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NURSING 3 > Rheumatic disorders > Flashcards

Rheumatic disorders Flashcards

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1
Q

Rheucmatic disorders affect what?

A

Affect joints, bones, skeletal muscles, and connective tissues

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2
Q

Rheumatic disorders: pain

A

Subtle - pain, weakness, fatigue, insomnia, disturbed body image, joint stiffness

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3
Q

Rheumatic disorders: general onset

A

acute or insideous with periods of remission

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4
Q

Rheumatic disorders: general treatment

A

aimed at localized relief

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5
Q

Rheumatic disorders: gerontological considerations

A

Rheumatic disorders are often consequences of aging

Many do not seek help thinking it’s a normal part of aging

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6
Q

Rheumatic disorders: gero considerations - support system

A

Need adequate support system

  • Exercise
  • Nutrition
  • General health maintenance
  • Pharmacotherapy
  • Nonpharmacologic
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7
Q

Why might the gero population experience failure to follow treatment regimens for rheumatic disorders?

A

hearing
visual acuity
memory loss
depression

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8
Q

What serologic studies can be age related for rheumatic disorders?

A

ESR

ANA

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9
Q

What are anti-arthritic drugs

A

NSAIDs
Disease-modifying antirheumatic drugs (DMARDs)
Glucocorticoids

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10
Q

What are non-pharmacologic treatment regimens for arthritis

A 
Heat or cold
Weight reduction
Joint rest and avoidance of join overuse
Orthotic devices
Exercise Regimen
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11
Q

How does the sed rate test work

A

Phlebotomist draws blood
Test measures how fast RBC fall to bottom of tube in an hour
Inflammation causes red blood cells to stick together and sink faster

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12
Q

Management Goals and strategies Rheumatic disorders: Suppress inflammation and the autoimmune response

A

Optimize pharmacologic therapy (anti-inflammatory and disease-modifying agents)

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13
Q

Management Goals and strategies for Rheumatic disorders: pain control

A

Project joints

Ease pain with splints, thermal modalities, relaxation techniques

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14
Q

Management Goals and strategies for Rheumatic disorders: maintain or improve joint mobility

A

Implement exercise programs for joint motion, muscle strengthening, weight loss as appropriate, and overall health

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15
Q

Management Goals and strategies for Rheumatic disorders: maintain or improve functional status

A

make use of adaptive devices and techniques

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16
Q

Management Goals and strategies for Rheumatic disorders: increase patient knowledge of disease process

A

provide and reinforce patient education

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17
Q

Management Goals and strategies for Rheumatic disorders: promote self management by patient adherence with the therapeutic regimen

A

Emphasize compatibility of therapeutic regiment and lifestyle

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18
Q

What is Osteoarthritis?

A

Degenerative joint disease
A chronic non-inflammatory progressive disorder

Erosion of articular cartilage combines with hypertrophy of bone at joint margins

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19
Q

Osteoarthritis risk factors

A

age and obesity

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20
Q

Osteoarthritis affects which joints (most of the time)

A

weight bearing joitns

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21
Q

Osteoarthritis s/s

A

pain, stiffness, and functional disability
Pain is worse with activity and alleviated by rest
Morning stiffness usually resolves after less than 10 minutes
May report limited ROM and patient report of limited ability to do daily activities.
Crepitus is heard or felt

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22
Q

Osteoarthritis: diagnostics

A

Xray is often used to diagnose, monitor and watch the progression of the disease

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23
Q

osteoarthritis: management

A

pharmacological and non-pharmacological

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24
Q

Osteoarthritis: education

A

Need education, reduce pain and inflammation, optimize physical function and attempt to prevent or slow progression

