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life span > Nurb test 2: arthritis > Flashcards

Nurb test 2: arthritis Flashcards

0
Q

Most common form of joint disease in North America
Slowly progressive non inflammatory disorder of the diarthrodial joints= movable synovial joint ex: knee and shoulders
Between 20-30 years old, sx don’t start until 50-60s

A

OSTEOARTHRITIS

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1
Q

What are the most common types of arthritis ?

A

Osteoarthritis, gout, and rheumatoid arthritis

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2
Q

contribute or accelerate destruction of the cartilage
Trauma, mechanical stress, inflammation, joint instability, neurologic disorder, skeletal deformities, hematologic/endocrine disorders, use of selected drugs=corticosteroids

A

Secondary disorder

osteoarthritis

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3
Q

: cartilage at the end of the bone begins to deteriorate, less soft and elastic/ leads to fissuring and erosion because it is soft
end up bone rubbing on bone= bone gets really thick and end up with bone spurs= surface is uneven and affects range of motion

A

Pathophysiology

osteoarthritis

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4
Q
  • Joints most commonly affected hands, hips, knees, neck, lower lumbar vertebrae, feet=big toe, fingers
  • joints are affected asymmetrically
A

osteoarthritis

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5
Q

No systemic sx: like fatigue or fever
Joint pain= main sx, mild to severe, can cause disability
Pain worsens with joint use- rest can relieve pain in early stages, late stages can’t help, affects sleeping
Becomes worse as barometric pressure ↓= raining
Over activity can cause mild joint effusion
Crepitation
-early morning stiffness that usually resolves within 30 min

A

sx osteoarthritis

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6
Q
  • grating sensation present in 90 percent in knee
A

osteoarthiritis Crepitation

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7
Q
  • specific to involved joint
    Finger- distal joint ____= caused by osteophytes or spurs, caused by repeated trauma that those joints
    ___same but affect middle joints
A

osteoarthritis Deformity Hand
Heberdens nodes
Bouchard’s nodes

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8
Q
  • often leads to joint misalignment= bowlegged, altered gait

- Advanced hip may cause one leg to be shorter because joint space is lost

A

Osteoarthritis: Clinical Manifestations Deformity Knee

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9
Q

___ =joint space tells us that cartilage is breaking down, bony sclerosis, bone spurs from osteophyte formation
* not always going to correlate with changes Ex: little change a lot of pain/ a lot of change no pain

A

In progressed OA: dx

xray

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10
Q
  • No cure
  • Managing pain and inflammation
  • Preventing disability
  • Maintaining and improving joint function
A

OSTEOARTHRITIS: Collaborative Care GOALS:

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11
Q

1.Rest and joint protection, avoid prolonged periods of standing, kneeling, encourage using cane or walker, pt rest with acute episodes, splints and braces
2. Heat= stiffness /cold applications- acute swelling
*Weight reduction- aerobic conditioning, muscle strengthening
Exercise- biking, walking, swimming
Arthroplasty- last resort, joint replacement

A

Focus on conservation measures

osteoarthritis

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12
Q

use nonpharmacological interventions will do more good

Nutritional Supplement

A

osteoarthritis

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13
Q

similar to substance that occurs naturally in joints, works by acting like a lubricant and a shock absorber

A

Hyaluronic Acid: mild to mod pain osteoarthritis

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14
Q

Joint pain and stiffness: type, duration, frequency
Ability to perform ADL’s
Duration and success of tx
Limitation of movement= tenderness, swelling, check both sides of the body

A

OSTEOARTHRITIS: Nursing Mgt Assessment

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15
Q

Health Promotion
Education of risk factors- *weight loss, stop smoking, safety measures to prevent trauma, exercise programs encouraged
Most time outpatient- collaborative care- doc, nurse, PT

A

OSTEOARTHRITIS: Nursing Mgt

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16
Q

Pain mgt plan
Physical therapy consult if needed- dev exercise plan
Patient and Family education: assistant devices= how to use, how to protect joint, nutritional guidelines to promote weight loss, exercise programs, edu on safety measures- railing stairs, rugs, shower chair, night light, grab bars

A

Acute Interventions

osteoarthritis

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17
Q

any time in life, peak 30-50
Chronic, systemic autoimmune disease
Char by: Inflammation of connective tissue in diarthrodial (synovial) joints
Periods of remission and exacerbation
Frequently accompanied by extra-articular manifestations: sx outside of the joint

A

Rheumatoid Arthritis-

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18
Q

cause is unknown

: autoimmune and genetic factor

A

Rheumatoid Arthritis: Etiology-

Theories

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19
Q

most commonly accepted, Igg and rheumatoid factor combine and form deposits and activate the inflammatory process
- hypertrophy of the synovial membrane affects surrounding cartledge, tendons, ligaments, cause articular cartilage to erode which leads to deformities

A

Autoimmune etiology

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20
Q
  • higher occurrence in twins, smoking increases risk for those who already are genetically predisposed
A

