rheumatoid arthritis Flashcards
patho of RA
- Synovial membrane inflammation resulting in cartilage destruction and bone erosion, inflammatory
- a chronic, progressive, systemic inflammatory autoimmune disease process that affects primarily the synovial joints. Systemic means this disease can affect any or all parts of the body
- RA, transformed autoantibodies (rheumatoid factors [RFs]) that attack healthy tissue, especially synovium, are formed, causing inflammation.
early signs of RA
Joint inflammation Systemic low-grade fever Fatigue Weakness Anorexia paresthesias
late s/s of ra
System-wide
Joint deformities Moderate to severe pain Morning stiffness Osteoporosis Severe fatigue Anemia Weight loss Subcutaneous nodules Peripheral neuropathy Vasculitis Pericarditis Fibrotic lung disease Kidney disease Feltt syndrome
nonpharmacological interventions of ra
- Heat or cold applications (combo of both) hot shower in morning and intermediate use ice during exacerbation
- Adequate rest
- Balance activity with rest
- Finger and hand exercising
- proper positioning
- Plasmapheresis
- Stress managemnet
- Weight loss
- Adequate nutrition
prednisone moa
Prednisone decreased inflammation via suppression of the migration of polymorphonuclear leukocytes and increasing capillary permeability
- Fast acting antiinflammatory and has an immunosuprrent act
prednisone nursing considerations
- Monitor and report signs of peptic ulcer
- Watch out for heartburn, vomiting blood, tarry stools, and loss of appetite
aspirin moa
Aspirin and other NSAIDS are known to treat inflammatory symptoms. Aspirin exerts its effects on cyclooxygenase activity which is linked to inflammation.
aspirin
- The nurse should monitor the patient for pain and pyrexia (fever)
- For long term therapy, the patients liver function, renal function and ototoxicity
- Ensure that the patient does not have any other medications that interact with aspirin, especially warfarin.
methotrexate
- drug of choice
Methotrexate inhibits enzymes responsible for nucleotide synthesis which prevents cell division and leads to anti-inflammatory actions - Extremely effective and cheap
methotrexate nursing considerations
- The nurse should monitor the patient for changes in skin, liver function and bone marrow suppression
- 4-6 weeks to feel effectiveness
- Look ot for infection
rheumatoid factor clinical significance
Rheumatoid factor: measures the presence of unusual antibodies of the immunoglobulins G (IgG) and M (IgM) types that develop in a number of connective tissue diseases: many patients have an RA have a positive titer
antinuclear antibody clinical significance
- measures the titer of a group of antibodies that destroy the nuclei of cells and cause tissue death in patients with autoimmune disease.
- If this test result is positive (a value higher than 1:40), various subtypes of this antibody are identified and measured.
invasive diagnostic
arthrocentesis
- invasive diagnostic procedure that may be used for patients with joint swelling caused by excess synovial fluid (effusion). Done as a diagnostic procedure. Can be done as a treatment modality
- The provider inserts a large-gauge needle into the joint (usually the knee) to aspirate a sample of synovial fluid and to relieve pressure caused by excess fluid. The fluid is analyzed for inflammatory cells and immune complexes, including RF. Fluid from patients with RA typically reveals increased WBCs, cloudiness, and volume.
- Patient nursing considerations are to teach the patient to use ice and rest the affected joint for 24 hours after arthrocentesis. Often the primary health care provider will recommend acetaminophen as needed for discomfort.
bucks traction
Buck’s traction is meant to keep the leg in an extended position by means of a longitudinal skin traction applied in one direction with a single pulley. This system is meant to help with fractures, realigns bones, helps correct contractures or deformities and is meant to immobilize the knee
bucks traction nursing considerations
- ensure that the weight bag is hanging freely, to not have the bag rest on the floor, if the rope becomes frayed, it must be replaced, the nurse should ensure that the rope is on the pulley track, and the nurse should make sure the bandages are free from wrinkles.
- Pulling force, pulls bones apart, decrease inflammation and destruction because bones are not being rubbed against
- (Buck) traction may be applied before surgery to help decrease pain associated with muscle spasm.
- Don’t remove weights until surgery or physician order
enoxaparin (Lovenox)
It is an anticoagulant medication. It is used to treat and prevent deep vein thrombosis and pulmonary embolism
postoperative problems
- hip dislocation
- venous thromboembolism
- infection
- decreased mobility
hip dislocation post op probelm
- teach pt. to maintain correct positioning of joint and leg at all times, place pt. in supine position, keep alignment, observe for s/s of hip dislocation: sudden pain
venous thromboembolism post op probelm
Blood thinners
Pt. moving
Antithrombotic devices
infection post op problem
Check for decreased mental status or elevated wbc don’t wait till patient has a fever
decreased mobility post op problem
- Deep breathing exercises
- As soon as permitted get patient out of bed to a recliner chair
two main goals for maintaining proper alignment of operative leg
The patient should not flex their leg greater than 90 degrees, adduction or internal rotation because these could lead to dislocation before the 6-week healing process is done.
- Maintain abduction avoid adduction
- Hip align with the ankles
how is proper alignment achieved by
- Using an elevated toilet seat
- Using a shower/tub chair
- Using a pillow between legs when lying on the side
- Notifying provider if there is severe pain, deformity, or loss of function
RA, what interventions should be implemented to prevent complications secondary to immobility
- Ambulation: up on day of surgery or pod1
- Elastic Stockings or Mechanical aids
- The patient should be receiving low-molecular weight heparin to reduce to risk of venous thrombosis and pulmonary embolism
- Frequent repositioning every 1 to 2 hours to reduce the risk of pressure ulcers
- Deep breathing/ Coughing techniques
- Encourage diet high in calcium and protein
what puts someone at risk for infection, bleeding and anemia
- prednisone
- methotrexate
techniques to protect herself from infections related to medication induced immunosuppression
- Avoid crowds and people who are ill
- Wash hands before and after handling food
- Avoid eating raw eggs and meat
- Practice safe food preparation
- Identification for s/s
- Proper wound care
