Rheumatoid Arthritis ( RA) Flashcards by Elizabeth Gausin

OAvsRA

OA- weight bearing joints (asymmetrical) , over age of 40
RA - small joints such as the hand, foot, wrist, elbow , shoulder or ankle (bilateral) , over age of 50

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How long can morning joint stiffness be in rheumatoid arthritis

Last for at least 60 minutes and can persist for hours

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How long does morning joint stiffness last in OA?

Last only a few minutes

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Symptoms besides joint pain of RA

Fatigue, weight loss, and fever (usually systemic)

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Overall health of OA is affected during

False

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Why is it important for someone with RA to stay active?

Stiffness will decrease

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disease progression with RA

Symptoms worsen over a period of weeks , months

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RA pain

May get worse doing yard work in back or knees

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Chronic
Extraarticular manifestations
Periods of remission and exacerbation
Genetic link*

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What are some factors that may cause RA

Enviromental factors and genetic link

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What antibody can SOME not all rehrumatoid arthritis pt test positive for

rheumatoid factor

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Clinical manifestations of RA

Sneaks up on you,
Fatigue, anorexia, weight loss, generalized stiffness
History of precipitating factors

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What are examples of precipitating events that can happen

Infection, stress , childbirth, surgery, emotional upset
(Physical exertion or environmental)

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JOINTZ N RA

Symmetrical
Morning stiffness 60 minutes or longer
Tender, painful warm to touch
Increase pain with motion
Intensify varies

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What joints of the hand l\get affected

MCP joint and PIP joint

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What is the appearance of the skin on hand look like in RA

Wrinkled part wi be smooth
More common in wrist than ankles and toes

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Things that can happen if RA left untreated

Tenosynovitis
Deformity and disability
Subluxation
Walking disability
Deformities in the hands

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Boutonnière deformity

Button hole
Middle joint stays in flexed position
Developed problems with tendons that straighten out that joint
If you want to straighten it out you’ll have it do it manually

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Bunion

Joint in toe leans outward

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Swan neck

Finger in a zig zag

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Rheumatoid nodules

Will show up if someone has not had a lot of access to treatment
Hardened, inflamed tissue
Teaching pt about pressure ulcers
(Skin break down biggest concern )

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Sjögren’s syndrome

Can be on its own or part of RA
Dry mouth and dry eyes , hard to swallow
( dry eyes prone to infection and dry mouth more prone to dental carries)
Targets silvery glands and tear glands

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Flexion contractures

Decrease mobility and decrease strength in the hand
Effects how thy live their life

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People with chronic pain typically deal with

Depression

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RA are prone to

Anemia problems Neuropathy issues lung stiff ness **(pleural, pericardium) Kidneys ( amyloidosis)

What do we want to teach our pt with RA with respiratory issues

Turn cough deep breath If pt on ventilator they can be hard to get off but just have to work a bit harder

Higher the inflammation in body

Higher chance of systemic impact Certain drugs will help prevent systemic damage

Subjective data

Precipitating factors Pattern of remissions & exacerbations Use of meds Family history Impact on functional ability Anorexia, weight loss, malaise Stiffness ad joint swelling, muscle weakness, difficulty walking Parasthesia of hands and feet Symmetric joint pain

What subjective data will nurse gather with join pain

Which joints Is it singular or bilateral Is there swelling, tenderness or tempature changes

Nursing assessment objective data

lymphadenopathy , fever Rheumatoid nodules Skin ulcers Shiny, taut skin over joints Cardiovascular involvement Respiratory And gi issues

Cardiovascular issues in RA

Raynaud’s phenomenon Dysrhythmias

Raynaud’s phenomenon

Exacerbated or extreme vasoconstriction when pt is exposed to cold Some pt use gloves

How is Raynaud’s phenomenon treated **

Beta blocker to help vasoconstriction

Dysrhythmias

Inflammation from RA causes scarring on SA node or AV node Makes pt prone to dysrhythmias

Respiratory issues that in RA are more prone to

Chronic bronchitis Tuberculosis

GI issues in RA

Splenomegaly (felty syndrome)

splenomegaly felty syndrome

An enlarged spleen Decrease WBC count (At risk for infections)

SANTA

Splenomegaly Anemia Neutropenia Thrombocytopenia Arthritis RA

Musculoskeletal RA

Symmetric joint involvement Swelling erythema Heat tenderness Deformities Joint enlargement

Lab findings RA

Rheumatoid factor (85% of ppl) increase ESR (erythrocyte sedimentation rate) Increase WBCs in synovial fluid

X-ray findings RA

Joint space narrowing Bony erosion Deformity Osteoporosis Thin

People who dont have rheumatoid factor positive but have other s/s

Usually s/s aren’t as bad compared to ppl who do test positive

C reactive protien

Not specific to RA but tell us that people have inflammation somewhere , but people with RA will usually have elevated CRP

If we start someone on a treatment what wold we expect in the labs

Decreased numbers

If we did an aspiration of the joint space what would you expect to see?

WBCs

What muscles do PT work with

Larger muscle groups and mobility Knees hips and back

Occupational therapies

Fine muscle movement, adls, adaptive devices Also deal with splints

Goals of drug therapy

Relieve symptoms Maintain joint function and ROM Manage systemic involvement Delay disease progression (No cure or prevention)

For every 5 pounds of weight

Puts an extra pressure 20 pounds on hips knees and ankles

Corticosteroids stimulate

Apetite = weight gain

What do we assess when it comes to nutritional therapy

Balanced nutrition Loss of appetite, weight loss weight gain

What’s the purpose of surgery therapy

Relieve severe pain Improve function

Synnovectomy

Removal of synovial of the joints

Total joint replacement (arthroplasty)

It’s not as effected in larger joint in hip and knee because of the atrophy so ROM may not be restored

Acute intervention

Plan care around morning stiffness To relieve joint stiffness and increase ability to perform ADLS Sit or stand in warm shower Sit in tub with warm towels around shoulders Soak hands in warm water

What is a good thing to contribute to ambulatory care

Remain active but rest!

Body alignment practice RA

Firm mattress or bed board Encourage. Position of extension Avoid flexion positons(no pillow under knees Small flat pillow under head and shoulders

Ice during exacerbation

Beneficial Helps with swelling 10-15 minutes at a time Towel in between the skin

Moist heat

Warm baths, showers, moist hot packs , paraffin Relieves stiffness 20 minutes at a time Be alert for potential burns

Excercise

Need recreational and therapeutic Gentle ROM done daily Weights limit to one or two reps urine acute inflammation (Moderate to light)

Psychological support

Pt constantly challenged by issues Limited function and fatigue Loss of self esteem Altered body image Fear of disability or deformity

Why are RA so immunosuppressed

a lot of the the drugs they take are immunosuppressive