Genetic factor etiology

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21
Q

Harmful but subtle

- fatigue, weight loss, generalized stiffness

A

Rheumatoid Arthritis: Clinical Manifestations

Prior to onset:

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22
Q

: pain and tenderness that is localized, stiffness after inactivity or in morning, limited range of motion, see sign of inflammation=heat swelling tenderness

A

rheumatoid arthritis sx

Progresses to specific articular involvement

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23
Q
  • equal on both sides, can start in couple of joints
A

rheumatoid arthritis sx Affects joint symmetrically

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24
Q
  • wrist, hands, elbows, shoulders, ankles, knees

Affects smaller joints first

A

Most common joints affected rheumatoid arthritis

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25
Q
  • inflammation and swelling of the tendon, sx similar to carpal tunnel, difficulty grasping objects
A

. Tenosynovitis

rheumatoid arthritis sx norm

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26
Q
  • Atrophy of muscle and wasting away

Ulnar drift, swan shape of fingers, deformity of fingers

A

Distortion of hand

rheumatoid arthritis norm sx

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27
Q
  • hammer toe
    Halluz valgus=deviation towards other toes
    Rheumatoid nodule
A

Distortion of feet

rheumatoid arthritis sx norm

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28
Q

RA: Extra articular (*outside joint) Clinical Manifestations

A

rheumatoid nodules
sjogrens syndrome
felty syndrome

29
Q
  • firm tender, not removed bc high risk in coming back, can break open and cause infection 25% get them can appear lung, heart, and other organs
A

Rheumatoid Nodules

rheumatoid arthritis extra articular sx

30
Q
  • dry eyes damage to surface, dry mouth increased tooth decay, disorder of the immune system the mucous membranes of eye and mouth affected first
A

Sjogren’s Syndrome

rheumatoid arthritis extra articular sx

31
Q
  • more common in those that have the nodules, increase risk for infection bc low wbc, char by splenomegaly, pulmonary disease, anemia, thrombocytopenia
  • have malaise=generally feeling of discomfort, pale looking, fatigued, recurrent infections, loss of appetite
  • can have spleen removed
A

. Felty Syndrome
rheumatoid arthritis
extra articular sx

32
Q

rheumatoid arthritis drug therapy

A

-disease modifying antirheumatic drugs
-antimalarials
-corticosteroids
- nsaids and salicylates
together
dmard+nsaid+ corticosteroid

33
Q
  • take blood out, filter out rf then put back in, once a week for up to 12 weeks
    Emotional stress frequently exacerbates sx
A

Rheumatoid Arthritis: Collaborative Care Apheresis

34
Q

Relief of morning stiffness- warm shower or bath
Therapeutic heat- joint stiffness/cold- exacerbation
Rest
Joint protection- splints, no pillow under knee bc flexion, avoid flexion
Relaxation techniques- to manage chronic pain
Exercise
Psychological support- limited function
PT/OT Consult
Adls around morning stiffness

A

Rheumatoid Arthritis: Nursing Intervention

35
Q

Rheumatoid Arthritis: Assistive Devices-

A

easy to grip items, long handle,

36
Q

-infectious
Invasion of joint cavity by microorganism, can travel through blood stream that has infection
Often involved=- knee and hip

A

Septic Arthritis

37
Q

Symptoms: pain, redness, swelling, fever, chills

A

sx septic arthritis

38
Q
  • important for prompt, can cause avascular necrosis
    Antibiotics- right after you do culture- broad-spectrum until u get back
    -Heat, gentle range of motion, monitor fever, pain, splinting help pain control
A

tx

septic arthritis

39
Q
  • arthrocentesis, blood culture, culture of synovial fluid
A

dx septic arthritis

40
Q
  • Sooner tick is removed, less likely to have infection

- Attached for 48 hours, peak season summer, can’t pass person to person

A

. LYME DISEASE

41
Q

*skin lesion, small red bump at site of tick bite, 2-3 days after exposure will have redness that expands with rash with bulls eye pattern, red outer ring with area of clearness
-Body ache, fatigue, joint muscle pain, stiffness
-If untreated nervous system becomes affected, can cause meningitis, severe headaches, bell’s palsy,
___- joint pain, swelling, can shift from one joint to another
Heart rhythm irregularities

A

sx lyme disease

arthritic sx

42
Q

hx tick bite, rash, bulls eye lesion=EM Elisa=show positive, or inconclusive will do western blot test, cerebral spinal fluid if have neuro signs

A

dx lyme disease

43
Q
  • reduce exposure , tick check after walking in heavy wood area, wear long sleeves, tick repellent,
A

Pt edu lyme disease

44
Q

Increased uric acid production- by kidneys, Under excretion of uric acid
Increased intake of foods high in purine- shellfish, asparagus

A

GOUT: Etiology & Pathophysiology
Causes:

45
Q

hereditary, or retention of uric acid

A

primary gout

46
Q
  • related to another disorder, diabetes, hypertension, renal disease, chemo drugs= increase rate of cell death
A

secondary gout

47
Q

less than 4 one or more joints , onset is at night
Swelling-* big toe
Pain, Low-grade fever
Joints appear dusky and cyanotic
Attacks subside 2-10 days with or without tx -free of sx between attacks

