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Module 4 (MedSurg 2) > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

Immune system main functions

A

fight disease and foreign invaders
constant surveilance
distinguish between normal and foreign (self and non-self)
attach, destroy, and get rid of

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2
Q

Why elderly are more prone to immune diseases and CA?

A

The body can no longer distinguish between self and nonself (DM and CA)

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3
Q

Onset difference between RA and OA

A

RA: < 50 y/o
OA: > 40 y/o

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4
Q

Location of joint pain difference between RA and OA**

A

RA: small joints (hands) on both sides of the body
OA: weight-bearing joints (one-sided)

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5
Q

Joint Appearance difference between RA and OA**

A

RA: inflammation causing warmth, red and swollen
OA: cool not red or swollen

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6
Q

Morning stiffness difference between RA and OA**

A

RA: > 60 mins persist for hours
OA: few minutes

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7
Q

S/S besides the joint difference between RA and OA

A

RA: fatigue, weight loss, and fever
OA: none

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8
Q

Progression difference between RA and OA

A

RA: worsens over weeks or months
OA: Over years

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9
Q

Easing pain and stiffness difference between RA and OA**

A

RA: decrease with activity
OA: rest and worsens with activity

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10
Q

Rheumatoid Arthritis def

A

Chronic, systemic autoimmune disease
Inflammation of connective tissue in joints

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11
Q

RA has what type of manifestations

A

extraarticular

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12
Q

RA has periods of

A

remission and exacerbation

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13
Q

Is there a possible genetic link to RA

A

YES

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14
Q

Causes of RA needs to be a combination of

A

genetics and environmental triggers

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15
Q

Antigen triggers the formation of what in RA

A

abnormal IgG

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16
Q

What develops against the abnormal IgG?

A

autoantibodies

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17
Q

What percentage of people with RA test positive for the Rheumatoid factor in the blood?

A

85

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18
Q

What are the stages of RA?

A

Synovitis
Pannus
Fibrous Ankylosis
Bony Ankylosis

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19
Q

Order of RA onset Patho

A

combination of genetic and environmental triggers
IgG forms
RF forms (autoantibodies against abnormal IgG)
RF and IgG combine
- deposits on synovial joints
- activation of inflammatory response
Neutrophils release damaging cartilage
- Thickening of synovial lining
- Cytokines drive inflammatory response in RA
If untreated goes into the 4 stages

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20
Q

What drives the inflammatory response in RA?

A

Cytokines

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21
Q

Stage 1 RA - Early

A

Synovitis
synovial swelling with excess blood
lymphocyte infiltration
High WBCs
no destructive change; swelling and osteoporosis

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22
Q

Stage 2 RA - Moderate

A

Pannus
increase inflammation
no deformities
muscle atrophy
possible lesions
signs of gradual destruction in the joint, narrowing from a loss of cartilage
osteoporosis

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23
Q

Stage 3 RA: Severe

A

Fibrous Ankylosis
form of pannus
cartilage eroded and bone exposed
possible deformities

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24
Q

Stage 4 RA: End - stage

A

inflammation subsides
bony ankylosis
loss of joint function
subcut nodules
bone forms in between the joint

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25
Q

RA S/S: Joints

A

Fatigue, anorexia, weight loss, generalized stiffness (morning > 60+ mins)
symmetrically
tender, painful, swollen, pain with motion, and varies with the intensity
skin is stretched tightly

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26
Q

The onset of RA is usually

A

insidious and sneaky
don’t feel good but don’t know why

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27
Q

Common areas of RA

A

wrist
MCP (metacarpophalangeal joint) - knuckle of thumb
PIP (proximal interphalangeal joint) - knuckle of pinky
big tow

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28
Q

May Report precipitating triggers such as

A

infection
stress
exertion
childbirth
surgery
emotional upset

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29
Q

Tensynovitis

A

inflammation of the fluid-filled synovium within the tendon sheath.

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30
Q

Subluxation

A

inflammation of tendons/joints shifts the alignment of bones (spine)

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31
Q

Joint RA manifestations result in what complications

A

Tenosynovitis
Deformity and disability
Subluxation
Walking disability
Deformities in the hands

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32
Q

Typical deformities of RA

A

Ulnar deviation
Boudamire (button-hole)
Bunion
Swan-neck

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33
Q

Ulnar deviation

A

hand drifts out to the pinky side

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34
Q

Boudamire

A

button-hole
usually middle joint
can’t straighten out

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35
Q

Bunion (hallux valgus)

A

the base of big to
joint shifts and the toe goes inward

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36
Q

Swan-neck deformity

A

middle joint goes down and the top joint goes up
palmar side injury

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37
Q

RA S/S Extraarticular

A

Rheumatoid nodules
Sjogren’s syndrome
Felty syndrome
Flexion contractures (low mobility and ADLs)
Depression (chronic pain)

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38
Q

Extraarticular s/s will show on someone without

A

treatment, uninsured, or money

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39
Q

What happens to the salivary and tear glands with RA?