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25
Q

Osteoarthritis: non pharm tx

A

– rest and joint protection – heat with some cold, weight reduction and exercise

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26
Q

Osteoarthritis: pharm tx

A

NSAIDs
Corticosteroids
surgery - arthroplasty

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27
Q

Osteoarthritis: monitor

A

Check Liver, CBC – Tylenol – caution with alcohol and OTC products

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28
Q

gout

A

Most common of the inflammatory arthritides
Monosodium urate crystal deposits into joints & tissues
Increased serum uric acid levels

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29
Q

Gout risk factors

A

males

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30
Q

Gout s/s

A

– excruciating pain and inflammation in joints.
Trauma, alcohol ingestion, dieting, medications, surgical stress or illness = triggers
Abrupt onset occurs at night
Pain, redness,

31
Q

Gout medications for tx

A

NSAIDs
Colchicine
Corticosteroids
Allopurinol

32
Q

Gout: nursing considerations

A 
Rest & elevate
Ice – NOT heat
Avoid alcohol, smoking
Avoid foods high in purine
Drink 2000mL daily
33
Q

Gout education (diet)

A

Restrict consumption of foods high in purines, especially organ meats and shellfish; others believe that limiting protein foods such as red meats, lamb and pork or avoiding trigger foods are sufficient.

34
Q

Gout: phase 1

A

asymptomatic hyperuricemia, is when the serum urate level is high, but gout manifested by arthritis or nephrolithiasis has not yet occurred. People can remain asymptomatic throughout their lifetimes. The subsequent development of gout is directly related to the duration and magnitude of the hyperuricemia. Therefore, the commitment to lifelong pharmacologic treatment of hyperuricemia is deferred until there is an initial attack of gout (phase 2)

35
Q

Gout: early attacks

A

Early attacks tend to subside spontaneously over 3 to 10 days even without treatment. The attack is followed by a symptom-free period (the intercritical stage or phase 3) until the next attack, which may not come for months or years. However, with time, attacks tend to occur more frequently, to involve more joints, last longer, and lead to long-term sequelae (phase 4).

36
Q

Gout diagnostics

A

clinically relevant to use the biologic value of 6.8 mg/dL or 408 μmol/L, a level of serum uric acid above the saturation point for crystal formation

37
Q

Fibromyalgia:

A

Chronic pain, exxagerated tenderness at 18 specified tender points

38
Q

Fibromyalgia: s/s

A

– sleep disturbances, fatigue, morning stiffness, muscle weakness, paresthesia, cognitive dysfunction, chronic headaches, mood disturbances, irritable bowel syndrome

39
Q

Fibromyalgia: treatment

A

Based on s/s

  • NSAIDs
  • Tramadol
  • Pregabalin
  • SNRI (Duloxetine)
  • nonpharm.
40
Q

Fibromyalgia: nursing considerations

A

holistic approach

Safety

41
Q

What is a hallmark of fibromyalgia

A

that individuals display diffuse hyperalgesia (increased pain to normally painful stimuli) and/or allodynia (pain to normally nonpainful stimuli). This suggests that these individuals have a fundamental problem with central dysfunction (pain processing mechanisms) that results in central pain sensitization.

42
Q

What is rheumatoid arthritis

A

Autoimmune disease occurring in synovial joint

Rheumatoid arthritis affects joint linings, causing painful swelling. Over long periods of time, the inflammation associated with rheumatoid arthritis can cause bone erosion and joint deformity.

43
Q

What are risk factors to rheumatoid arthritis?

A

pollution
smoking
family history
bacterial and viral diseases

44
Q

rheumatoid arthritis: lab values

A 
Rheumatoid Factor (RF)
Anticitrullinated peptide antibody (ACPA)
Erythrocyte sedimentation rate (ESR)
C-reactive protein (CRP)
CBC
TB
Hepatitis B & C
Liver & Kidney Functions
X-ray
Ultrasound
Arthrocentesis
45
Q

Rheumatoid arthritis: clinical manifestations

A 
Symmetric joint pain 
Morning joint stiffness lasting longer than 1 hour
Swelling
Warmth
Erythema
Lack of function
Joints feel spongy
Fluid can be aspirated
Bilaterally and symmetric
46
Q

RA is a systemic disease with multiple extra-articular features, such as

A 
Fever
weight loss
fatigue
anemia 
lymph node enlargement 
Raynaud's disease
47
Q

What is raynaud’s disease?

