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NRSG 200: Med Surg 3 > [Exam 4] Chapter 38 - Assessment and Mx of Patients with Rheumatic Disorders, RA and SLE > Flashcards

[Exam 4] Chapter 38 - Assessment and Mx of Patients with Rheumatic Disorders, RA and SLE Flashcards

1
Q

Diffuse Connective Tissue Disease: What is this?

A

Group of chronic disorders characterized by diffuse inflammation and degeneration in the connective tissue

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2
Q

Diffuse Connective Tissue Disease: What is the cause of this?

A

Cause is unknown but thought to have an immunologic basis

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3
Q

Diffuse Connective Tissue Disease: What are rheumatic arthritis disorders?

A

They are connective tissue disorders, autoimmune disorders. Bodies produces antibodies that attack their own healthy tissue.

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4
Q

Diffuse Connective Tissue Disease: Is there a cure?

A

There is no cure for this. We can only just treat the symptoms

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5
Q

Diffuse Connective Tissue Disease: Treatment will focus on what?

A

Controlling manifestations , and there will be periods of exacerbation’s and remissions.

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6
Q

Diffuse Connective Tissue Disease: What types of diseases doees this include?

A

RA, Systemic Lupus Erythematosus (SLE), Scleroderma, Polymyositis, and Polymtalgia rheumatica

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7
Q

Patho and Physical Signs of RA: This affects who more?

A

Females

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8
Q

Patho and Physical Signs of RA: What type of disease is this??

A

Autoimmune disease

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9
Q

Patho and Physical Signs of RA: This is thought to be associated with what?

A

Other disease processes, like atherosclerosis because it interferes with high density lipoproteins causing increase in bad cholesterol.

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10
Q

Patho and Physical Signs of RA: What is the Patho of this?

A

WBCs attack synovial tissue. Cause Synovial tissue to become inflamed.

Leads to systemic disease that can affect the whole body.

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11
Q

Patho and Physical Signs of RA: Initially patient will have what signs?

A

systemic joint pain and morning joint stiffness lasting longer than 1 hour. More than a little stiff after you get out of bed in morning.

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12
Q

Patho and Physical Signs of RA: This will have a normal course of what?

A

Exacerbations and remissions

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13
Q

Patho and Physical Signs of RA: What is the detailed patho hat occurs?

A

Presentation of antigen to T Cells

T,B Cells proliferate. Angiogensis in synovial lining.

Neutrophil accumulation in synovial fluid. Cell proliferation.

Synovitis, where there is degradation of cartilage by proteinase

Subchrondral bone erosion.

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14
Q

Patho and Physical Signs of RA: What signs occurs once T and B Cells proliferate?

A

Swelling in small joints, associated with pain, stiffness and fatigue

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15
Q

Patho and Physical Signs of RA: What signs occur with neutrophil accumulation in synovial fluid?

A

Warm, swollen effusions, pain and decreased motion with possible rheumatoid nodules

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16
Q

Patho and Physical Signs of RA: What signs occur with synovitis?

A

Increase in severity of physical signs and symptoms

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17
Q

Patho and Physical Signs of RA: What signs occur with subchrondral bone erosion?

A

Joint instability, contractures, decreased ROM

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18
Q

Extra Articular Features of RA: TO diagnose RA, what is tested?

A

Different antibodies, specifically this anti-CCP. This is really sensitive for RA.

If ESR is elevated

If CRP is elevated

IF WBCs are elevated

If Inflammatory makrers are elevated

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19
Q

Extra Articular Features of RA: What diagnostic can be done to determine degree of destruction?

A

X-RAY to determine destruction within joints,

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20
Q

Extra Articular Features of RA: What happens in Stage 1 of RA?

A

Body mistakenly attacks its own joint tissues

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21
Q

Extra Articular Features of RA: What happens in Stage 2 of RA?

A

Body makes the antibodies and the joints start swelling up

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22
Q

Extra Articular Features of RA: What occurs in Stage 3 of RA?

A

Joint becomes bent and deformed, fingers crooked, and can press on nerves to cause pain

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23
Q

Extra Articular Features of RA: What occurs in Stage 4 of RA?

A

If not treated, disease will progress to last stage, in which there’s no joint remaining and joint essentially fused

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24
Q

Extra Articular Features of RA: These are systemic manifestations , which include what?

