Rheumatic & Allergic Disorders Flashcards
1
Q
Inflammatory
A
Gout (affects Joints, Bones and Muscles)
Rheumatoid Arthritis (affects Connective Tissue) Systemic Lupus Erythematosus (affects Connective Tissue)
2
Q
Noninflammatory
A
Osteoarthritis (affects Joints, Bones and Muscles)
Fibromyalgia (affects Joints, Bones and Muscles)
3
Q
Assessments r/t Rheumatic Disorders
A
- Health History
- Physical exam (look at joints, note deformities, compare sides, tenderness/pain?)
- Functional (see how they do with normal ADLs, are adaptive devices necessary; pt may be adapting in unknown ways)
- Aging Considerations (aging can throw off lab tests; elderly respond to meds different)
4
Q
Diagnostic Tests r/t Rheumatic Disorders
A
- Radiologic (x-rays)
- Labs:
- ESR = Men: 0-15mm/hr (over age 50 is 0-20mm/hr); women 0-20mm/hr (over age 50 is 0-30mm/hr)
- Antinuclear-Antibody (ANA) = normal is negative; titer is 1:160; low titers are present in the elderly
- Autoantibodies = negative is 26 U/mL
- RF = 0 to 20 U/mL negative titer; >1:80 is positive titer
5
Q
Goals of Tx
A
- Suppress inflammation/autoimmune response
- Pain control (pharm and nonpharm)
- Functional Status (OT/PT, splints, adaptive devices)
- Joint mobility (PT…teaches out to use joints correctly)
- Pt Compliance (educate about disorder, how to decrease flair ups and preserve function, encourage self-care)
6
Q
Pharm Tx
A
- Analgesics (usually NSAIDs or acetaminophen….salycilates NOT used d/t GI effects)
- DMARDs (methotrexate is example; for more serious RA and SLE)
- Glucocorticoids (use for acute stages usually, but may use for chronic if severe dysfunction/impairment)
- Biologic agents aka immunomodulators (for severe RA and combo with DMARDs)
7
Q
Nonpharm Tx
A
- hot/cold application
- nutrition
- yoga
- music therapy
- joint rest
- weight reduction
- massage
- music therapy
- exercise
8
Q
Osteoarthritis (OA) - from overuse
A
CARTILAGE
Labs/Dx:
- X-ray
- Arthroscopy
S/S:
- joint stiffness after periods of inactivity but pain AFTER activity
- bone spurs!
NC:
- alteration of heat/cold application
- weight reduction
- activity designed to promote joint rest
- splint
- need 2000mL/day of H20 if on tylenol
- psychological issues
Medical Mgmt:
- pain mgmt (acetaminophen originally and then NSAIDs)
- Surgical
9
Q
Gout
A
Labs/Dx:
- increase in uric acid levels
- for dx must have s/s and elevated uric acid (if uric acid is 6.8mg/dL, more prone to get gout)
S/S:
-acute attacks take place at night
NC:
- nonpham pain mgmt
- joint rest
- avoidance teaching - purines and alcohol
- ice packs
- diet changes
- 2000mL/day of H2O with meds!
Medical Mgmt:
- NSAIDs and corticosteroids (usually for acute flair ups)…also sometimes allopurinol for acute
- Allopurinol and Probenecid (for Chronic; we want uric acid levels around 6 with probenecid..watch for rash and N with this med)
10
Q
Fibromyalgia
A
this is muscle tenderness at 18 specific points
NC:
- Emotional support
- Education on compliance
- Increase independence
- Increase physical activity
- Diet changes
Medical Mgmt:
- NSAIDS
- Tramadol (good for photophobia and auditory pain)
- Pregabalin (good for photophobia and auditory pain)
- Tricyclic antidepressants
11
Q
Rheumatoid Arthritis (RA) - autoimmune
A
INFLAMMATION
Labs/Dx:
-ESR, ANA, anti-CCP, CRP, RF (RF only present in 70% of pts)
NC:
- Emotional support
- Education
- Independence (functional and nonpharm)
Medical Mgmt:
- NSAIDS and Salicylates
- DMARDS…these mute inflame response (AEs include anemia, GI toxicity, birth defects)
- Glucocorticosteroids (for ACUTE)
- Blood filtration (in severe cases)
12
Q
Labs for RA
A
- ESR (see other flash); measures the rate at which red blood cells settle out of unclotted blood in 1 hr)
- ANA (see other flash)
- anti-CCP (positive in RA, neg otherwise)
- CRP (normal is
13
Q
Systemic Lups Erythematosus
A
Labs/Dx:
- 4/11 on American College of Rheumatology Scales is positive for SLE
- ESR, ANA, CRP,
S/S:
- can target any organ
- variable presentation
- butterfly rash
- early photosensitivity
NC:
- preserve independence
- avoid sunlight
- identify stress triggers
- teaching r/t drug AEs
14
Q
Anaphylaxis - progression
A
Body recognizes foreign substance which is good but the RESPONSE is exaggerated
- first exposure
- second exposure
- recognition of antigen
- release of histamine (continuous release)
- release histamine is intensified
- cell destruction and surround tissue inflammation
- increased vascular permeability (allows proteins and larger substances and fluids to get through…which causes tissue inflammation)
- failure of compensatory mechanisms
15
Q
Anaphylaxis - S/s
A
MILD
- watery eyes
- sneezing
- swelling of eyes
- itching
MODERATE
- flushing
- itching (can’t STOP)
- anxiety
SERIOUS
- hives
- effects airway at this point
- significant coughing to get secretions out
- panicky
- bronchospasms
- wheezing
SEVERE:
DON’T DIE
