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

Question 1

What is a Rheumatic Disease?

Answer 1

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

Question 2

Rheumatic Disease most commonly manifest the clinical features of

Answer 2

arthritis (inflammation of a joint) and pain

Question 3

Rheumatic Diseases encompass

Answer 3

autoimmune, degenerative, inflammatory, and systemic conditions

Question 4

How many types of Rheumatic Diseases are there?

Answer 4

Over 100 types

Question 5

Problems caused by rheumatic diseases?

Answer 5

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

Question 6

How can Rheumatic Diseases be classified?

Answer 6

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

Question 7

Common symptoms of Rheumatic Disease

Answer 7

Pain
Joint Swelling
Limited Movement
Stiffness
WEakness
Fatigue

Question 8

Three distinct characteristics of pathophysiology include

Answer 8

inflammation, autoimmunity, and degeneration

Question 9

Phagocytosis produces chemicals such as

Answer 9

leukortrienes and prostaglandins

Question 10

Leukotrienes contribute to the inflammatory process by

Answer 10

attracting other white blood cells to the area

Question 11

Prostaglandins act as

Answer 11

modifiers to inflammation

Question 12

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

Answer 12

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

Question 13

Joints become swollen because

Answer 13

T and B Cell Proliferation

Question 14

What is Autoimmunity?

Answer 14

The body mistakenly recognizes its own tissue as a foreignn antigen

Question 15

Autoimmunity leads to

Answer 15

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

Question 16

What may be affected by autoimmunity?

Answer 16

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

Question 17

What occurs in Degeneration?

Answer 17

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

Question 18

What happens with Neutrophil accumulation in synovial fluid?

Answer 18

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

Question 19

Increasein severity of physical signs and symptoms due to

Answer 19

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

Question 20

Health History Assessment includes

Answer 20

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

Question 21

Functional Assessment includes

Answer 21

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

Question 22

Imaging studies commonly used for patients with rheumatic diseases include

Answer 22

X Rays
CT
MRI
Arthrography

Question 23

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

Answer 23

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

Question 24

Medications used with Rheumatic diseases include

Answer 24

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

Question 25

DMARDs have the ability to

Answer 25

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

Question 26

DMARDs have been found to

Answer 26

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

Question 27

Nonbiologic DMARDs are thought to reduce

Answer 27

proin-inflammatory cytokines and increase anti-inflammatory cytokines

Question 28

Nonpharmacologic PAin Management Examples

Answer 28

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

Question 29

Nursing Process: Planning : Goals may include

Answer 29

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 ```

Question 30

Lisas Major Goals

Answer 30

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

Question 31

Two types of Salicytates?

Answer 31

Acetylated and Nonacetylated

Question 32

What falls under a Acetylated Salicylate?

Answer 32

Aspirin

Question 33

What falls under a Nonacetylated Salicylate?

Answer 33

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

Question 34

Action of Salicyates?

Answer 34

Anti inflammatory, Analgesic, Antipyretic

Question 35

Accetylated Salicylate are

Answer 35

platelet aggregation inhibitors

Question 36

You should administer Salicylates with

Answer 36

meals to prevent gastric irritation

Question 37

Salicylates: Assess for

Answer 37

tinnitus, gastric intolerance, GI bleeding , purpura

Question 38

Salicylates: Monitor for possible

Answer 38

confusion in older adult

Question 39

Rheumatoid ARthritis is a

Answer 39

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

Question 40

Risk factors for development of RA include

Answer 40

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

Question 41

What has a specificty of 95% at detecting RA?

Answer 41

Antibodies to cyclic citrullinated peptide (Anti-CCP)

Question 42

Nursing Process Intervention: Pain

Answer 42

Provide comfort measures | Administer Anti-Inflammatory Analgesic

Question 43

Nursing Process Intervention: Fatigue

Answer 43

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

Question 44

Nursing Process Intervention: Imparied Physical Mobility

Answer 44

Assess for need of PT/OT | Encourage independence

Question 45

Nursing Process Intervention: Self-Care Deficit

Answer 45

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

Question 46

Nursing Process Intervention: Distrubed Body Image

Answer 46

Assist to identify elements of control over disease | Encourage verbalization of feelings

Question 47

Nursing Process Intervention: Ineffective Coping

Answer 47

Identify ares of life affected by disease | Develop plan for managing symptoms and enlisting support of family and friends to promote daily function

Question 48

Nursing Process Intervention: Complciations secondayr to medications

Answer 48

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

Question 49

Normal range for RBC?

Answer 49

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

Question 50

Clinical Manifesations: Stiffness takes

Answer 50

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

Question 51

What is the goal of giving someone DMARD?

Answer 51

Preventing inflammation and joint damage

Question 52

Biologic DMARDs have been specifially engineered to target

Answer 52

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

Question 53

Downside to DMARDs?

Answer 53

Can decrease your immune system, which can lead to infection