Rheumatoid Arthritis Flashcards
Rheumatoid Arthritis
-Risk Factors
- Women Between the ages of 40-60 yrs
- Family Hx
- Heavy Smokers
Rheumatoid Arthritis
-Etiology
- Combination of:
- Genetic, environmental, hormonal, and reproductive factors
- Ebstein-Barr Virus T - Long-term exposure to unidentified antigen causes immune response in genetically susceptible host
RA
-Characteristic Manifestations
- Characterized by remissions and exacerbations
- Tender, swollen, red, warm, “boggy” joints
- Symmetric inflammation
- Disease progresssion is fastest in 1st 6 years, then slows down
Rheumatoid Arthritis
-Systemic Manifestations (Extra-Articular)
- Fatigue
- Loss of appetite & Weight loss
- Nonspecific aching and stiffness
- Low grade fever
- Anemia resistant to iron therapy
Rheumatoid Arthritis
-Joint Manifestations
- Clients report Joint swelling, stiffness, warmth, tenderness & pain
- Proximal interphalangeal (PIP) & Metacarpophalangeal (MCP) joints of the fingers, wrists, knees, ankles and toes are most often involved
- Morning stiffness lasting >1hr
Rheumatoid Arthritis
-Swan-neck deformity
- Characterized by hyperextension of the PIP joints w/ compensatory flexion of the distal interphalangeal joints
RA
-Cause of Deformities
- Deformities are caused by the development of a PANNUS
- Pannus = longterm, severe proliferation of the synovial intimal layer
Rheumatoid Arthritis
-Extra-Articular Manifestations
- Rheumatoid Nodules in the
- heart, lungs, intestinal tract, & dura - Subcutaneous nodules
- Pleural effusion
- Vasculitis, pericarditis
- Splenomegaly
Rheumatoid Arthritis
-Effects on Perfusion
- Increased risk of CAD, MI & Death
Rheumatoid Arthritis
-Goals of Therapy
- Relive pain
- Reduce inflammation
- Slow or stop joint damage
- Improve well-being & ability to function
Rheumatoid Arthritis
-Diagnostic Tests
- Lab tests for Rheumatoid factors and ESR
- usually elevated in RA - CBC to ID anemia (wbc)
- Cyclic citrullinated peptide **
- New test for early detection - Synovial fluid Exam (shows inflammatory changes)
- X-ray
- Most specific test.. doesn’t show many changes early in RA
Rheumatoid Arthritis
-Pharmacology
- Aspirin & NSAIDS
- Help with Inflammation but NO EFFECT on disease progression - Low-dose corticosteroids
- Pain and inflammation relief. SLOW progression of RA
Corticosteroid
-PT Teaching
- Pt’s may experience weight gain
- Increase Blood sugar & decreases Immune response
- Long term use causes CUSHING SYNDROME
Rheumatoid Arthritis
-Anti-rheumatic Drugs
- Gold salts
- Make patient very tired - Antimalarial agents
- Plaquenil - irreversible vision loss - check eyes every 3 months - Sulfasalazine
Rheumatoid Arthritis
-Nursing Care for NSAIDS
- Monitor for bleeding, bruising unexpectedly
2. Stomach irritation
Rheumatoid Arthritis
-Corticosteroids Nursing Care
- Take it with food and the same time every day
2. Check blood sugar
Rheumatoid Arthritis
-Immunosuppressants Nursing Care
- Everyone who is around you should have a flu shot
- Avoid people who are sick
- Avoid large crowds
Rheumatoid Arthritis
-Nursing Care for Surgery and other RA procedures
- Watch for infection
- Treat pain
- Pt will have limited mobility
Rheumatoid Arthritis
-Alternative Therapies
- Rest and Exercise
- Physical & Occupational therapy
- Heat and Cold
- Nutrition
Rheumatoid Arthritis
-Nursing Care to Deal with Pain & Immobility
- Space out ADL’s to deal with fatigue
- Long periods of rest make immobility worse
- Treat acute and chronic pain
RA
-Nursing Diagnosis
- Acute & Chronic Pain RT joint inflammation
- Fatigue RT chronic pain & complications
- Disturbed Body Image RT joint deformities
- Activity Intolerance RT chronic pain
RA
-Nursing Implementation
- Promoting mobility
- Encouraging adequate nutrition
- Teach family and client about disease and its mgmt
