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Exam 4 > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

What is rheumatoid arthritis?

A

Chronic systemic autoimmune disorder

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2
Q

How is rheumatoid arthritis described?

A
  • Inflammation in connective tissues, primarily in joints
  • Course and severity variable
  • Most prevalent inflammatory arthritis
  • Chronic pain, alterations in body image
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3
Q

What are transformed antibodies called?

A

Rheumatoid factors

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4
Q

Normal antibodies become what in rheumatoid arthritis?

A

Autoantibodies

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5
Q

In rheumatoid arthritis- leukocytes become attracted to what?

A

Synovial membrane

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6
Q

In rheumatoid arthritis- what ingests the immune complex to release enzymes?

A

Neutrophils and macrophages

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7
Q

What type of immune response occurs in a generally susceptible host resulting in rheumatoid arthritis?

A

Aberrant

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8
Q

The inflammation from rheumatoid arthritis causes what?

A
  • Hemorrhage
  • Coagulation
  • Fibrin deposits on synovial membrane
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9
Q

The formation of pannus tissue results in an abnormal what?

A

Tissue layer within synovial membrane

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10
Q

The formation of pannus tissue leads to what?

A
  • Greater loss of bone and cartilage

- Scar formation

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11
Q

What is the most common form of arthritis in older adults?

A

osteoarthritis

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12
Q

Rheumatoid arthritis affects which gender more?

A

Women

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13
Q

What is the typical age for onset of rheumatoid arthritis?

A

Between 40 to 60 years of age

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14
Q

Remissions of rheumatoid arthritis most likely occur when?

A

In the first year of the disease

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15
Q

What is the cause of Rheumatoid arthritis?

A

It is unknown

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16
Q

What are the risk factors of rheumatoid arthritis?

A
  • Family history
  • Female sex
  • Obesity
  • Heavy smokers- can be reduced if you stop
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17
Q

What are the clinical manifestations of rheumatoid arthritis?

A
  • Joint deformity

- Redness, warmth, pain, swelling of affected sites

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18
Q

What are the clinical manifestations of the active phase of rheumatoid arthritis?

A
  • Fever
  • Anorexia
  • Fatigue
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19
Q

What can be said about the stiffness a patient will experience when they have rheumatoid arthritis?

A
  • More pronounced in morning, lasting more than 1 hour
  • May occur with prolonged rest during the day
  • May be more severe after strenuous activity
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20
Q

What are the five ways that the onset of joint issues in rheumatoid arthritis can be described?

A
  • Usually insidious with stiffness
  • May be acute, precipitated by stressor
  • May be preceded by systemic manifestations of inflammation
  • Polyarticular, symmetrical
  • Rate of development can fluctuate
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21
Q

What are the three types of joint manifestations in the hands and fingers due to rheumatoid arthritis?

A
  • Ulnar deviation
  • Boutonniere deformity
  • Swan neck deformity
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22
Q

What types of joint manifestations of the knee occur due to rheumatoid arthritis?

A
  • Visible swelling
  • Instability
  • Quadriceps atrophy
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23
Q

In rheumatoid arthritis patients what is a nearly universal joint manifestation?

A

Wrist involvement

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24
Q

What happens to the spine if you have rheumatoid arthritis?

A
  • Usually limited to cervical vertebrae

- Neurological complications

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25
Q

What kinds of deformities occur in the feet and ankles of a patient with rheumatoid arthritis?

A
  • Subluxation
  • Hallux valgus
  • Lateral deviation of toes
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26
Q

In a patient with rheumatoid arthritis what causes their ambulation to be limited?

A

Due to pain especially in ankles and feet

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27
Q

What are the extra-articular manifestations of rheumatoid arthritis?

A
  • Systemic disease
  • Anemia of chronic disease
  • Skeletal muscle atrophy
  • Rheumatoid nodules
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28
Q

What is the issue with anemia caused by rheumatoid arthritis?

A

Its resistant to iron therapy

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29
Q

What two syndrome’s a systemic affect of rheumatoid arthritis?

A
  • Sjogren’s syndrome

- Raynaud’s syndrome

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30
Q

What are the seven systemic affects of rheumatoid arthritis?

A
  • Fever, weight loss, fatigue
  • Lymph node enlargements
  • Arteritis
  • Neuropathy
  • Scleritis
  • Pericarditis
  • Splenomegaly
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31
Q

Why would a patient with rheumatoid arthritis be at an increased risk of coronary heart disease?

A

It has a direct effect on blood vessels and the medications these patients take have damaging side effects on the heart.

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32
Q

What are patients with rheumatoid arthritis at an increased risk for that also increases their risk of coronary heart disease?

A
  • Low HDL levels
  • High cholesterol and triglycerides
  • Hypertension
  • High homocysteine levels
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33
Q

What is Juvenile idiopathic arthritis?

