Protection Flashcards
Rheumatoid Arthritis
•chronic, systemic, autoimmune disease
- inflammation of the connective tissue in the synovial joints
•Periods of remission and exacerbation!!
RA risk factors
•Peak age 30-50 women more common
•Unknown cause
- likely a combination of genetic, smoking, and environmental triggers–typically autoimmune.
• Smoking increases risk in patients genetically predisposed and may interfere with treatment
RA 3 distinct characteristics
Inflammation
Autoimmune
Degeneration
RA symptoms
Onset typically subtle: •Fatigue •Anorexia •Weight loss •Generalized stiffness that becomes localized stiffness with progression
RA Articular Manifestations: Joints
Characteristics and signs
Symmetrically and bilaterally in the small joints of the hands, wrist and feet.
- Knees, hips, elbows, ankles, cervical spine joints may also be affected
- Morning stiffness-60 min to several hr
- Pain
- Limited motion
- Signs of inflammation (erythema, heat, swelling, tenderness
- Tenosynovitis: inflammation of tendon
- Subluxation: dislocation
- Deformities in the hands
Other RA Manifestations: Extra-articular (outside a joint)
- flexion contractures
- Sjögren’s syndrome
- dry eyes and mouth
- felty syndrome
- swollen spleen, decreased white blood cell count, and repeated infections
RA: Diagnostic Studies lab findings for early detection
•RF positive
•ESR and CRP (increased = active inflammation)
•Anti-CCP
- can be seen 5-10 years before symptoms develop.
RA Treatment: Goals
Treatment must begin early to avoid deformity—early treatment is key!!
- Decrease joint pain and swelling
- Achieve clinical remission
- Decrease likelihood of joint deformity
- Minimize disability/Maximize participation in ADLs
RA: Management
- Pharmacologic therapy
- Non-pharmacologic therapy
- Nutritional therapy
- Sleep promotion
- Joint Protection
- Heat/cold therapy
- Exercise therapy
•The progression of joint damage can be slowed or stopped with aggressive, early treatment.
RA Pharmacological Therapy
- Non-biologic DMARDS (Disease-Modifying Anti-Rheumatic Drugs)
- Biologic Response Modifiers (BRMs)
- NSAIDS
- COX-2 enzyme blockers
- Short-term, low-dose antidepressants for depression or sleep problems. Amitriptyline (Elavil), paroxetine (Paxil), sertraline (Zoloft).
- Corticosteroids
What happens if drug therapy not started for RA
Irreversible changes can occur in the first year if drug therapy not started
Disease-modifying antirheumatic drugs (DMARDs)
•Slow disease progression and decrease risk of joint deformity and erosion
RA Drug Therapy: DMARDs
•Methotrexate
What are the side effects ?
•Early treatment
•Side effects (rare): 🦴 marrow suppression and hepatotoxicity
- Need to monitor CBC
RA Drug Therapy: DMARDs
•Sulfasalazine (Azulfidine) and Hydroxychloroquine (Plaquenil)
- Used for mild to moderate disease
- Drink fluids
- Wear sunscreen
- Eye exam: baseline, then every 6 to 12 months
RA Drug Therapy: Biologic Response Modifiers (BRMs)
Slow progression
•Used to treat moderate to severe disease not responsive to DMARDs
•Used alone or in combination with DMARDs
•Are more expensive.
•Examples: Remicade, Humira, Cimzia, Etantercept, (Infliximab)
RA Drug Therapy: Celebrex
Decrease inflammation process.
- Less likely to cause gastric irritation and ulceration
- increased risk of blood clots
RA Drug Therapy: Corticosteroids
Where are they given? What are complications?
** Intraarticular injections
•Low-dose oral for limited time
•Complications: osteoporosis and avascular necrosis(death of 🦴 tissue due to a lack of 🩸 supply)
Can result in weight gain
RA: Non-Pharmacologic therapy
•Heat:
- baths or showers, warm moist compresses (20 min)
- Tends to improve effectiveness of therapeutic exercises.
•Assistive Devices to support joints (Crutches, splints, walkers, cervical collars, canes, shoe supports)
•Muscle relaxation techniques
•Self hypnosis
RA: Nutritional Therapy
•Balanced nutrition important
•Pain, fatigue, and depression lead to decreased appetite
•Lower endurance and mobility cause inability to shop for and prepare food resulting in weight loss
- work with OT for plan
RA: Sleep Promotion
•Alternate rest periods with activity
•Avoid total bed rest
•8 to 10 hours of sleep plus daytime rest
•Modify activities to avoid overexertion
•Firm mattress or bed board
•Encourage positions of extension
- Avoid flexion positions
•No pillows under knees
•Small, flat pillow under head and shoulders
•Low-dose antidepressants to reestablish sleep patterns and improve pain management.
RA: Joint Protection
- Modify tasks for less stress on joints
- Energy conservation
- Work simplification techniques
- Pacing and organizing
- Use of carts
- Joint protective devices
- Delegation
- Occupational therapy
- Assistive devices
RA cold and heat therapy
Relieve pain, stiffness, and muscle spasm
Cold:
- benefit during disease activity
- don’t exceed 15 min
- ice or frozen veggies
Heat:
- relieve chronic stiffness
- don’t exceed 20 mins
- heating pad, moist hot packs, paraffin baths, warm bath or shower
- be carful about burns, DONT use with topical heating cream
RA: Exercise Therapy
Individualized exercise plan to
•Improve flexibility and strength
•Increase overall endurance
•Need both recreational and therapeutic exercise
•Avoid overly aggressive exercise
•Gentle ROM exercises done daily to keep joints functional
•Aquatic exercises in warm water beneficial
•Limit to one or two repetitions during acute inflammation
RA: Surgical Therapy
Relieve severe pain
•improve function
- Synovectomy
- Total joint replacement (arthroplasty)
RA older population considerations
- May also have OA (fracture risk)
- Polypharmacy can lead to joint pain
- Musculoskeletal pain / weakness may be related to depression and inactivity
- More sensitive to therapeutic and toxic drug effects
- Need simple plan to improve adherence
RA patient education
Medications
Independence/ safety at home
Manage fatigue and depression
RA groups
RA continuing care
Referral to home care for elderly Assess home environment (safety) Asses ability to do ADL - may need adaptive devices - may need home assistance Medical follow up care
What are STI and how are the spread
Infectious diseases spread through sexual contact with the penis, vagina, anus, mouth, or sexual fluids of an infected person
spread:
•Skin-to-skin
•Via blood
•Autoinoculation (spread through touch of infection)
•Not typically transmitted from inanimate objects
STI risk factors
Alcohol / drug use New / multiple partners Sexual partners that have more partners Incorrect use of condom Sharing needles
Already had a STI
Being non vaccinated for STI
