Test #3: Musculoskeletal Flashcards
What is arthritis?
inflammation of a joint
What would be present in stage 1 of Rheumatoid Arthritis?
No destructive changes on x-ray; possibly evidence of osteoporosis of x-ray
What is subluxation?
Incomplete or partial dislocation of a joint
What does a elevated “sed rate” (ESR) lab result indicate?
Inflammation
What are the 3 most common manifestations of rheumatoid arthritis?
Rheumatoid nodules, Sjogren’s syndrome and Felty syndrome
What are the 4 typical deformities of RA?
Ulnar drift, Boutonniere deformity, Hallus valgus and swan neck deformity
What is the “ulnar drift”?
Fingers shifting, over time, away from the thumb
What is “Boutonniere’s deformities”?
Condition where the knuckle will not fully extend; it keeps the finger from ever completely straightening
What is Hallux valgus?
Also called a “bunion”; big toe deviates to the side (point hard towards the other toes)
What is the “swan neck” deformity?
Where the knuckle almost hyperextends and distal knuckle stays bent, creating a “swan neck” appearance
What is a side effect of Methotrexate?
Bone marrow supression and hepatotoxicity
What is a notable side effect of Anti-Malarial drugs?
Vision effects
How long does taking Gold (Ridaura) take to build to therapeutic levels?
3-4 months
How long should you apply hot/warm pack?
No more than 20 minutes
How long should you apply cold/ice packs?
No more than 10-15 minutes
What teaching would need to be given to a patient who has been prescribed immunosuppressants?
Avoid crowds and sick people
What are risk factors for gout?
Obesity, Hypertension, using diuretics, excessive alcohol intake and purine-rich diet
What tests indicate gout?
Uric acid (level about 6), 24-hour uric acid level, synovial fluid aspiration
The diagnosis of gout is normally based on what?
80% are simply based on clinical symptoms
How are acute gout flare-ups treated?
With Colchicine and NSAIDS
What drug is given for chronic gout?
Allopurinol or Febuxostat (Uloric)
What are the two specific manifestations of SLE?
Butterfly rash and photo sensitivity
What is the patho of gout?
Overproduction or impaired excretion of uric acid
What type of drug is Colchizine?
An anti-inflammatory used to treat acute gout “flare-ups”
What is a “Uricosuric”?
Uricosuric is the class of drugs that increase the amount of uric acid excreted in urine (thus lowering the amount in circulation)
What is a xanthine oxidase inhibitor?
Xanthine oxidase inhibitor is a class of drugs that inhibits xanthine oxidase, an enzyme used in purine metabolism
What drugs, used to control chronic gout, are xanthine oxidase inhibitors?
allopurinol (Zyloprim) and febuxostat (Uloric)
What drug should probenecid (Benemid) not be given with?
Aspirin
Patients that do not respond to traditional therapies for gout may be given what?
Corticosteroids or the drug pegloticase (Krystexxa)
Patients given medication to excrete more uric acid should be taught to do what?
Increase their fluid intake to prevent kidney stones
What is the mechanism of action of probenecid (Benemid)?
It inhibits renal tubular absorption of urates
Why would probenecid (Benecid) be ineffective for a gout patient?
If a patient’s kidney’s are damaged/creatinine clearance is elevated
A patient with gout should be instructed to make what dietary modifications?
Reduce alcohol intake and purine-rich foods
What side effects should the patient on corticosteroids be monitored for?
Electrolyte imbalance and weight gain
The patho of SLE includes..?
the production of a variety of autoantibodies directed against components of the cell nucleus
In Rheumatoid Arthritis, what process damages the joints?
Bony ankylosis and Pannus; bony ankylosis is the joining of bones by extra bone cells, and pannus is highly vascular granulation tissue that forms within the joint and eats away at the cartilage.
What signs should a patient, suspected of having scleroderma be assessed for?
Calcinosis, Raynaud’s phenomenon, Esophageal dysfunction, Sclerodactyly, and Telangiectasia.
What is scleroderma?
Scleroderma, is a disorder of connective tissue characterized by fibrotic, degenerative, and occasionally inflammatory changes in the skin, blood vessels, synovium, skeletal muscle, and internal organs.
Assessing the hands of a patient with RA, what would the nurse expect to see?
Spindle-shaped fingers
The pathophysiology of systemic lupus erthematosus (SLE) is characterized by?
destruction of nucleic acids and other self-proteins by autoantibodies
According to the auto-immune theory, how does rheumatoid arthritis begin?
An antigen triggers the formation of an abnormal immunoglobulin. The body then forms auto-antobodies, known as “rheumatoid factor”, against the abnormal immoglobulin and begins an inflammatory response.
When caring for a patient with scleroderma, what exercises should the nurse recommend?
Mouth excursion and Isometric exercises
What medications would be given to a patient with Chronic Fatigue Syndrome?
Antihistamines, Antidepressants and NSAIDS
What possible complications should a woman of child-bearing-age with SLE be informed of?