A

cold- and stress-induced vasospasm causing episodes of digital blanching or cyanosis

48
Q

What is the goal of treatment with RA

A

decrease joint pain and swelling
achieve clinical remission
decrease the likelihood of joint deformity
minimize disability

49
Q

RA: early medical management medications

A

medication
Methotrexate
Hydroxychloroquine
NSAIDS

50
Q

What is medical management for someone with moderate RA?

A

OT/PT

Cyclosporine

51
Q

RA medical management for someone with persistent RA

A

Reconstructive surgery

Corticosteroids

52
Q

RA: nutrition therapy

A

Anorexia
Weight loss
Anemia
Food high in vitamins, protein, and iron

53
Q

RA potential complication

A 
Cardiovascular disease
	Elevated lipid values
	Chronic inflammation
	Dysfunction of the endothelium
	Abnormal homocysteine levels
54
Q

What is systemic lupus erythematous?

A

Inflammatory, autoimmune disorder

Body’s immune system inaccurately recognizes the cell’s nucleus as foreign

55
Q

SLE triggers?

A 
Cigarette smoke
UV rays
Medications
Viral Infections
Emotional Stress
Stress on the body
Dust exposure
56
Q

SLE s/s

A 
Systemic Symptoms
Fever
Malaise 
Weight loss
Anorexia
Joint pain
57
Q

SLE: cutaneous s/s

A

Butterfly-shaped erythematous rash bride of nose and cheeks

Rashes

58
Q

SLE: assessment

A

Cardiovascular
Joint Swelling
Neurologic
Kidney

it can impact any organ in the body

59
Q

SLE labs

A

ANA
Anti-DNA
CBC

60
Q

the labs and what they mean are on this ppt

A

go look if you ned

61
Q

SLE: pharm therapy – monoclonal antibodies

A

Example: Belimumab

education: No live vaccines

62
Q

SLE: corticosteroids

A

education about the complications that can arise such as osteoporosis and fractions

63
Q

SLE: example of antimalarial agents for tx

A

Hydroxychloroquine

64
Q

SLE treatment: NSAIDS

A

just know this is a treatment options

65
Q

SLE pharm therapy: examples of immunosuppressive agents

A

Cyclophosphamide

Azathioprine

66
Q

SLE medical and nursing management

A

Interventions are directed at controlling exacerbations
Body image
Skin integrity
medication education

67
Q

What is Sjogren’s syndrome

A

progressively affects the lacrimal and salivary glands

68
Q

Sjogren’s syndrome s/s

A 
dry eyes
dry mouth
lesions 
trigeminal neuralgia 
sensory neuropathy
69
Q

Sjogren’s syndrome: diagnostics

A

Histopathy of salivary glands

70
Q

Sjogren’s syndrome: medical management

A

No cure
Treat symptoms
Cholinergic agents

71
Q

What is scleroderma

A

begins with changes in the skin

cause is unknown

72
Q

What are the 3 cardinal features of scleroderma

A

Vascular injury and damage

Activation of innate and adaptive arms of the immune system autoimmunity

Generalized interstitial and vascular fibrosis

73
Q

Scleroderma: management

A

depends on the clinical manifestations

74
Q

The limited symptoms of scleroderma are referred to as CREST

A

Calcinosis: calcium deposits in skin

Raynaud’s phenomenon

Esophageal dysfunction: acid reflux and decrease in motility of esophagus

Sclerodactyly: thickening and tightening of the skin on the fingers and hands

Telanglectasis: dilation of capillaries causing red marks on surfaces of the skin

NURSING 3 (16 decks)

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