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Module 4 > Rheumatoid Arthritis ( RA) > Flashcards

Rheumatoid Arthritis ( RA) Flashcards

1
Q

OAvsRA

A

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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2
Q

How long can morning joint stiffness be in rheumatoid arthritis

A

Last for at least 60 minutes and can persist for hours

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3
Q

How long does morning joint stiffness last in OA?

A

Last only a few minutes

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4
Q

Symptoms besides joint pain of RA

A

Fatigue, weight loss, and fever (usually systemic)

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5
Q

Overall health of OA is affected during

A

False

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6
Q

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

A

Stiffness will decrease

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7
Q

disease progression with RA

A

Symptoms worsen over a period of weeks , months

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8
Q

RA pain

A

May get worse doing yard work in back or knees

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9
Q

RA

A

Chronic
Extraarticular manifestations
Periods of remission and exacerbation
Genetic link*

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10
Q

What are some factors that may cause RA

A

Enviromental factors and genetic link

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11
Q

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

A

rheumatoid factor

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12
Q

Clinical manifestations of RA

A

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

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13
Q

What are examples of precipitating events that can happen

A

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

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14
Q

JOINTZ N RA

A

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

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15
Q

What joints of the hand l\get affected

A

MCP joint and PIP joint

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16
Q

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

A

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

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17
Q

Things that can happen if RA left untreated

A

Tenosynovitis
Deformity and disability
Subluxation
Walking disability
Deformities in the hands

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18
Q

Boutonnière deformity

A

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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19
Q

Bunion

A

Joint in toe leans outward

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20
Q

Swan neck

A

Finger in a zig zag

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21
Q

Rheumatoid nodules

A

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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22
Q

Sjögren’s syndrome

A

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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23
Q

Flexion contractures

A

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

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24
Q

People with chronic pain typically deal with

A

Depression

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25
Q

RA are prone to

A

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

26
Q

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

A

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

27
Q

Higher the inflammation in body

A

Higher chance of systemic impact

Certain drugs will help prevent systemic damage

28
Q

Subjective data

A

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

29
Q

What subjective data will nurse gather with join pain

A

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

30
Q

Nursing assessment objective data

A

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

31
Q

Cardiovascular issues in RA

A

Raynaud’s phenomenon
Dysrhythmias

32
Q

Raynaud’s phenomenon

A

Exacerbated or extreme vasoconstriction when pt is exposed to cold

Some pt use gloves

33
Q

How is Raynaud’s phenomenon treated **

A

Beta blocker to help vasoconstriction

34
Q

Dysrhythmias

A

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

35
Q

Respiratory issues that in RA are more prone to

A

Chronic bronchitis
Tuberculosis

36
Q

GI issues in RA

A

Splenomegaly (felty syndrome)

37
Q

splenomegaly felty syndrome

A

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

38
Q

SANTA

A

Splenomegaly
Anemia
Neutropenia
Thrombocytopenia
Arthritis RA

39
Q

Musculoskeletal RA

A

Symmetric joint involvement
Swelling erythema
Heat tenderness
Deformities
Joint enlargement

40
Q

Lab findings RA

A

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

41
Q

X-ray findings
RA

A

Joint space narrowing
Bony erosion
Deformity
Osteoporosis
Thin

42
Q

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

A

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

43
Q

C reactive protien

A

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

44
Q

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

A

Decreased numbers

45
Q

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

A

WBCs

46
Q

What muscles do PT work with

A

Larger muscle groups and mobility

Knees hips and back

47
Q

Occupational therapies

A

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

48
Q

Goals of drug therapy

A

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

49
Q

For every 5 pounds of weight

A

Puts an extra pressure 20 pounds on hips knees and ankles

50
Q

Corticosteroids stimulate

A

Apetite = weight gain

51
Q

What do we assess when it comes to nutritional therapy

A

Balanced nutrition
Loss of appetite, weight loss weight gain

52
Q

What’s the purpose of surgery therapy

A

Relieve severe pain
Improve function

53
Q

Synnovectomy

A

Removal of synovial of the joints 

54
Q

Total joint replacement (arthroplasty)

A

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

55
Q

Acute intervention

A

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

56
Q

What is a good thing to contribute to ambulatory care

A

Remain active but rest!

57
Q

Body alignment practice RA

A

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

58
Q

Ice during exacerbation

A

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

59
Q

Moist heat

A

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

60
Q

Excercise

A

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

61
Q

Psychological support

A

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

62
Q

Why are RA so immunosuppressed

A

a lot of the the drugs they take are immunosuppressive

Module 4 (47 decks)

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