A

GOUT: Clinical Manifestations acute

48
Q

multiple joints
Uric acid deposits called tophi
Chronic inflammation
Cartilage destruction and deformation

A

Chronic gout sx

49
Q
  • elevated uric acid level

aspirate synovial fluid- see if sodium uraite crystals

A

GOUT Diagnostics

50
Q
  • limit alcohol, food high in purine
A

Pt edu gout meds

51
Q
  • inflammatory disease of connective tissue
    Autoimmune reactions directed against constituents of cell nucleus, DNA
    Antibody response related to B and
    T cell hyperactivity
    Inflammation will start,
    Areas most commonly affected: kidneys, heart, lungs, brain, skin, and joints
    Enviro triggers-sun burn, infectious agent
    Any organ can be affected
A

SYSTEMIC LUPUS ERYTHEMATOSUS

52
Q 
dermatologic
musculoskeletal
cardiopulmonary
renal
nervous system
hematologic
Anxiety, depression, increase sensibility to infection
A

sx systemic lupus erythematosus

53
Q

– butterfly rash, alopecia= hair loss

A

Dermatologic sx systemic lupus erythematosus

54
Q
  • arthritis, polyarthalgeia- pain in two or more joints=1st complaint
A

Musculoskeletal sx

systemic lupus erthematosus

55
Q
  • tachypnea- rapid breathing, pleurisy
A

Cardiopulmonary sx systemic lupus erythematosus

56
Q
  • leading cause of death, lupus nephritis

Primary goal- slow progression and preserve renal function

A

Renal sx systemic lupus

erythematosus

57
Q
  • seizures most common, peripheral neuropathy

- anemia, thrombocytopenia

A

nervous system
hematologic
sx systemic lupus erythematosus

58
Q 
Antinuclear antibody (ANA)- will be present 
Anti-DNA
*Anti-Smith (Sm)- only 20% have, 99 % that do have lupus, exclusive to systemic lupus
A

SLE Diagnostics

59
Q
  • fever, joint inflammation, fatigue, fluid balance, neuro status, limitation of motion
  • Pain management and pace activities
A

SLE: Nursing Implementation

Monitor

60
Q
  • sun protection, precipitating factors= stress or infection, pregnancy, infertility= renal involvement, increase risk preeclampsia, and preterm birth
A

Patient Education sle

61
Q

Chronic pain syndrome causing nonarticular pain and fatigue with multiple tender points,
Mostly women – some men
Affects all ages

A

Fibromyalgia

62
Q

-Abnormal sensory processing in CNS causing pain amplification

A

Pathophysiology fibromyalgia

63
Q
  • can begin as physical trauma or gradual

Widespread pain above and below the waist, both sides of body, fatigue, point tenderness

A

Fibromyalgia Clinical Manifestations

64
Q 
- At least 3 months of widespread pain
left & right sides of the body 
above and below the waist, 
Axial pain (central part of the body)
Pain (not just tenderness) in 11 of 18 specific tender points
A

Diagnostics fibromyalgia

65
Q
  • no cure
    NSAIDs
    Antidepressants- help with stress, fatigue, sleep disturbances
    Ssri- depression and fibromyalgia
    Muscle relaxants- flexerile= sleep disturbances
A

Fibromyalgia Syndrome Drug Therapy

66
Q

Heat/cold
Massage if tolerated
Yoga, relaxation exercises
Stretching to release tension
Stretching exercises- low impact= walking, swimming, biking, balance
Teach limit sugar caffeine, alcohol interfere with med
Vit good to add- combat immune and stress

A

Nursing Implementation

fibromyalgia

67
Q

early phase, inflammation beginning, don’t show up on xray

A

Stage 1- rheumatoid arthritis

68
Q

moderate, have some destruction with inflammed synovial tissue growing into the joint cavity, thickening of synovium, muscular atrophy’s present, no involvement of panes of synovium

A

Stage 2- rheumatoid arthritis

69
Q
  • severe, x ray shows cartilage and bone destruction, joint deformity, narrow joint cavity, extensive muscular atrophy, extra articular soft tissue lesions, involves panes and synovium
A

Stage 3 rheumatoid arthritis

70
Q
  • terminal, less inflammation, deformities sticking out, fibrous, abnormal bony fusion
A

Stage 4 rheumatoid arthritis

71
Q
  • 4 of these present
    Morning stiffness lasts more than an hour
    Rheumatoid nodules
    Positive rf (rheumatoid factor)- occurs in 80%
    Swelling in 3 or 4 joints
    Swelling in hand joints
    Symmetric joint swelling
    Antinuclear antibody titer- ana = substance produced by own body tissue, only in some ra patients
    Synovial fluid increased wbc count
    Xray-erosion or decalcification
    Bone scan- better for early stages
A

Rheumatoid Arthritis: Diagnostics Criteria for Diagnosis:

life span (23 decks)

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