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Nursing 2 Exam 4 > Unit 16 Arthritis and Connective Tissue Disease > Flashcards

Unit 16 Arthritis and Connective Tissue Disease Flashcards

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1
Q

How can arthritis generally be described and what are the major symptoms?

A

progressive and leads to disability

Pain and may include join swelling, limited movement, stiffness, weakness, fatigue, and disability

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2
Q

What is the generally goal with arthritis?

A

PT comfort, increase mobility, and prevent progression

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3
Q

Describe Gout.

A

-Metabolic disorder

-Hyperuricemia (elevated level of uric acid in blood)
>or= to 6.8 mg/dl -diagnosed gout

  • Periods of exacerbations and remissions
  • Could be primary (genetic) or secondary (medications or disease that increases uric acid)
  • Extremely painful
  • Risk for development of tophi and kidney stones because of increased uric acid
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4
Q

What are the risk factors for gout?

A

Common in males

Increased age

Increased BMI

Increased Uric acid levels

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5
Q

What are the defining characteristics of Gout?

A
  • Acute pain
  • Swelling
  • Erythema
  • Renal damage
  • Tophi (crystallized uric acid on surface of joints, think of the toe picture)

-Great Toe (*podagra: gout of the foot, redness, swelling); other joints and cartilage

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6
Q

What two anti-inflammatory and pain medications are used in the treatment for Gout exacerbation? Describe them.

A

-colchicine
Interferes with the function of WBCs in initiating and maintaining inflammatory response
For acute stage, works very fast
SE: GI upset, *diarrhea, N/V, abd. pain, *aplastic anemia, can increase digoxin levels, muscle pain
Take with meals, avoid grapejuice

-NSAIDs (indomethacin and ibuprofen) does nothing for uric acid levels

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7
Q

Name the 2 Uricosuric medications taken to treat gout, prophylactically .

A

-probenecid
inhibits renal absorption of urates and increases renal excretion- decreases serum uric acid
SE: kidney stones, GI upset, aplastic anemia, flushing.
**action is decreased by salicytats(aspirin)

-colbenemid (combo Rx)
made of colchicine and probenecid

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8
Q

What are the xanthine oxidase inhibitors(XOI) medications use to treat Gout prophylactically? Name Describe them.

A 
xanthine oxidase inhibitors(XOI)
-febustat
interrupts the breakdown of purines
-allopurinol   
prevents uric acid in the blood by blocking uric acid formation

SE: increases action of anti-diabetic agents, hypotension, hepatitis, rash, bone marrow depression, N/V, increases theophylline toxicity, hypoglycemia

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9
Q

What category of medication can be used to treat gout and HTN that are good for the elderly?

A

ARBs

ex: artans
- promotes urinary excretion

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10
Q

What are the goals for treatment of Gout?

A

Pain management, dietary modifications, prevention of deformity, decrease exacerbations

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11
Q

What are nursing interventions for Gout?

A
  • Prevention of exacerbations
  • Medications
  • Weight loss strategies
  • Control hypertension
  • Hydration (to flush system)
  • Avoid alcohol use
  • Avoid excess intake of purines
  • Maintain uric acid level less than 6.8
  • Prevent deformity and maintain musculoskeletal function
  • Ice, no heat
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12
Q

What is Osteoarthritis (OA)?

A

-a chronic, progressive disorder that cause cartilage deterioration in synovial joints and vertebrae

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13
Q

What medications block the renal excretion of uric acid (which is bad)?

A

Aspirin and thiazide diuretics

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14
Q

What are the major risk factors for OA?

A

Age
Obesity
Overuse

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15
Q

What is the main problem in OA?

A

progression leads to disability

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16
Q

What are the main goal for OA?

A

Maintain mobility
Pain management
Improve joint function
Prevent disability

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17
Q

What are the clinical manifestations/defining characteristics of OA?

A
  • Pain
  • Joint Stiffness (occurs during periods of long rest, static position, and repetitive activity)
  • Loss of movement and function
  • Early morning stiffness resolves in less than 10-30 minutes
  • Crepitus
  • Local inflammation
  • Not auto-immune
  • Limited ROM
  • Herberden’s DIP and Bouchard’s nodes PIP
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18
Q

Where are main sites that osteoarthritis occurs?

