Infection and Inflammation

Question 1

What is osteoarthritis (OA)?

Answer 1

Slow progressive noninflammatory disorder of the diarthrodial (synovial) joints.

Think wear and tear

Question 2

Etiology & Pathophysiology of OA

Answer 2

-gradual loss or destruction of articular cartilage.
-Cartilage become weak & dull.
-Formation of osteophytes occur.

Question 3

Main cause of OA?

Answer 3

-No single cause.
-Caused by an event or condition which leads to joint instability.

Question 4

What can cause OA?

Answer 4

-Drugs (e.g. indomethacin & corticosteroids)
-Hematologic/ endocrine (e.g. chronic hemarthrosis)
-Joint instability
-Mechanical stress (e.g. sports)
-Neuro problems (e.g. diabetic neuropathy)
-Skeletal deformities (e.g. broken hip)
-Trauma

Question 5

Risk factors for OA?

Answer 5

-Age
-Decreased estrogen increases the risk in women.
-Obesity
-Anterior cruciate ligament (ACL) , injury from sports.
-Work (constant kneeling & stooping)

Regular moderate exercise decreases risk

Question 6

Clinical manifestation of joint pain (OA).

Answer 6

-NO SYSTEMIC MANIFESTATIONS!
-Joint pain (main symptom)
-Joint stiffness
-Crepitation
-Affects asymmetrically
-Deformities

Question 7

Joint pain with OA typically goes away with rest? true or false?

Answer 7

-True
-Typically occurs in the morning, but resolves in 30 mins.
-This is what distinguishes it from RA.

Question 8

What can happen with OA affecting joints asymmetrically?

Answer 8

-One limb will initially be affected.
-Strong limb will over compensate.
-The strong limb becomes more susceptible.

Question 9

Cold therapy pt. teaching…

Answer 9

-For inflammation
-Cover source w/ towel or cloth.
-Keep off areas w/ radiation, open wounds, & poor circulation.
- If it’s not possible to apply directly to site, try above or below or opposite side of body on corresponding site.

Question 10

Heat therapy pt. teaching…

Answer 10

-For stiffness
-Cover source w/ towel or cloth.
-Keep off areas w/ radiation, decreased sensation, or injury within 24 hrs.
-Don’t use w/ menthol products.

Question 11

What are the deformities with OA?

Answer 11

-HEBEDEN NODES: “distal” (DIP Joint)
-BOUCHARD’S NODES: “Proximal” (PIP Joint)
-Knee: bowleg, knock- kneed
-Hip: One leg shorter

Question 12

What does care of OA focus on?

Answer 12

-PAIN MANAGEMENT
-PAIN MEDS
-No cure
-NSAIDS ARE 1ST LINE OF DEFENSE

Question 13

What’s one MAJOR safety measure for a pt. with OA?

Answer 13

-FALL RISK
-TEACH STAIR SAFETY, USE HANDRAILS OF LIVE IN ONE STORY.

Question 14

What is Rheumatoid Arthritis?

Answer 14

-Chronic, systemic autoimmune disease.
-CHARACTERIZED BY INFLAMMATION OF CONNECTIVE TISSUE in the diarthrodial (synovial joints).

Question 15

What test is primarily looked at for RA?

Answer 15

-ERYTHROCYTE SEDIMENTATION RATE (ESR)

Question 16

What are the clinical manifestations of RA?

Answer 16

-Pain
-Stiffness
-Limited motion
-Signs of inflammation
-OCCURS SYMMETRICALLY

Question 17

What does synovial fluid look like in RA?

Answer 17

-CLOUDY, STRAW-COLORED FLUID, W/ FIBRIN FLECUS, & INCREASED WBCs IN THE FLUID.

Question 18

What’s the preferred drug for early treatment with RA?

Answer 18

METHOTREXATE

Question 19

What should we monitor when using Methotrexate?

Answer 19

-HEAPATOTOXICITY, ALT/AST before and during treatment!
-INFECTION, MONITOR CBC!
-PREGNACY! MUST HAVE NEGATIVE PREGNACY TEST!

Question 20

what’s the normal ALT & AST for the liver?

Answer 20

ALT: 7 - 56 (u/l)

AST: 5 - 40 (u/l)

Question 21

What is systemic lupus erythematosus (Lupus)?

Answer 21

Autoimmune disease that effects multiple systems & organs.

Question 22

2 Cardio complications with lupus.

Answer 22

-Pericarditis = inflammation of the pericardium.
-Myocarditis = inflammation of the heart muscle.

Question 23

One MAJOR complication of Lupus?

Answer 23

ANTIPHOSPHOLIPID SYNDROME (causes blood clots)!!!

Question 24

What’s the MOST SERIOUS from an upper GI bleed?

Answer 24

SUDDEN ONSET OF SEVERE ABDOMINAL PAIN!!!!

Question 25

What is a Mallory-Weiss tear (GI bleed)? & what is the CAUSE?

Answer 25

-Tear in mucous membrane or inner lining where the esophagus meets the stomach.
-CAUSED BY > forceful vomiting or retching (dry heaving).

Question 26

What happens when the GI tract absorbs blood?

Answer 26

BUN INCREASES!

Question 27

TYPING/ CROSS MATCHING in UGI bleed is important to have because…..

Answer 27

-this will help you be prepared for POSSIBLE BLOOD TRANSFUSIONS!

Question 28

What to MONITOR for those @ risk for HYPOVOLEMIC SHOCK? (UGI bleed)

Answer 28

-BP (ORTHOSTATIC HYPOTENSION)
-SKIN (PALLOR, COLD, CLAMMY)
-along with other signs…

Question 29

Nursing care if pt. is in hypovolemic shock & kidneys are not being perfused? (UGI bleed)

Answer 29

INSERT AN INDWELLING URINARY CATHETER!

Question 30

Why HEMODYNAMIC MONITORING for UGI bleeds?

Answer 30

To check blood circulation & evaluate how well the heart is working.

Question 31

cholelithiasis Vs. cholecystitis

Answer 31

cholelithiasis = stones in gallbladder.

cholecystitis = inflammation of gallbladder wall.

Question 32

Clinical manifestations of cholecystitis (RUQ)?

Answer 32

Pain may be referred to the right shoulder or scapula.

Question 33

DARK AMBER TO BROWN URINE WHICH FOAMS…

Answer 33

this occurs b/c bilirubin can’t reach the intestines when the common bile duct is obstructed.

Question 34

STEATORRHEA

Answer 34

Undigested fat because the bile in not reaching the intestines.

Question 35

What is ERCP?

Answer 35

-endoscopic retrograde cholangiopancreatography.
-used for gallbladder and/ or the pancreas.