A

A chronic inflammatory autoimmune disorder that is similar to rheumatoid arthritis but diagnosed in children.

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34
Q

What is Juvenile idiopathic arthritis characterized by?

A

Chronic or remittent joint inflammation, swelling, and pain

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35
Q

What is the treatment for juvenile idiopathic arthritis similar to?

A

The treatment of rheumatoid arthritis in adults

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36
Q

Juvenile idiopathic arthritis is more prevalent in what gender?

A

female

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37
Q

What are the complications associated with juvenile idiopathic arthritis?

A
  • Eye chronic uveitis
  • Interference with normal growth
  • Bone growth disturbances
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38
Q

What is the main goal for rheumatoid arthritis treatment?

A

Relieve manifestations

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39
Q

What are the interdisciplinary approaches for treatment of rheumatoid arthritis?

A
  • Balance of rest and exercise
  • Physical therapy
  • Suppression of inflammatory processes
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40
Q

What type of fluid needs to be examined to diagnose a patient with rheumatoid arthritis?

A

the synovial fluid

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41
Q

What two types of antibodies are tested to diagnose a patient with rheumatoid arthritis?

A
  • Antibodies to cyclic citrullinated peptide

- Antinuclear antibody (ANA)

42
Q

What protein should be tested to diagnose a patient with rheumatoid arthritis?

A

C-reactive protein

43
Q

What type of factor should be tested when diagnosing a patient with rheumatoid arthritis?

A

the rheumatoid factor

44
Q

What type of erythrocyte testing needs to be evaluated to diagnose a patient with rheumatoid arthritis?

A

Erythrocyte sedimentation rate

45
Q

Where should you X-ray a patient when trying to diagnose a patient with rheumatoid arthritis?

A

Xray the affected joints

46
Q

A score of at least what out of seven on the American College of Rheumatology will diagnose a patient with rheumatoid arthritis?

A

4 out of 7

47
Q

What are the 7 categories from the American College of Rheumatology test that a patient needs to fall into to be diagnosed with rheumatoid arthritis?

A
  • Morning stiffness greater than one hour
  • Arthritis of three or more joint areas
  • Arthritis of hand joints
  • Symmetric arthritis
  • Rheumatoid nodules
  • Positive rheumatoid factor
  • Radiographic changes
48
Q

What medications will a patient with rheumatoid arthritis be placed on within 2 years of diagnosis?

49
Q

What is the Immunosuppressor that falls into the DMARD category?

A

Methotrexate

50
Q

What is the biologic response modifier that falls in the DMARDs category?

A

Adalimumab

51
Q

Aside from immunesuppressors and biologic response modifiers what is the other drug falls in the DMARDs category?

A

Antimalarials

52
Q

What are the 4 rheumatoid arthritic medication categories?

A
  • DMARDs
  • NSAIDs, ASA, COX-2 inhibitors
  • Corticosteroids
  • Antidepressants
53
Q

What is the mechanism of action for antimalarial the DMARD?

A

Relieves severe inflammation

54
Q

What are the contraindications/cautions for antimalarial the DMARD?

A

Hepatic or renal disease and alcoholism

55
Q

What are the adverse effects of antimalarial the DMARD?

A
  • Retinopathy
  • Anorexia
  • GI disturbances
  • Loss of hair
  • Agranulocytosis
  • Unusual Skin Pigmentation
  • Thrombocytopenia
56
Q

When does the maximal benefit occur when taking the antimalarial drug?

57
Q

What does DMARD stand for?

A

Disease-Modifying Antirheumatic Drugs

58
Q

What is the method of action for Methotrexate?

A

Immunosupressor and antimitotic

59
Q

What class does Methotrexate belong to?

A

Immunosupressor

60
Q

What category does Methotrexate belong to?

61
Q

What are the contraindications/cautions for Methotrexate?

A

Hepatic and renal disease, infections, blood dycrasias, very young and very old

62
Q

What are the adverse effects for Methotrexate?

A
  • Hepatotoxicity
  • Bone Marrow suppression
  • Malaise
  • Fetal defects
  • Infections
  • Sudden death
63
Q

What should you get the baseline of a monitor when they are on Methotrexate?

A
  • CBC
  • LFT
  • Renal function tests
64
Q

What should you not take with Methotrexate?

A

-Vitamins with folic acid or PPI

65
Q

What should you make sure to do when taking Methotrexate?

A

Stay well hydrated

66
Q

What are the two route a patient could take Methotrexate?

A

Oral and intravenous

67
Q

What is the onset of oral Methotrexate?

68
Q

What is the peak of oral methotrexate?

69
Q

What is the onset of IV Methotrexate?

70
Q

What is the peak of IV methotrexate ?