A

DRY UP
hard to swallow, infection in dry eyes, and dental hygiene decrease in dry mouth

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40
Q

Rheumatoid nodules

A

skin breakdown main concern
painless, inflamed tissue get hard over time

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41
Q

Sjogren’s syndrome

A

separate or combination with RA
salivary and tear glands become dry and hard to swallow
dry eyes = infection
dry mouth = dental

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42
Q

Felty syndrome

A

enlarged spleen

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43
Q

S/S of RA - Lungs

A

pleura effusions - stiffness
lung fibrous nodules effusions

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44
Q

S/S of RA - Eyes

A

scleritis
keratoconjunctivitis

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45
Q

S/S of RA - Lymph nodes

A

lymphadenopathies

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46
Q

S/S of RA - Pericardium

A

effusions

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47
Q

S/S of RA - Kidney/Gut

A

amyloidosis

48
Q

S/S of RA - Spleen

A

splenomegaly

49
Q

S/S of RA - Bone marrow

A

anemia
thrombocytosis

50
Q

S/S of RA - Muscle

A

wasting/atrophy

51
Q

S/S of RA - Nervous System

A

peripheral neuropathy

52
Q

S/S of RA - Skin

A

thinning
ulcerations

53
Q

HIgher the inflammation = higher

A

systemic impact

54
Q

With pleural effusion, what nursing management needs to be done?

A

TCDB
IS
harder to get off the ventilator

55
Q

Subjective Nursing Assessment of RA

A

The presence of precipitating factors,
Pattern of remissions and exacerbations
H&P (medications (current and past)) - ADLs 3-6 months through questionnaire of activity
Impact on functional ability
- Anorexia, weight loss, malaise
- Stiffness and joint swelling, muscle weakness, difficulty walking
- Paresthesia of hands and feet
Symmetric joint pain and aching, and temp

56
Q

Extraarticular means

A

outside the joint

57
Q

Objective Data of RA

A

Lymphadenopathy, fever
Rheumatoid nodules
Skin ulcers
Shiny, taut skin over joints
Raynaud’s phenomenon
Dysrrthrmias
chronic bronchitis
TB
Splenomegaly

58
Q

RA pts are more prone to

A

swollen lymph nodes
skin ulcers

59
Q

Raynaud’s phenomenon

A

exaggerated/severe vasoconstriction when pt is exposed to the cold
think of tip of finger is white while the others are red

60
Q

Raynould’s phenomenon is commonly located in

A

hands
feet
ears
nose

61
Q

What med is used to help prevent Raynould’s phenomenon?

A

mild beta-blocker, Ca channel blockers, ACE, Alpha-blockers
(gloves)

62
Q

RA pts are more susceptible to TB because

A

immunosuppressants allow for dormant TB to become active

63
Q

S/S of felty syndrome

A

S – Splenomegaly
A – Anemia
N – Neutropenia
T – Thrombocytopenia
A – Arthritis (Rheumatoid)

64
Q

How does dysrhythmias occur in RA pts?

A

scaring of AV or SA node in a regular pt

65
Q

S/S of felty syndrome
mnemonic

A

SANTA

66
Q

Decrease WBC means increase in

A

infection

67
Q

Objective Data RA
M/S

A

Symmetric joint involvement
Swelling, erythema
Heat, tenderness
Deformities
Joint enlargement

68
Q

RA Labs

A

+ RF
increase ESR and CRP
increase of WBC in synovial fluid
SFA

69
Q

RA Xray findings

A

Joint space narrowing
Bony erosion
Deformity
Osteoporosis type

70
Q

ESR means

A

erythrocyte sedimentation rate
- the amount of inflammation

71
Q

CRP means

A

C-reactive protein
made in the liver and increase with inflammation

72
Q

If not + RF,

A

A lesser degree of RA can still be dx with it s/s not as severe
85% of people who do have RA will have + RA factor

73
Q

Pt teaching of RA

A

drug therapy
- Individualized PT and OT
- NSAIDs, DMARDs, AND glucocorticoids
- delay progression and relieve symptoms
disease process
- build up over time
Mgmt
- Joint function and ROM
- manage systemic involvement

74
Q

PT works on

A

mobility and larger muscle groups

75
Q

OT works on

A

fine motor skills
ADLs - hands, adaptive devices

76
Q

Is there a cure for RA?

A

NO

77
Q

DMARDs types

A

non bio (traditional chem based)
bio (genetic base)

78
Q

What drugs are used in RA pts?

