joint disorders

Question 1

what are some causes/risk factors for rheumatoid arthritis

Answer 1

• chronic inflamatory disorder
• autoimmune with unknown etiology
• risk factors: smoking, egenetics, viral or bacterial illness

Question 2

whats happening with rheumatoid arthritis

Answer 2

• immne system attacks synovial lining of joints
• begins in disal joints (fingers and toes)
• inflammation thickens synovium destroying joint (pannus formation)
• tendons and ligaments weaken and stretch
• lose joint mobility and use of joints

Question 3

how will the client present with rheumatoid arthritis

Answer 3

• tender, warm, swollen and erythemic joints (bilateral and symmetric)
• joint stiffness worse in mornings and after inactivity
• fatigue, fever, and loss of appetite

Question 4

what labs and diagnostic tests are used for rheumatoid arthritis

Answer 4

• arthocentesis (check that synovial fluid)
• CT
• CBC, ESR and CRP (inflammatory markers), rheumatoid factor

Question 5

what meds can help with rheumatoid arthritis

Answer 5

• avoid opioids
• DMARDs (disease modifying antirheumatic drugs): nonbiologic (methotrexate - nasty, need annual blood tests) and biologic (adalimumbab)
• NSAIDs: ibuprofen and naproxyn (not for long term, just flare ups)
• Cox-2: celecoxib
• corticosteroids: prednisone (for flare ups)

Question 6

what are some complications of rheumatoid arthritis

Answer 6

• CVD
• medication toxicity (methotrexate is shitty)
• damage to skin, eyes, lungs, heart, blood vessels, kidneys, nerve tissue, salivary glands, and bone marrow
• deformity of hands and feet

Question 7

whats included in treatment of rheumatoid arthritis

Answer 7

• educate
• aggressive teratment early
• goals: decrease joint pain and swelling, prevent joint damage, and minimize disability
• exercise (discuss complications of immobility on joints)
• nonpharm methods (relaxation, heat and cold)
• yoga (improve mood and quality of life, gentle stretching)
• complimentary alternative medicine (CAM): fish oils and plant oils
• weight management

Question 8

what are some causes of osteoarthritis

Answer 8

• noninflammatory joint destruction
• end result of autoimmune disorder but not an autoimmune disorder
• obesity
• laborious occupations and sports
• genetic predisposition

Question 9

whats happening with osteoarthritis

Answer 9

• breakdown of articular cartilage
• progressive damage to underlying bone
• narrowing of joint space
• pain and damage
• progressive joint degeneration

Question 10

how will the clinet with osteoarthritis present

Answer 10

• pain, stiffness, and functional impairment
• joint pain aggravated by movement/exercise
• relieved by rest
• morning stiffness
• decreased ROM in affected joint
• crepitus (rice crispies) over kneee or grating sensation

Question 11

what labs and diagnostic tests are used for osteoarthritis

Answer 11

• xray or MRI (shows articular cartilage is gone)
• blood test to rule out RA

Question 12

whta meds can help with osteoarthritis

Answer 12

• NSAIDs (ibuprofen, naproxen)
• cox-2 (celecoxib)
• intra-articular corticosteroids
• acetaminophen
• diclofenac
• glucosamine and chrondroitin

Question 13

what are some complications of osteoarthritis

Answer 13

• depression and anxiety
• difficulty with ADLs
• need for arthoplasty

Question 14

how can nurses help with osteoarthritis

Answer 14

• educate
• exercise and lower extremity strength training
• weight loss
• OT/PT
• splints/braces or walking aids
• CMA therapies
• heat/cold

Question 15

what are some causes of gout

Answer 15

• high levels of uric acid in blood (fructose-rich beverages, alcohol consumption - beer)
• age, BMI
• HTN meds: beta blockers, aces and arbs
• thiazide diuretics

Question 16

whats happening with gout

Answer 16

• hyperuricemia
• macrophages in joint space phagocytize urate
• macrophages become crystalized (crystals are sharp and needle like)
• deposits in peripheral areas (great toe, hand and ear)

Question 17

how will the client present with gout

Answer 17

• arthritis
• sudden and severe attacks of pain
• pain, swelling and tenderness (great toe, knee or ankle)
• limited ROM

Question 18

what are some labs and diagnostic tests for gout

Answer 18

• joint fluid analysis
• xray/dual energy CT scan

Question 19

what are some meds that can help with acute gout attacks

Answer 19

• cochicine
• NSAIDs
• corisosteroids

Question 20

what are some management meds for gout

Answer 20

• xanthines (allopurinol)
• uricosurics (probenecid)

Question 21

what are some complications of gout

Answer 21

• tophi (deformity in joint from crystals hardening)
• kidney stones

Question 22

how can nurses help with gout

Answer 22

• educate
• eat food low in purines and avoid high purine diet
• coffee, vitamin C, and cherries can reduce uric acid
• lifestyle changes
• weight loss
• decrease alcohol intake
• avoid certain meds
• med compliance
• avoid trauma/stress

Question 23

what are some causes of fibromyalgia

Answer 23

• unknown
• triggers: genetics, anxiety, depression, physical/emotional trauma, infection

Question 24

whats happening with fibromyalgia

Answer 24

amplified pain d/t CNS abnormally amplifying pain signals

Question 25

how will the client present with fibromyalgia

Answer 25

• bilater widespread pain (dull ache x3mo)
• fatigue (restless leg/sleep apnea)
• cognitive difficulties (fibro fog)
• other conditions usually coexist

Question 26

what are some labs and diagnostic tests for fibromyalgia

Answer 26

none but may rule out other conditions

Question 27

what are some meds that can help with fibromyalgia

Answer 27

• NO opioids
• NSAIDs/acetaminophen
• TCAs
• muscle relaxants
• SNRIs/SSRIs
• anticonvulsants

Question 28

how can nurses help with fibromyalgia

Answer 28

• educate
• CAM/exercise therapy
• CBT
• sleep hygiene
• support groups
• stress reduction
• provide education on pharm/nonpharm methods