lewis ch 64 - arthritis and connective tissue disease Flashcards

1
Q

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

A

osteoarthritis

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2
Q

type osteoarthritis: caused by direct damage or

joint instability

A

secondary osteoarthritis

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3
Q

risk factors osteoarthritis (5)

A
  • age
  • decreased estrogen
  • obesity
  • ACL injury
  • frequent kneeling/stooping
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4
Q

S+S osteoarthritis (4)

A
  • joint pain
  • early morning stiffness 30 mins
  • asymmetric affect
  • deformity
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5
Q

varus deformity

A

bowlegged

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6
Q

valgus deformity

A

knock kneed

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7
Q

Deformity on DIP joints d/t osteophyte formation

and loss of joint space (in osteoporosis)

A

heberdens nodules

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8
Q

deformity on PIP joints of the fingers and the MCP

joint of thumb (in osteoporosis)

A

bouchards nodules

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9
Q

drug therapy osteoarthritis (4)

A
  • NSAIDs
  • topical salicylates
  • COX2 inhibitor
  • intraarticular corticosteroid injections
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10
Q

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

A

misoprostol (cytotec)

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11
Q

complications rheumatoid arthritis (4)

A
  • deformities, stress fractures
  • anemia
  • pericarditis
  • fibrosis, pneumonitis
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12
Q

3 stages RA

A
  • synovitis
  • pannus
  • fibrous ankylosis
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13
Q

S+S RA (4)

A
  • morning stiffness 1 hr+
  • low fever
  • anorexia
  • fatigue
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14
Q

treatment RA (3)

A
  • NSAIDs
  • COX1 and 2 inhibitors
  • disease modifying antirheumatic drugs (plaquenil, gold salts)
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15
Q

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

A

rheumatoid arthritis

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16
Q

2 complications RA

A

heart attack

stroke

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17
Q

risk factors RA (3)

A
  • older age
  • sedentary lifestyle
  • pollution
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18
Q

muscle atrophy and tendon destruction

A

subluxation

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19
Q

4 extraarticular manifestations RA

A
  • sjogrens syndrome
  • felty syndrome
  • flexion contractures
  • depression
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20
Q

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

A

felty syndrome

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21
Q

4 stages RA

A
  • pre-clinical
  • synovitis
  • destruction
  • deformity
22
Q

2 side effects methotrexate

A
  • bone marrow suppression

- hepatotoxicity

23
Q

3 examples DMARDs for RA

A
  • methotrexate
  • sulfasalazine
  • hydroxychloroquine
24
Q

3 nursing considerations for pts taking DMARDs

A
  • drink fluids
  • wear sunscreen
  • eye exam
25
what drug therapy can pts with RA take when they dont respond to DMARDs
biologic response modifiers (BRMs)
26
nursing considerations for tumor necrosis factor inhibitor (BRMs) (4)
- TB test and chest xray before starting - monitor for infection - avoid live vaccinations - report bruising, bleeding, persistent fever
27
complications intraarticular injections for RA (2)
- osteoporosis | - avascular necrosis
28
Type of arthritis characterized by hyperuricemia and deposition of uric acid crystals in one or more joints, periods of flare-ups
gout
29
what can cause secondary gout (2)
- more uric acid in body | - immunosuppressants
30
what causes gout (5)
- 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
31
examples high purine foods (3)
- red and organ meat - shellfish - fructose
32
2 processes of gout
- crystallization | - inflammation
33
S+S gout (4)
- dusky/cyanotic - very tender - symptom onset at night - low grade fever
34
most common site gout
big toe
35
Painless nodules filled with uric | acid crystals
tophi of chronic gout
36
best diagnostic study for gout
synovial fluid aspiration
37
drug therapy for acute gout attack
- colchicine - NSAIDs - corticosteroids
38
what med used for acute gout attack can cause leukopenia
colchicine
39
drug therapy for longer management gout
-xanthine oxidase inhibitor (allopurinol): decrease production uric acid
40
adverse effects allopurinol (3)
- hypersensitivity syndrome - GI effects - neurologic effects
41
drug of choice for chronic tophaceous gout
allopurinol
42
characteristic sign lyme disease
bulls eye rash
43
probable causes lupus (3)
- genetic - hormones (contraceptives, pregnancy) - environmental factors (sun, UV light, stress, toxins)
44
S+S lupus (7)
- fever - weight loss - joint pain - butterfly rash - excessive fatigue - alopecia - vascular skin lesions
45
most common infection developed by pts with lupus
pneumonia
46
what should patients taking corticosteroids or cytotoxic drugs avoid
live vaccines
47
drug therapy for lupus (4)
- NSAIDs - corticosteroids - antimalarial drugs - immunosuppressive drugs
48
```  Chronic central pain syndrome  Widespread, bilateral, burning musculoskeletal pain and fatigue  Multiple tender points ```
fibromyalgia
49
S+S fibromyalgia (5)
- pain - fatigue - nonrestorative sleep - IBS - anxiety
50
what cells are released in RA that can cause damage to cartilage and thicken synovial lining
neutrophils
51
2 criteria that must be met to diagnose fibromyalgia
- pain experienced atleast 11/18 tender points upon palpation - history of widespread pain atleast 3 months
52
drug therapy fibromyalgia (7)
- pregabalin (lyrica) - duloxetine (cymbalta) - milnacipin (savella) - antidepressants - muscle relaxants - OTC and nonopioid analgesics - zolpidem (ambien)