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NURS 240 Exam 3 > Rheumatic/Autoimmune > Flashcards

Rheumatic/Autoimmune Flashcards

1
Q

3 Distinct Characteristics of Rheumatic Diseases

A
  • Inflammation (results in pannus - swelling of synovial tissue)
  • Autoimmunity (HALLMARK; body recognizes own tissue as foreign)
  • Degeneration (secondary to inflammation)
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2
Q

Rheumatic Diseases: Common S/S

A
  • pain (most common)
  • joint swelling
  • limited movement
  • stiffness
  • weakness
  • fatigue
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3
Q

Pharmacologic Interventions

A
  • salicylates (aspirin)
  • NSAIDS
  • corticosteroids
  • DMARDs
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4
Q

Traditional/Nonbiologic DMARDs

A
  • usually taken orally
  • examples: methotrexate, sulfasalazine, hydroxychloroquine, leflunomide, azathioprine
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5
Q

Biologic DMARDs

A
  • targets specific cells
  • usually injection or infusion
  • examples: etanercept, infliximab, adalimunab, anakinra, tocilzumab, abatacept, rituximab
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6
Q

Hydroxychloroquine

A
  • Traditional/Nonbiologic DMARD
  • emphasize need for regular eye exams
  • may be administered concurrently with NSAIDs
  • assess for visual changes, GI upset, skin rash, HA, photosensitivity, bleaching of hair
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7
Q

sulfasalazine

A
  • Traditional/Nonbiologic DMARD
  • administer concurrently with NSAIDs
  • emphasize adequate fluid intake
  • assess for GI upset, skin rash, HA, liver abnormalities, anemia
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8
Q

methotrexate and azathioprine

A
  • Traditional/Nonbiologic DMARD
  • teratogenic (contraceptives)
  • assess for bone marrow suppression, GI ulcers, skin rashes, alopecia, bladder toxicity, increased infections
  • monitor CBC, liver enzymes, creatinine
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9
Q

Leflunomide

A
  • Traditional/Nonbiologic DMARD
  • contraindicated ins pregnancy and breast feeding
  • assess for bone marrow suppression, GI ulcers, skin rashes, alopecia, bladder toxicity, increased infections
  • monitor CBC, liver enzymes, creatinine
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10
Q

Adalimumab

A
  • Biologic DMARD
  • tested for TB before beginning medication
  • increased risk for infection and to withhold medication if fever occurs and notify provider
  • injection site reactions
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11
Q

abatacept

A
  • Biologic DMARD
  • subcutaneous self-injections given daily
  • increased risk of infection and to withhold medication if fever occurs
  • monitor for injection site reactions
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12
Q

rituximab

A
  • Biologic DMARD
  • increased risk of infection
  • premeditate with acetaminophen, antihistamine, and methylprednisolone 30 min prior to infusion
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13
Q

anakinra

A
  • Biologic DMARD
  • subcutaneous self-injections given daily
  • medication must be refrigerated
  • increased risk of infection and to withhold medication if fever occurs
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14
Q

tocilzumab

A
  • Biologic DMARD
  • increased risk of infection
  • IV Q4 weeks
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15
Q

Dx Imaging

A
  • x-rays
  • CT scan
  • MRI
  • anthrology
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16
Q

Antinuclear Antibody (ANA)

A

increased = inflammation

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17
Q

Anti-DNA, DNA Binding

A

increased = increase in disease activity (usually SLE)

18
Q

C-reactive protein 9

A

+ = active inflammation

19
Q

Rheumatoid Factor (RF)

A

increased = inflammation

20
Q

Creatinine

A

indicates kidney damage in SLE and scleroderma

21
Q

Erythrocyte Count

A

decrease can be seen in RA and SLE

22
Q

Erythrocyte Sedimentation Rate (ESR)

A

increase = inflammation

23
Q

Hematocrit

A

decrease (anemia) can be seen in chronic inflammation

24
Q

WBC

A

decreased in SLE

25
Q

Uric Acid

A

increased w/ gout

26
Q

Rheumatic Diseases: Complications

A
  • limitations in mobility
  • pain and fatigue
  • altered self image
  • sleep disturbances
  • systemic effects that can lead to organ failure and death
27
Q

Nursing Considerations: Pain Management

A
  • provide comfort measures (heat: warm baths and compresses, paraffin baths)
  • administer anti-inflammatory, analgesic medications
28
Q

Nursing Considerations: Fatigue Management

A
  • explain energy-conserving techniques
  • facilitate development of activity/rest schedule
  • cluster care
29
Q

Nursing Considerations: Functional Mobility Management

A
  • assess need for PT/OT
  • encourage independence in mobility
30
Q

Nursing Considerations: Self-Care Management

A
  • assist in identifying self-care deficits and factors that interfere w/ ability to perform self-care activities
  • provide assistive devices
  • consult w/ community agencies (support groups)
31
Q

Nursing Considerations: Effective Coping Behaviors

A
  • identify areas of life affected by disease
  • develop plan for managing symptoms and enlisting support of family and friends to promote daily function
32
Q

RA: Pathophysiology

A
  • chronic, progressive inflammatory disease that can affect tissues and organs but principally attacks and joints bilaterally and symmetrically
33
Q

RA: S/S

A
  • pannus formation (destroys cartilage and erodes bone)
34
Q

RA: Risk Factors

A
  • family hx
  • environmental influences: diet, geographic location
  • nulliparity
  • modifiable: smoking, obesity
35
Q

SLE: S/S

A
  • malar rash (butterfly rash)
  • scaly raised rash to face or upper body
  • splinter hemorrhages
  • alopecia
  • Raynaud’s phenomenon
  • joint pain and swelling
  • fever, weakness, malaise
  • anorexia, weight loss
  • pericarditis, myocarditis
  • nephritis
36
Q

SLE: Risk Factors

A
  • more common in African, Hispanic, Asian, and Native Americans than Caucasian Americans
  • genetics
  • female hormones
  • cigarette smoke
  • ultraviolet rays
  • sunlight and fluorescent light bulbs
  • medications (hydralazine, minocycline, or procainamide)
  • viral infections
  • emotional stress
  • stress on the body (surgery, pregnancy, etc.)
  • silica dust exposure
37
Q

Scleroderma: Pathophysiology

A
  • rare and progressive
  • affects connective tissue of the skin, blood vessel walls, and internal organs w/ remissions and exacerbations
  • more often in women between 25-50
38
Q

Scleroderma: Types

A
  • Localized: affecting only the cutaneous system
  • Diffuse: systemic sclerosis affecting multiple organ systems
39
Q

Scleroderma: S/S

A
  • CREST
  • Calcinosis: calcium deposits on skin
  • Raynaud’s phenomenon: spasm of blood vessels in response to cold or stress
  • Esophageal dysfunction: acid reflux and decrease in motility of esophagus
  • Sclerodactyly: thickening and tightening of the skin on fingers and hands
  • Telangiectasis: dilation of capillaries causing red marks on surface of skin
40
Q

Scleroderma: Medications

A
  • based on organ involvement
  • ACE inhibitors for kidney involvement to reduce HTN

NURS 240 Exam 3 (8 decks)

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