A

0.5-2 hours

71
Q

What class does Adalimumab belong to?

A

Biologic response modifiers

72
Q

What category of drugs does Adalimumab belong to?

73
Q

What is the mechanisms of action for Adalimumab?

A

Inhibits tumor necrosis factor which is a cytokine thereby blocking the normal inflammatory and immune response controlled by TNF

74
Q

What are the contraindications/cautions for Adalimumab?

A
  • Active infection
  • Neoplastic disease
  • CV disease
  • Neuro disease
  • Active or latent TB
75
Q

What are the adverse effects for Adalimumab?

A
  • Infections
  • Fatigue
  • Hypertension
  • Injection site irritation
76
Q

If a patient is on Adalimumab what should you not give them?

A

live vaccines

77
Q

What drug class does Celecoxib belong to?

A

COX-2 inhibitor

78
Q

What is the method of action for celecoxib?

A

-Inhibits prostaglandin synthesis by inhibiting COX-2

79
Q

What are the contraindications/cautions for Celecoxib?

A
  • Advanced renal disease
  • Hepatic failure
  • Anemia
  • GI bleed
80
Q

What are the adverse effects of celecoxib?

A
  • CV events
  • Dizziness
  • Sinusitis
  • Edema
  • Nausea
  • Flatulence
  • Diarrhea
  • Rash
81
Q

What should you monitor on a patient on celecoxib?

A
  • Fluid retention in those with HTN or CHF
  • Black tarry stools
  • CBC
  • LFT
  • BUN
  • Creatinine
82
Q

What class does Prednisone belong to?

A

Systemic Corticosteroid

83
Q

What is the mechanism of action for prednisone?

A

Suppress histamine and prostaglandins

-Immunosuppressant and anti-inflammatory

84
Q

What are the contraindications/cautions for Prednisone?

A
  • Systemic infections
  • Cataracts
  • Peptic Ulcer Disease
  • Osteoporosis
  • Hypertension
  • Renal disease
85
Q

What should you give prednisone with?

86
Q

Why should you not abruptly withdrawal prednisone?

A

To give adrenals a chance to recover

87
Q

what are the serious adverse effects of systemic corticosteroids?

A
  • Suppression of adrenal gland function
  • Hyperglycemia
  • Long-term therapy may result in Cushing syndrome
  • Mood changes
  • Cataracts
  • Peptic ulcers
  • Hypokalemia
  • Osteoporosis
88
Q

What may systemic corticosteroids mask?

A

Infections

89
Q

If a systemic corticosteroid masks infections what can this lead to?

A

-Existing infections to grow rapidly and undetected

90
Q

What is the route of prednisone?

91
Q

What is the onset of prednisone?

92
Q

What is the peak of prednisone?

93
Q

What is the duration of prednisone?

A

1-1.5 days

94
Q

What are the nonpharmacologic therapies for rheumatoid arthritis?

A
  • Rest and exercise
  • Physical and occupational therapy
  • Heat and cold
  • Orthotic and assistive devices
  • Nutrition
  • Plasmapheresis and irradiation
95
Q

What are the complementary and alternative therapies for rheumatoid arthritis?

A
  • Acupuncture
  • Hydrotherapy
  • Nutritional supplements (fish oils)
  • Nontraditional treatments such as diets, hormones, and plant extracts
96
Q

Why are nontraditional treatments such as diets, hormones, and plant extracts not typically recommended for patients trying to manage their rheumatoid arthritis?

A

Because they are often costly and non have shown to be effective

97
Q

Upon assessment of a patient with rheumatoid arthritis what should you include in your health history?

A
  • Pain, stiffness, fatigue
  • Joint problems
  • Fever
  • Sleep patterns
  • Past illnesses
  • Surgery
  • Ability to carry out ADLs
98
Q

Upon assessment of patient with rheumatoid arthritis what should you include in your physical assessment?

A
  • Height
  • Weight
  • Gait
  • Joints
  • Skin
  • Respiratory
  • Cardiovascular
99
Q

What planning should be included for a patient with rheumatoid arthritis?

A
  • Client will report effectiveness of pain management
  • Client will perform ADLs independently or with minimal assistance
  • Client will express feelings about diagnosis
100
Q

What implementations will the nurse do for a patient with rheumatoid arthritis?

A
  • Monitor and treat chronic pain
  • Prevent fatigue
  • Teach use of heat and cold applications
  • Teach use of medications
  • Encourage use of nonparmacologic pain relief
101
Q

What evaluations will the nurse do for a patina tight rheumatoid arthritis?

A
  • Client maintains joint mobility
  • Client expresses comfort and freedom from pain
  • Client develops or maintains positive body image
  • Client is free from infection
  • Client, family display adequate understanding, support management of therapeutic regimen

Exam 4 (13 decks)

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