lewis ch 64 - arthritis and connective tissue disease

Question 1

Slowly progressive noninflammatory disorder of the synovial joints
-more common in women

Answer 1

osteoarthritis

Question 2

type osteoarthritis: caused by direct damage or

joint instability

Answer 2

secondary osteoarthritis

Question 3

risk factors osteoarthritis (5)

Answer 3

• age
• decreased estrogen
• obesity
• ACL injury
• frequent kneeling/stooping

Question 4

S+S osteoarthritis (4)

Answer 4

• joint pain
• early morning stiffness 30 mins
• asymmetric affect
• deformity

Question 5

varus deformity

Answer 5

bowlegged

Question 6

valgus deformity

Answer 6

knock kneed

Question 7

Deformity on DIP joints d/t osteophyte formation

and loss of joint space (in osteoporosis)

Answer 7

heberdens nodules

Question 8

deformity on PIP joints of the fingers and the MCP

joint of thumb (in osteoporosis)

Answer 8

bouchards nodules

Question 9

drug therapy osteoarthritis (4)

Answer 9

• NSAIDs
• topical salicylates
• COX2 inhibitor
• intraarticular corticosteroid injections

Question 10

what med can be given if pt is at high risk for GI side effects (osteoarthritis patient taking NSAIDs)

Answer 10

misoprostol (cytotec)

Question 11

complications rheumatoid arthritis (4)

Answer 11

• deformities, stress fractures
• anemia
• pericarditis
• fibrosis, pneumonitis

Question 12

3 stages RA

Answer 12

• synovitis
• pannus
• fibrous ankylosis

Question 13

S+S RA (4)

Answer 13

• morning stiffness 1 hr+
• low fever
• anorexia
• fatigue

Question 14

treatment RA (3)

Answer 14

• NSAIDs
• COX1 and 2 inhibitors
• disease modifying antirheumatic drugs (plaquenil, gold salts)

Question 15

Chronic, systemic autoimmune
disease; inflammation of connective
tissue in diarthrodial (synovial) joints

Answer 15

rheumatoid arthritis

Question 16

2 complications RA

Answer 16

heart attack

stroke

Question 17

risk factors RA (3)

Answer 17

• older age
• sedentary lifestyle
• pollution

Question 18

muscle atrophy and tendon destruction

Answer 18

subluxation

Question 19

4 extraarticular manifestations RA

Answer 19

• sjogrens syndrome
• felty syndrome
• flexion contractures
• depression

Question 20

extraarticular manifestation RA: Enlarged spleen and low WBCs result in increased risk of infection and lymphoma

Answer 20

felty syndrome

Question 21

4 stages RA

Answer 21

• pre-clinical
• synovitis
• destruction
• deformity

Question 22

2 side effects methotrexate

Answer 22

• bone marrow suppression

- hepatotoxicity

Question 23

3 examples DMARDs for RA

Answer 23

• methotrexate
• sulfasalazine
• hydroxychloroquine

Question 24

3 nursing considerations for pts taking DMARDs

Answer 24

• drink fluids
• wear sunscreen
• eye exam

Question 25

what drug therapy can pts with RA take when they dont respond to DMARDs

Answer 25

biologic response modifiers (BRMs)

Question 26

nursing considerations for tumor necrosis factor inhibitor (BRMs) (4)

Answer 26

- TB test and chest xray before starting - monitor for infection - avoid live vaccinations - report bruising, bleeding, persistent fever

Question 27

complications intraarticular injections for RA (2)

Answer 27

- osteoporosis | - avascular necrosis

Question 28

Type of arthritis characterized by hyperuricemia and deposition of uric acid crystals in one or more joints, periods of flare-ups

Answer 28

gout

Question 29

what can cause secondary gout (2)

Answer 29

- more uric acid in body | - immunosuppressants

Question 30

what causes gout (5)

Answer 30

- too much uric acid in body: kidneys can't excrete enough or too much is being made - metabolic syndrome - increased intake high purine foods - prolonged fasting - excessive alcohol

Question 31

examples high purine foods (3)

Answer 31

- red and organ meat - shellfish - fructose

Question 32

2 processes of gout

Answer 32

- crystallization | - inflammation

Question 33

S+S gout (4)

Answer 33

- dusky/cyanotic - very tender - symptom onset at night - low grade fever

Question 34

most common site gout

Answer 34

big toe

Question 35

Painless nodules filled with uric | acid crystals

Answer 35

tophi of chronic gout

Question 36

best diagnostic study for gout

Answer 36

synovial fluid aspiration

Question 37

drug therapy for acute gout attack

Answer 37

- colchicine - NSAIDs - corticosteroids

Question 38

what med used for acute gout attack can cause leukopenia

Answer 38

colchicine

Question 39

drug therapy for longer management gout

Answer 39

-xanthine oxidase inhibitor (allopurinol): decrease production uric acid

Question 40

adverse effects allopurinol (3)

Answer 40

- hypersensitivity syndrome - GI effects - neurologic effects

Question 41

drug of choice for chronic tophaceous gout

Answer 41

allopurinol

Question 42

characteristic sign lyme disease

Answer 42

bulls eye rash

Question 43

probable causes lupus (3)

Answer 43

- genetic - hormones (contraceptives, pregnancy) - environmental factors (sun, UV light, stress, toxins)

Question 44

S+S lupus (7)

Answer 44

- fever - weight loss - joint pain - butterfly rash - excessive fatigue - alopecia - vascular skin lesions

Question 45

most common infection developed by pts with lupus

Answer 45

pneumonia

Question 46

what should patients taking corticosteroids or cytotoxic drugs avoid

Answer 46

live vaccines

Question 47

drug therapy for lupus (4)

Answer 47

- NSAIDs - corticosteroids - antimalarial drugs - immunosuppressive drugs

Question 48

```  Chronic central pain syndrome  Widespread, bilateral, burning musculoskeletal pain and fatigue  Multiple tender points ```

Answer 48

fibromyalgia

Question 49

S+S fibromyalgia (5)

Answer 49

- pain - fatigue - nonrestorative sleep - IBS - anxiety

Question 50

what cells are released in RA that can cause damage to cartilage and thicken synovial lining

Answer 50

neutrophils

Question 51

2 criteria that must be met to diagnose fibromyalgia

Answer 51

- pain experienced atleast 11/18 tender points upon palpation - history of widespread pain atleast 3 months

Question 52

drug therapy fibromyalgia (7)

Answer 52

- pregabalin (lyrica) - duloxetine (cymbalta) - milnacipin (savella) - antidepressants - muscle relaxants - OTC and nonopioid analgesics - zolpidem (ambien)