Stillbirth and spontaneous abortion, Intrauterine growth retardation and overall high risk to mother and baby due to organ involvement
What is “calcinosis”?
Painful deposits of calcium in the skin
What is the acronym that represents the disorders/symptoms of scleroderma?
CREST
A patient is suffering from scleroderma. Which symptoms suggest the involvement of an internal organ?
Dysphagia, Dental caries and Esophageal dysfunction
Describe Stage I RA
Possible signs of osteoporosis in xray, but no destructive changes
Describe Stage II RA
Evidence of osteoporosis. Possible nodules and possible slight bone and cartilage damage.
Describe Stage III RA
Bone and cartilage destruction, and joint deformities (like subluxation, ulnar deviation, or hyperextension) No fibrous or bony ankylosis.
Describe Stage IV RA
Fibrous or bony ankylosis
What foods are high in purines and should be avoided by a patient with gout?
Anchovies, Bouillon, Brains, Broth, Consommé, Goose, Gravy, Heart, Herring, Kidney, Mackerel, Meat extracts,
Mincemeat, Mussels, Partridge, Roe, Sardines, Scallops, Sweetbreads and Yeast
A patient is diagnosed with scleroderma. What should the nurse anticipate in the pharmacologic treatment plan?
Bosentan (Tracleer), Reserpine (Serpasil) and Cyclophosphamide (Cytoxan)
A patient just starting gold sodium thiomalate (Myochrysine) therapy for rheumatoid arthritis will need what precautions?
Monitoring of hepatic and renal function, rule out pregnancy before starting and teach the patient to immediately report any new rash.
What “esophageal dysfunction” is associated with scleroderma?
Difficultly swallowing associated with internal scarring
What is “sclerodactyly”?
Tightening of the skin on the fingers and toes
What is “Telangiectasia”?
Red spots on the hands, forearms, palms, face and lips
What does an increased matrix metallopeptidase (MMP) -3 enzyze indicate?
Progressive joint damage
A patient with fibromylagia is having trouble sleeping. What medicaton should the nurse recommend?
Melatonin (not Benadyrl; it builds tolerance)
A 24-year-old female patient with systemic lupus erythematosus (SLE) tells the nurse she wants to have a baby and is considering getting pregnant. Which response by the nurse is most appropriate?
Infertility can result from the medications used to control your disease.
What is the drug of choice for treating early rheumatoid arthritis?
methotrexate (Rheumatrex); it is inexpensive, has a lower toxicity than many other RA drugs and reduces symptoms in days to weeks.
What labs should be monitored for s patient taking methotrexate? Why?
CBC and Chemistry panel; because methotrexate can cause bone marrow suppression or hepatotoxicity
Sulfasalazine and hydroxychloroquine are what class of drugs? Given for what?
Antimalarial drugs; given for mild-to-moderate RA
What is leflunomide?
A synthetic DMARD that blocks immune cell overproduction.
What are side effects to leflunomide?
Severe liver injury, diarrhea, and teratogenesis.
Pregnancy MUST be ruled out before an RA patient can be given what medication?
leflunomide
To maintain joint motion and muscle strength, a RA pt should be referred for..?
Physical therapy
What drug is commonly used to treat early RA?
Methotrexate
What labs should be monitored for the patient on Methotrexate?
CBC and Chemistry Panel
What anti-malaria drugs are used to treat RA?
Sulfasalazine and Hydroxychlorquine
What RA drug cannot be given until pregnancy is ruled out?
Leflunomide
What are the side effects of Leflunomide?
Severe liver damage, diarrhea and teratogenesis
What RA drugs inhibit tumor necrosis factor from initiating an inflammatory response?
Etanercept, Infliximab and Adalimumab
What side effect should patients on Etanercept, Infliximab or Adalimumab be monitored for?
Infection; they must be taught to report any possible signs
What is Anakinra?
It is a recombinant version of IL-1 receptor antagonist; it binds to IL-1 and inhibits it from binding to receptors that would start an inflammatory response
What drugs can Anakinra be given with?
Anakinra can be given with DMARDs but NOT with TNF inhibitors
Why can Anakinra not be administered with TNF inhibitors?
Giving both together can cause serious infection and neutropenia
What drug would be given to patients that do not respond to DMARDs or TNF inhibitors?
Abatacept
What is Abatacept’s mechanism of action?
Abatacept blocks activation of T cells
What drugs cannot be given with Abatacept?
TNF inhibitors
What drug might be used in combination with methotrexate in RA that is not responding to TNF inhibitors?
Rituixmab (Rituxan)
What new drug might be used for a patient who has not responded or cannot tolerate other RA drugs?
Tocilizumab (Actemra)
What 5 overall goals would be established for the RA patient?
The patient will:
- Have satisfactory pain management
- Have minimal loss of functional ability of the affected joints
- Participate in planning and carrying out the therapeutic regimen
- Maintain a positive self-image
- Perform self-care to the maximum amount possible
