Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NUR 145 FINAL > Rhematoid Arthritis > Flashcards

Rhematoid Arthritis Flashcards

1
Q

Who is predisposed to contracting RA

A

Effects everyone equally but it is thought that a genetic predisposition is triggered and sets of the disease. Chances of getting it increases with age peaking between 30 and 50 years of age. Women however are more likely than men to have the disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pathophysiology of RA

A

The antigen which is probably not the same in all patients triggers the formation of abnormal immunoglobulin G / IgG.

RA is characterized by autoantibodies agents the abnormal IgG. The antibodies known ad rheumatoid factor combines with IgG to form immune complexes that initially deposit on synovial membranes or superficial articulate cartilage in the joints. Activation an inflammatory response. Attracting neutrophils to the site on inflammation and releasing an enzyme that attacks the cartilage and thickens the synovial lining. Ultimately creating cytokines which drive the inflammatory response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Anatomical Stages of Rheumatoid Arthritis:

Stage 1

A

Early

No destructive changes on X-ray

Possible X-ray evidence of osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Anatomical Stages of Rheumatoid Arthritis:

Stage 2

A

Moderate

X-ray evidence of osteoporosis with or without slight bone or cartilage destruction

No joint deformities (possible limited joint movement though)

Adjacent muscles atrophy

Possible presence of extraartiuclar soft tissue lesions (nodules)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Anatomical Stages of Rheumatoid Arthritis:

Stage 3

A

Severe

X-ray evidence of cartilage and bone destruction + osteoporosis

Joint deformity (subluxation, ulnar deviation or hyperextension with ought fibrous or bony ankylosis)

Extensive muscle atrophy

Possible presence of extraartiuclar soft tissue lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Anatomical Stages of Rheumatoid Arthritis:

Stage 4

A

Terminal

Fibrous or bony ankylosis with stage 3 criteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is important in the development of RA

A

Genetic predisposition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When does smoking increase RA risk

A

When you posses a genetic predisposition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Clinical Manifestation: Joints

What joints are affected?

A

Joint symptoms occur symmetrically and frequently affecting small joints of the hand (PIP, MCP) and feet (MTP)

  • wrist, elbows, shoulders, knees, hips, ankles and jaw may also be involved
  • cervical spine may be affected but on the spin and bones connected to it generally
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Clinical Manifestations: Joints***

What does it feel like?

A
  • joint stiffness after inactivity
  • morning stiffness last one to several hours or more depending on disease
  • symmetrical
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Clinical Manifestations: Joints

Early Stages
Think mean girls principle

A

Fingers become spindle shaped from synovial hyper trophy and thickened joint capsules

joints become tender, painful and warm to touch increasing pain with motion varies in intensity and may not be proportional to inflammation

Tenosynovitis frequently effects extensor and flexor tendon of the wrist = carpal tunnel syndrome manifestations. Making it hard to grasp objects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Clinical Manifestations: Joint

As disease activity progresses what happens?

A

Inflammation and fibrosis lead to deformities: ulnar drift, boutonnière deformity, hallucinations values and swan neck

Atrophy of muscles and destruction of tendons around the joint cause one bone surface to slip past another = SUBLUXATION

Metatarsal head dislocation and subluxation in feet = pain and walking disability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Clinical Manifestations: Extraartiuclar Manifestations

Rheumatoid Nodules

A

Firm non tender granule a type masses located over extensor surfaces of joints like fingers and elbows. Also occur at base of spine and back of head in older adults.

Cardiopulmonary effects may occur in later disease = pleurisy, pleural effusion, pericarditis, pericardial effusion and cardio myopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Clinical Manifestations: Extraarticular Manifestations

Sjogren’s Syndrome

A

Diminished lacrimal and salivary gland secretion = dry mouth, burning itch eyes with decreased tearing and photo sensitivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Clinical Manifestations: Extraarticular Manifestations

Felty Syndrome

A

Occurs mainly in pt with sever nodule forming RA

Characterized by spenomegaly and leukopenia

Flexion contract urea and hand deformities cause diminished grasp and self care deficit

Modular myosotis and muscle fiver degeneration can lead to pain similar to vascular insufficiency

Cataract development and vision loss = sclera nodules

Depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Diagnostic Studies***

A

Diagnosis is made based on physical findings.
Lab test are useful for confirmation and to monitor progression:
- CBC
- Erythrocytes sedimentation rate (ESR) - general inflammation indicator = ELEVATED
- Rheumatoid factor = positive***
- Anti citrus linage protein antibody (ACPA) = more specific than RF and VERY IMPORTANT because they sometimes allow for early dx
-Antinuclear antibody (ANA) = an increase seen in some RA pt
- C-reactive protein (CRP) = inflammation indicator = ELEVATED

  • synovial fluid analysis = early in disease shows straw colored fluid with Gibran fleets and MMP-3 enzyme is present along with elevated WBC (25k)
  • X-ray inconclusive in early states only showing soft tissue swelling and bone demineralization and later in disease = joint space narrowing and cartilage destruction.
17
Q

Collaborative Care: What is important to teach patients? Drugs and non drug teaching.

