Rheumatic/Autoimmune Flashcards
3 Distinct Characteristics of Rheumatic Diseases
- Inflammation (results in pannus - swelling of synovial tissue)
- Autoimmunity (HALLMARK; body recognizes own tissue as foreign)
- Degeneration (secondary to inflammation)
Rheumatic Diseases: Common S/S
- pain (most common)
- joint swelling
- limited movement
- stiffness
- weakness
- fatigue
Pharmacologic Interventions
- salicylates (aspirin)
- NSAIDS
- corticosteroids
- DMARDs
Traditional/Nonbiologic DMARDs
- usually taken orally
- examples: methotrexate, sulfasalazine, hydroxychloroquine, leflunomide, azathioprine
Biologic DMARDs
- targets specific cells
- usually injection or infusion
- examples: etanercept, infliximab, adalimunab, anakinra, tocilzumab, abatacept, rituximab
Hydroxychloroquine
- 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
sulfasalazine
- Traditional/Nonbiologic DMARD
- administer concurrently with NSAIDs
- emphasize adequate fluid intake
- assess for GI upset, skin rash, HA, liver abnormalities, anemia
methotrexate and azathioprine
- Traditional/Nonbiologic DMARD
- teratogenic (contraceptives)
- assess for bone marrow suppression, GI ulcers, skin rashes, alopecia, bladder toxicity, increased infections
- monitor CBC, liver enzymes, creatinine
Leflunomide
- 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
Adalimumab
- 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
abatacept
- Biologic DMARD
- subcutaneous self-injections given daily
- increased risk of infection and to withhold medication if fever occurs
- monitor for injection site reactions
rituximab
- Biologic DMARD
- increased risk of infection
- premeditate with acetaminophen, antihistamine, and methylprednisolone 30 min prior to infusion
anakinra
- Biologic DMARD
- subcutaneous self-injections given daily
- medication must be refrigerated
- increased risk of infection and to withhold medication if fever occurs
tocilzumab
- Biologic DMARD
- increased risk of infection
- IV Q4 weeks
Dx Imaging
- x-rays
- CT scan
- MRI
- anthrology
Antinuclear Antibody (ANA)
increased = inflammation
Anti-DNA, DNA Binding
increased = increase in disease activity (usually SLE)
C-reactive protein 9
+ = active inflammation
Rheumatoid Factor (RF)
increased = inflammation
Creatinine
indicates kidney damage in SLE and scleroderma
Erythrocyte Count
decrease can be seen in RA and SLE
Erythrocyte Sedimentation Rate (ESR)
increase = inflammation
Hematocrit
decrease (anemia) can be seen in chronic inflammation
WBC
decreased in SLE
Uric Acid
increased w/ gout
Rheumatic Diseases: Complications
- limitations in mobility
- pain and fatigue
- altered self image
- sleep disturbances
- systemic effects that can lead to organ failure and death
Nursing Considerations: Pain Management
- provide comfort measures (heat: warm baths and compresses, paraffin baths)
- administer anti-inflammatory, analgesic medications
Nursing Considerations: Fatigue Management
- explain energy-conserving techniques
- facilitate development of activity/rest schedule
- cluster care
Nursing Considerations: Functional Mobility Management
- assess need for PT/OT
- encourage independence in mobility
Nursing Considerations: Self-Care Management
- 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)
Nursing Considerations: Effective Coping Behaviors
- identify areas of life affected by disease
- develop plan for managing symptoms and enlisting support of family and friends to promote daily function
RA: Pathophysiology
- chronic, progressive inflammatory disease that can affect tissues and organs but principally attacks and joints bilaterally and symmetrically
RA: S/S
- pannus formation (destroys cartilage and erodes bone)
RA: Risk Factors
- family hx
- environmental influences: diet, geographic location
- nulliparity
- modifiable: smoking, obesity
SLE: S/S
- 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
SLE: Risk Factors
- 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
Scleroderma: Pathophysiology
- 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
Scleroderma: Types
- Localized: affecting only the cutaneous system
- Diffuse: systemic sclerosis affecting multiple organ systems
Scleroderma: S/S
- 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
Scleroderma: Medications
- based on organ involvement
- ACE inhibitors for kidney involvement to reduce HTN