A

Shoulders, elbows, knees, hips

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19
Q

What are the diagnostics available for OA?

A

X-ray
H&P
Arthroscopy (slightly painful w/minimal swelling, consent needed, local anesthesia) endoscope going into the joint space, invasive

20
Q

What are the Interventions for OA?

A 
>Non-pharmacological:
Nutritional supplementation 
Exercise: Yoga, T'ai Chi, swimming
Positioning, ROM
Joint support with splint (never put on all day)
Balance rest with activity 
Heat & Cold

> Pharmacological management
Arthroplasty in severe cases
(surgical reconstruction or replacement of joint)

21
Q

What are the pharmacological therapies for OA? Describe them.

A

-Acetaminophen- max dose 2600mg/day (over 4000 causes liver damage)
-Topical creams
-NSAIDs
(take misoprostol with GI complications, protects GI tract.)

-COX 2-Inhibitors (cyclooxygenase suppressant)
(celecoxib)
highly effective for joint pain
SE: CV disease and GI stress

Viscosupplemenation- injection of fluid

22
Q

What are teaching plan points for PTs with osteoarthritis?

A 
Balance rest and activity 
Improve activity intolerance 
Self-care
Home safety
How to use medications
Therapeutic exercise program
Community wellness programs
23
Q

Describe Rheumatoid Arthritis.

A
  • Autoimmune System Disease
  • Has remissions and exacerbations
  • Extra-articular manifestations (problems occurring outside the joints)
  • Felty and Sjogren’s syndrome (dries mucus membrane)
  • Progressive disability
  • Loss of tendon and muscle contractility
  • Systemic symptoms
  • Attacks bodies own collagen
  • Bi-lateral joint pain
24
Q

What are the defining characteristics of RA?

A
  • Early morning stiffness lasting 30-45 minutes
  • Swelling, warmth, erythema and pain in affected joints
  • Loss of function
  • Joints feel spongy/bogey on palpation
  • Bilateral and systemic symptoms (including fever, weight loss, fatigue)
  • Deformities of metatarsals and PIP
  • Signs and symptoms with exacerbations
25
Q

What is Felty’s syndrome?

A 
(S)plenomegaly
(A)nemia 
(N)eutropenia 
(T)hrombocytopenia 
(A)rthritis
26
Q

What is the American College of Rheumatoid Arthritis diagnostic criteria for RA?

A

4 of 7 of the following criteria for at least 6 weeks:

  • Morning stiffness that lasts 30-45 min
  • Swelling in three or more joints*
  • Swelling in hand joints*
  • Symmetric joint swelling*
  • Erosions or decalcification seen on hand x-rays
  • Rheumatoid nodules
  • Presence of serum RF (Rheumatoid factor)
27
Q

What are diagnostic tests for RA?

A
  • ESR (erythrocyte sedimentation rate; blood test revealing inflammatory activity)
  • Serum Rheumatoid factor
  • Antinuclear antibody (ANA)
  • C-reactive protein
  • RBC and complements C3 and C4 (decreased)
  • X-ray bony erosions and narrowed joint spaces
  • Arthrocentesis- complement and inflammatory cells
28
Q

What are the goals of treatment for RA?

A

Pain relief, decrease inflammation, slow progression of disability, address psychosocial needs

29
Q

What markers will be elevated in RA?

A

Inflammatory markers

30
Q

What are interventions for RA?

A 
>Non-pharmacological pain relief 
>Nutrition: anti-inflammatory diet
  -Whole grain
  -Fresh fruits and vegetables
  -Legumes
  -Seeds and nuts
  -Avoid excessive high glycemic load calories including 
   simple sugars
  -Animal products in moderations
  -Dietary supplementation: omega 3 fatty acids
>Psychosocial self care
>Pharmacological management (PT's will always need to take them)
31
Q

What are the 3 Pharmacological categories of Disease modifying agents used to treat RA?