A

Regarding drug therapy:
Correct administration
Reporting side effects
Frequent medical and lab follow up visits

Non drug teaching:
Teach caregiver about the disease process and home management strategies

18
Q

Drug Therapy: Disease Modifying Antirhumatic Drugs

A

DMARDS have the potential to lessen the permanent effects of RA ( joint erosion and deformities)

19
Q

Drug Therapy: The choice of drug is based on, what?

A 
Disease activity
Pt level of function
Lifestyle considerations (do you want to have a baby?)
20
Q

Drug Therapy: Biological and Targeted Therapies

A

Can be used for those who don’t respond to DMARD or in combination with DMARD. Blocks the binding of TNF to the cell surface receptor inhibiting inflammatory response.

21
Q

Collaborative Care: Other drug therapy used?

A

Corticosteroid for symptom control

NSAIDs and salicylates treat arthritic pain and inflammation

22
Q

Collaborative Care: Nutritional Therapy

What is a RA diet?
How does RA effect intake and weight?
How can occupational therapist help?

A

No specific diet just balanced nutrition because loss of appetite or inability to prepare food may occur. Resulting in wight loss. Occupational therapist help make food prep easier with modifications.

23
Q

Collaborative Care: Corticosteroids and weight/nutrition

A

They cause

  • weight gain
  • increase in appetite
  • moon face
  • redistribution of fat to the trunk
  • physical appearance changes

But your weight will adjust to normal after several months after cessation so don’t stop or change the dose

24
Q

Overall goals for pt with RA

A
  1. Have satisfactory pain management
  2. Have minimal loss on functional ability of the affected joints
  3. Participate in planing and carrying out the therapy regimen
  4. Maintain a positive self image
  5. Perform self-care to the maximum amount possible
25
Q

Nursing Implementation: Health Promotion

A

Prevention isn’t possible.

Early treatment can prevent further joint damage

26
Q

Nursing Implementation: Acute Intervention

How to begin?

A 
Physical assessment (joint pain, swelling, ROM and gen. Health status)
Evaluate psychosocial needs ( fam support, sexual satisfaction, emotional stress, money problems, vacation all and career limits

Environmental concerns (transportation, home or work modifications)

Next coordinate a pan for rehab and education

27
Q

Nursing Implementation: Acute Intervention

Drug regimen

A

Inflammation suppression is effectively achieved by: NSAIDS, DMARDs and biological and targeted therapies

Carefully time drugs because they can help prevent morning stiffness

Discuss action and side effects along with how to successful take drugs

28
Q

Nursing Implementation: Acute Intervention

Non drug regimen

A 
Head and cold therapy
Rest and relaxation techniques
Joint protection
Biofeedback
Transcutaneous electrical nerve stimulation
Hypnosis

Allow pt and caregiver to choose what works for the pt

29
Q

Joint Protection: Small joint instructions

A

Maintain joint in neutral position to minimize deformities (press water from a sponge don’t squeeze)

Use strongest join available for any task (push out of chair with palms not fingers)

Distribute weight over many joints instead of stressing a few (slide don’t lift)

Change positions frequently (avoid grasping for prolonged time)

Avoid repetitious movements (rest between)

Modify chores to avoid stress on joints (no heavy lifting, sit on a stool instead of standing during meal prep)

30
Q

Nursing Implementation: Acute Intervention

Ambulatory and Home Care

A

Rest - schedule rest periods to help relieve fatigue and pain. It varies according to severity of disease and pt limitations

Joint Protection- pace yourself and organize activities to avoid over insertion. Use assistive devices to simplify task.

Heat and Cold therapy and Exercise - help relieve stiffness, pain and muscle spasm. Ice is especially beneficial during exacerbation. Moist heat is good for chronic stiffness. Frozen veg = good for shoulder knees and wrist because the adhere to shapes.
HEAT = 20 MINUTES AT ONE TIME
COLD - 10-15 MINUTES AT ONE TIME
PT = Create a therapeutic exercise program to improve flexibility and strength of joints and endurance overall. Also do gentle ROM daily and aquatic exercise is good.

31
Q

Nursing Implementation: Acute Intervention

How to provide psychological support?

A

They should have a understanding of RA and nature and course of disease as well as the goals of therapy. Help the pt recognize fears and concerns. Discuss alterations in sexuality. Evaluate family support system and financial planning. Music, reading, exercising and counseling may decrease depressive symptoms. Hypnosis and biofeedback may work too.

32
Q

Gerontological Consideratons

A

Age causes lava value interpretation difficult - RF, ESR

Drug drug interactions

NSAIDS with short half life = more frequent dosing

Corticosteroids can add to bone density decrease but can be minimized by age appropriate exercise.

Ability to follow treatment regimen

33
Q

What is rheumatoid arthritis

A

A chronic systems autoimmune disease characterized by inflammation o f connective tissue in the synovial joints.

Periods of remission and exacerbation.

34
Q

What is different about RA from OA?**

A

Autoimmune and systemic

35
Q

RA: how do symptoms occur?***

A

Effects 3 or more joints with exacerbation and remission

36
Q

S/s: **

A 
Weak 
Fatigue
Anorexia
Weight loss or maintained
Muscle ache

NUR 145 FINAL (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions