process. Cartilage has been broken down and increased mechanical stress on bone ends causes stiffening of bone tissue

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18
Q

What happens with Neutrophil accumulation in synovial fluid?

A

Warmth, swelling, Effusions, Pain and Decreased Motion with Possible Rheumatoid Nodules

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19
Q

Increasein severity of physical signs and symptoms due to

A

synovitis, early pannus invasion, chrondrocyte activcation, and degradation of cartilage by protteinase

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20
Q

Health History Assessment includes

A

Onset and Evolution of Symptoms
Family History
Past Health History
Contributing Factors

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21
Q

Functional Assessment includes

A

Combination of History and Observation
Gait, Posture, General Musculoskeletal Size and Structure
Gross Deformities and Abnormalities in movement
Symmetry, size, and contour of other connective tissues such as the skin and adipose tissue

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22
Q

Imaging studies commonly used for patients with rheumatic diseases include

A

X Rays
CT
MRI
Arthrography

23
Q

Nursing Process: The Care of a Patient With a Rheumatic Disease Diagnosis

A 
Acute and Chronic Pain
Fatigue
Imparied Physical Mobility
Self-Care Deficity
Distrubed Body Image
Ineffective Coping
Complications SEcondary to Effects of Medications
24
Q

Medications used with Rheumatic diseases include

A

Salicylates
NSAIDs
Biologic and Nonbiologic Disease-Modifying Antirheumatic drugs (DMARDs)

25
Q

DMARDs have the ability to

A

suppress the autoimmune response, alter disease progression, and stop or decrease durther tissue damage on the joints

26
Q

DMARDs have been found to

A

hallt the progresion of bone loss and destruction and can induce remission.

27
Q

Nonbiologic DMARDs are thought to reduce

A

proin-inflammatory cytokines and increase anti-inflammatory cytokines

28
Q

Nonpharmacologic PAin Management Examples

A

Heat helpful in relieving pin, stiffness, and muscle spasms. Maximum is 20 minnutes.

29
Q

Nursing Process: Planning : Goals may include

A

Suppress inflammation adn the autoimmune response

Control Pain
Maintain or improve joint mobility
Maintain or improve functional status
Increase patietns knowledge
Promote self-management by patient adherence
30
Q

Lisas Major Goals

A 
Relief o f Pain or Discomofrt
Relief of Fatigue
Increasd Mobility
Maintanence of Self CAre
Improved Body Image
Effective coping
Absence of Complications
31
Q

Two types of Salicytates?

A

Acetylated and Nonacetylated

32
Q

What falls under a Acetylated Salicylate?

A

Aspirin

33
Q

What falls under a Nonacetylated Salicylate?

A

Choline Trilisalicylate (Arrthropan, TRilisate)
Salsalate (Disalcid)
Sodium Salicylate

34
Q

Action of Salicyates?

A

Anti inflammatory, Analgesic, Antipyretic

35
Q

Accetylated Salicylate are

A

platelet aggregation inhibitors

36
Q

You should administer Salicylates with

A

meals to prevent gastric irritation

37
Q

Salicylates: Assess for

A

tinnitus, gastric intolerance, GI bleeding , purpura

38
Q

Salicylates: Monitor for possible

A

confusion in older adult

39
Q

Rheumatoid ARthritis is a

A

autoimmune disease of unknown irign that affects 1% of population worldwide.

40
Q

Risk factors for development of RA include

A

environmental factors such as pollution, smoking, family hisotry, and illnesses

41
Q

What has a specificty of 95% at detecting RA?

A

Antibodies to cyclic citrullinated peptide (Anti-CCP)

42
Q

Nursing Process Intervention: Pain

A

Provide comfort measures

Administer Anti-Inflammatory Analgesic

43
Q

Nursing Process Intervention: Fatigue

A

Explain energy convserving techniques
Facilitate development of activity / rest schedule
Combat fatigue by exercising

44
Q

Nursing Process Intervention: Imparied Physical Mobility

A

Assess for need of PT/OT

Encourage independence

45
Q

Nursing Process Intervention: Self-Care Deficit

A

Assist in identifying self-care deficits
Provide assistive devices (This can include wheel chair, reaching device, shoe horns)
Consult with community agencies

46
Q

Nursing Process Intervention: Distrubed Body Image

A

Assist to identify elements of control over disease

Encourage verbalization of feelings

47
Q

Nursing Process Intervention: Ineffective Coping

A

Identify ares of life affected by disease

Develop plan for managing symptoms and enlisting support of family and friends to promote daily function

48
Q

Nursing Process Intervention: Complciations secondayr to medications

A

Perform periodic clinical assesment and laboratory evaulation
Provide education about correct self-administration, potential side effects, importance of monitoring
Counsel regarding methods to reduce side effects
Administer medication in modified doses

49
Q

Normal range for RBC?

A

4.7-6.1 for Men
Women: 4.2 - 5.4
Children: 4.0 - 5.5

50
Q

Clinical Manifesations: Stiffness takes

A

an hour or more to go away when they first wake up

51
Q

What is the goal of giving someone DMARD?

A

Preventing inflammation and joint damage

52
Q

Biologic DMARDs have been specifially engineered to target

A

a certain cell or molecule within the immune system to otreat the specific theumatologic condition

53
Q

Downside to DMARDs?

A

Can decrease your immune system, which can lead to infection

NRSG 102: Med Surg 1 (52 decks)

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