A
  • Disease modifying anti-rheumatic drugs (DMARDs)
  • Biologic Therapy (serious infection risk, no live vaccines)
  • Antimalarial therapy
32
Q

Name and describe the Rx’s that are Disease modifying anti-rheumatic drugs (DMARDs).

A

-methatrexate
drug of choice, rapid anti-inflammatory
SE: myelosuppression, aplastic anemia, and GI toxicity, infection risk

**teratogenic (Rx harmful to fetus)

  • sulfasalazine
  • leflunomide
33
Q

Name and describe the Biological therapy medications for RA.

A
  • etanercept
  • adalimumab
  • infliximab

-All 3 injectable

SE: bacterial sepsis, invasive fungal infections, and TB

*Manteaux testing before starting treatment is recommended

34
Q

Name and describe the antimalarial therapy Rx and describe it.

A

-hydroxychloroquine

anti-inflammatory works with methotrexate
improves long term outcomes

SE: BM suppression, GI ulcers, infection risk, rashes, alopecia, and bladder toxicity

35
Q

What are the pharmacological treatments for anti-inflammatory symptom treatment of RA?

A 
NSAIDs
Glucocorticoids
Antibiotics
Gold salts
Antidepressants 
Sleep aids
36
Q

What are good self-care points for RA PTs?

A 
Pain management
Medication regimen 
Alternate rest with activity 
Maintain body alignment 
Positive self image
Joint protection 
Self-help groups
37
Q

What is Systemic Lupus Erythematous (SLE)?

A
  • Chronic inflammatory autoimmune disease
  • Characterized by exacerbations and remission
  • Exaggerated production of autoantibodies (against DNA) and antigens
  • Difficult to Dx

autoimmune

38
Q

Who is at a higher risk for Systemic Lupus Erythematous (SLE)?

A

Young women

39
Q

What are clinical manifestations/defining characteristics of Systemic Lupus Erythematous (SLE)?

A

-Fatigue
-Reynaud’s phenomena
-Myalgia’s/arthralgia’s (joint pain caused by Rx’s)
-Cutaneous: Scleroderma:
>CREST syndrome *
>Butterfly rash
>Discoid lesions
>Photosensitivity
-GI system esophageal dysfunction
-Glomerulonephritis*

40
Q

What are the diagnostics for Systemic Lupus Erythematous (SLE)?

A

**Antinuclear antibody (ANA) INCREASED (confirmatory for SLE)

  • ESR increased
  • Lupus cell prep
  • Anti-DNA antibody -presence
  • Anti-Sm antibody prosence
  • Anti-Ro (SSA)
  • Skin biopsy (cellular changes)
  • American College of Rheumatology criteria
41
Q

What are the goals for a PT with SLE?

A

Improve QOL, pain management, rest and activity, adequate nutrition, self-care

42
Q

What are interventions for Systemic Lupus Erythematous (SLE)?

A
  • Maintain skin integrity
  • Management of fatigue and stress
  • Promotion of adequate nutrition
  • Sunscreen and protective clothing
  • Monitoring of strict I and Os
  • Assessment of Infection
  • Pharmacologic management
43
Q

What is the pharmacologic management of a PT with Systemic Lupus Erythematous (SLE)?

A

> Immunosuppressants/cytotoxic

  • azathioprine
  • cyclophosphamide steroids: systemic and topical

> NSAIDs
DMARDS
Antimalarial (fatigue, moderate skin, and joint problems)
Anticonvulsants (for possible seizures)

44
Q

What PT teaching can be done regarding Systemic Lupus Erythematous (SLE)?

A 
Alternate rest with activity
When to contact HCP
Improve QOL
Home safety
Joint protection
Adequate nutrition
Support groups
Medication management
45
Q

What is primary gout characterized by?

A

hyperuricemia

46
Q

What do Rheumatic disorders affect?

A

joints, bones, muscles and connective tissues

47
Q

What is the first choice Rx for RA [symptoms]?

A

NSAIDs

Nursing 2 Exam 4 (5 decks)

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