A

NSAID
DMARD
Glucocorticoid

79
Q

DMARDs do what

A

disrupt inflammatory process

80
Q

Non-biologic DMARD has what type of effect

A

shotgun (overall)
1st to be used
chemical base

81
Q

Biologic DMARD has what type of effect

A

genetic base
Sniper approach in one area

82
Q

Methotrexate (MTX) class

A

DMARD immunosuppressant

83
Q

Methotrexate (MTX) use

A

RA
psoriasis
leukemia
CA

84
Q

Methotrexate (MTX) assess and monitor

A

CBC
WBC
Liver Function
pain and ROM

85
Q

Methotrexate (MTX) side effects

A

GI upset
anemia
thrombocytopenia
fetal harm

86
Q

Methotrexate (MTX) eduation

A

risk of infection
birth control needed
photosensitivity

87
Q

All DMARDs are toxic to what organ and can cause infection-type

A

liver (hepatotoxic)
opportunistic

88
Q

Methotrexate (MTX) is what DMARD type

A

NON-BIOLOGIC
common because cheap and form differences

89
Q

BRMs (biologic and immunotherapy)

A

slow progression
mech of action
used to treat moderate to severe diseases
alone or combination

90
Q

Biologic DMARDs adverse effects

A

Injection site irritation, pain, redness
Risk for serious infections
Heart failure
Liver failure
Hematologic disorders
Neurologic Disorders
Severe allergic reactions
Cancer

91
Q

Etanercept (Enbrel) class

A

biologic DMARD (specific TNF inhibitor)

92
Q

Etanercept (Enbrel) use

A

RA
psoriatic arthritis

93
Q

Etanercept (Enbrel) assess and monitor

A

pain, swelling, and ROM
Monitor CBC, WBC and TB

94
Q

Etanercept (Enbrel) side effects

A

URI
injection site reaction
risk of TB and malignancies

95
Q

Etanercept (Enbrel) education

A

self admin SQ injection
risk of adverse reaction to live-virus vax
case manager on support for money (Expensive)

96
Q

TB testing needs to be done when

A

before med and during

97
Q

Corticosteroid Therapy

A

intraarticular injections
low dose oral for a limited time

98
Q

NSAID and salicylates

A

anti-inflammatory, analgesic, and antipyretic
2-3 weeks for full effectiveness
**DO NOT STOP or progression of RA and flareups occur

99
Q

Corticosteroids

A
100
Q

TB testing in what conditions

A

dormant to active
crowded areas

101
Q

Nutrition Therapy for RA

A

balanced
loss of appetite leads to wt loss
corticosteroids = wt gain

102
Q

Surgical Therapy for RA

A

if nothing else works
relieve severe pain
improve function
synovectomy
total joint replacement

103
Q

Arthroplasty

A

joint replacement

104
Q

Health Promotion for RA

A

prevention
early id and treatment to prevent further damage
s/s recognition

105
Q

What is the 1st to be stopped when the RA pt has an infection

A

immunosuppressant

106
Q

Acute Care of RA

A

decrease inflammation
manage pain and function
prevent deformities

107
Q

OT can provide what to RA pts

A

lightweight splints
-plan care around morning sytiffness

108
Q

How to relieve joint stiffness and increase ability to perform ADLs?

A

sit/stand in warm shower
sit in tub with warm towels around the shoulders
soak hands in warm water

109
Q

Ambulatory Care: RA rest

A

Alternate rest periods with activity
helps relieve pain and fatigue
8-10 hours of rest and daytime rest PRN
modify activities to avoid overexertion
plan out activites

110
Q

For every 5 lbs of weight gain =

A

20 lbs of weight on the lower body

111
Q

Body Alignment of RA for sleeping

A

firm mattress
encourage extension
avoid flexion positions
no pillows under knees, small,flat pillow under head and shoulders

112
Q

Cold Therapy of RA

A

Beneficial during periods of exacerbation**
Application 10–15 minutes at one time
Helps with swelling to decrease blood flow

113
Q

Moist Heat Therapy of RA

A

Moist hot packs, paraffin baths, warm baths, or showers
Relieve stiffness
20 minutes at a time
Be alert for burn potential
parastesia
Everyday stiffness

114
Q

Exercise of RA

A

need
gentle ROM daily
wt limit to one or two reps during acute inflammation (same reps diff weights)

115
Q

Psychologic of RA

A

SUPPORT
Patient is constantly challenged by problems
Limited function and fatigue
Loss of self-esteem*
Altered body image*
Fear of disability or deformity
Evaluate family support system**
Financial planning**
Consider community resources*
Self-help groups are helpful
Strategies to decrease depression*

116
Q

Etanercept (Enbrel) is prescribed for a patient with stage II rheumatoid arthritis. The nurse determines that the medication is effective if which of the following is observed?

A) Decreased lymphocyte count
B) Absence of Rh factor in the blood
C) Decreased C-reactive protein (CRP)
D) Increased serum immunoglobulin G

A

C) Decreased C-reactive protein (CRP)
higher RH factor = more inflammation, severity, and increase of RA

never absent of antibodies

Module 4 (MedSurg 2) (36 decks)

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