A

Fever, Weight Loss

Fatigue/Anemia

Lymph Node Enlargement/Raynaud Phenomenon

Arteritis (inflammation of arteries)

Neuropathy

Pericardium

Sjorgen Syndrome

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25
Q

Extra Articular Features of RA: What is Raynaud Phenomenon?

A

Cold and stress induces vasopasms which causes episodes of distal blanching and cyanosis. Will see this in hands and toes. Loses blood flow to distal extremities

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26
Q

Extra Articular Features of RA: What is Sjorgen Syndrome?

A

Has to do with dry eyes, dry mouth, attacks glands that produce tears and end up with dry eyes.

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27
Q

Extra Articular Features of RA: What are the classic symtpoms seen with RA?

A

Joint pain, swelling, warmth, erythema.

Joints start to lose function

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28
Q

Extra Articular Features of RA: That symptoms of RA usually begins where and progresses where?

A

Begins in the hands, feet, wrists. As it progreses, will move into knees, shoulders, and larger joints

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29
Q

Extra Articular Features of RA: RA is a systemic disease which means what?

A

It can affect the rest of the body, so you always need to make sure that you’re assessing patients for these manifestations seen .

30
Q

Medical Mx of RA - Early RA: The goal of treatmetn is what?

A

Is to decrease the joint swelling, decrease pain, try to minimize the amount of exaberations, minimize amount of joint deformity.

31
Q

Medical Mx of RA - Early RA: What types of exercises will they perform?

A

Balance of rest and exercise

32
Q

Medical Mx of RA - Early RA: What medications will they take to alleviate pain?

A

Salicylates and NSAIDS

33
Q

Medical Mx of RA - Early RA: They may get started on what meds?

A

DMARDS, which are disease modifying anti-rheumatic drugs

34
Q

Medical Mx of RA - Early RA: May be placed on what?

A

Biologic response modifiers which are genetically engineered which block cytokines which block the inflammatory process to help with swelling and inflammation in the joints

35
Q

Medical Mx of RA - Early RA: May be placed on a low dose what?

A

Low dose steroid such as prednisone that may improve that patient outcome as well

36
Q

Medical Mx of RA - Moderate/Erosive RA: What treatment will be given?

A

Will start a formal OT/PT program to try to keep the joints as mobile as possible

37
Q

Medical Mx of RA - Moderate/Erosive RA: What medication may be added?

A

Immunosuppressant like DMARDS. Can also be on different types of medications to suppress immune system. Treatmetn progresses as RA progresses.

38
Q

Medical Mx of RA - Persistent Erosive RA: How will joints be here

A

Will be so inflammed and disfigured that they need to have some reconstructive surgery done.

39
Q

Medical Mx of RA - Persistent Erosive RA: What medication will be given here?

A

Corticosteroids, like a local injection of steroid into the joint to try to help with that.

40
Q

Medical Mx of RA - Advancd, Unremitting RA: What drug will they still be on?

A

Immunosuppressive agents to try to suppress the inflammation process.

41
Q

Medical Mx of RA - Advancd, Unremitting RA: Antidepressants will be given why

A

To help with their mood and reestablish the normal sleeping pattern

42
Q

Medical Mx of RA - Advancd, Unremitting RA: Plasmapheresis, is it common?

A

You don’t see it done as often since there has been an improvement in the medication regiment. Might be on Methotrexate amino suppressant agent used for RA.

43
Q

Medical Mx of RA - Advancd, Unremitting RA: Is Plasmapheresis were to occur, how is it done?

A

You remove blood, which separates plasma and cells.

The antibodies that are attacking the patient are removed and the blood is then returned to the patient.

44
Q

Medical Mx of RA - Advancd, Unremitting RA: Why is Plasmapheresis not done anymore?

A

Because the antibodies are usually managed with DMARDS, Methotrexate, Steroids.

45
Q

Nursing Process - Assessment of Pt with RA: You will focus on what for the assessment?

A

Health Hx and Physical Assessment

Also want to focus on psychological and mental status.

Also their activity , which you want to encourage to keep joint mobility and making sure they have safe environment at home.

Assistive devices will be key

46
Q

Nursing Process - Nursing Diagnosis of Pt with RA: This includes what?

A 
Acute/Chronic Pain
Fatigue
Disturbed Sleep Pattern (Antidepressants)
Impaired Physical Mobility
Self-Care Deficits (PT/OT)
Disturbed Body Image (Hands distorted)
ineffective Coping
47
Q

Teaching Patient Self-Care for RA: Patients need to understand what?

A

The disease process and the medicatiosn that they are taking and that they need to follow-up and continue monitoring. Also manage pain and joint protection.
Also exercising and using assistive devices

MAke sure they have balance of rest and exercise.

48
Q

Teaching Patient Self-Care for RA: What is a huge aspect that they must focus on?

A

Being compliant with medication and ensuring that they stay active with PT/OT

49
Q

Systemic Lupus Erythematosus (SLE): This is a result of what?

A

Disturbed immune regulation that causes an exaggerated production of auto antibodies

50
Q

Systemic Lupus Erythematosus (SLE): What does this lead to?

A

Immune complex deposition and tissue damage

51
Q

Systemic Lupus Erythematosus (SLE): What is this?

A

Immune system is attacking its own tissue and affects the connective tissue in multiple organs and multple body systems that leads to multiple organ failure.

52
Q

Systemic Lupus Erythematosus (SLE): Why is this difficult to dignose?

A

The symptoms may be really vague at first.

53
Q

Systemic Lupus Erythematosus (SLE): Onset may be what?/

A

Acute or Insidious

54
Q

Systemic Lupus Erythematosus (SLE): What type of signs will you see?

A

A lot of joint pain, arthritis, skin manifestations like a butterfly rash on face

Pericarditis

Renal Involvement

CNS Involvement

55
Q

Systemic Lupus Erythematosus (SLE): Signs in the oral cavity?

A

Mouth and nose ulcers

56
Q

Systemic Lupus Erythematosus (SLE): Signs on skin?

A

Butterfly rash and red patches

57
Q

Systemic Lupus Erythematosus (SLE): Signs in heart?

A

Endocarditis
Atherosclerosis
Inflammation of fibrious sac

58
Q

Systemic Lupus Erythematosus (SLE): Signs of abdomen?

A

Several abdominal pain

59
Q

Systemic Lupus Erythematosus (SLE): Signs in blood?

A

Anemia

High blood pressure

60
Q

Systemic Lupus Erythematosus (SLE): Signs in muscle and joints?

A

Pain and artritisaches

Swollen joints

61
Q

Systemic Lupus Erythematosus (SLE): Signs in kidney?

A

Blood in urine

62
Q

Systemic Lupus Erythematosus (SLE): Signs in Lungs?

A

Pleuritis
Pneumonitis
PE
Pulmonary Hemorrhage

63
Q

Systemic Lupus Erythematosus (SLE): What may occur with head?

A

Hair loss
High Fever
Abnormal Headache

64
Q

Systemic Lupus Erythematosus (SLE): Diagnosed with what?

A

Antibody, like anti-nuclear antibodies that are specific to SLE

Kidney function bc BUN/CREATININE increased.

65
Q

Systemic Lupus Erythematosus (SLE): What will increase in the body lab wise?

A

Increased sed rate, protein in urinalysis,

66
Q

Systemic Lupus Erythematosus (SLE): What is the criteria for classifying this?

A

Based on 11 criteria, they must have 4 or above of the criteria at any time

67
Q

Systemic Lupus Erythematosus (SLE): Waht are some of the criteria that must be meed?

A 
MalarRash
Discoid Rash
Photosensitivity
Oral Ulcers
Nonerosive Arthritis
Pleuritis or Pericarditis
Kidney Disease
Neurologic Disease
hematologic Disorder
Immunologic Disorder
Positive Antinuclear antibody
68
Q

Systemic Lupus Erythematosus (SLE) - Med Mx, Pharm: What will be given?

A

NSAIDS - Reduces inflammation and pain from arthretisi

Prednisone for immunosuppression. Make sure that this steroid is tapered however.

Methotrexate can be given as well. (immunosuppressants)

Antimalarials will be given for suppression of fever, fatigue. Can help with rashes

69
Q

Systemic Lupus Erythematosus (SLE) - Nursing MX: Because there is an increased risk for involvement of other organs, patients need to be careful with what?

A

Need to understand that they need to have routine screenings with doctors to monitor kidneys, not developing any kind of organ failure.

70
Q

Systemic Lupus Erythematosus (SLE) - Nursing MX: Important that patients are educated on what?

A

The importance of taking their medication, which may be a knowledge deficit that we must teach.

May be having image disturbances

Fatigue, so educate on how to limit fatigue. Having times of rest and when to go do activites.

NRSG 200: Med Surg 3 (46 decks)

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