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Module 4 > UNIT 3- RHEUMATOID ARTHRITIS > Flashcards

UNIT 3- RHEUMATOID ARTHRITIS Flashcards

1
Q

OA vs. RA what are the ages of onset?

A

OA: usually begins after age 40

RA: May begin at any age usually before age 50

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2
Q

OA vs. RA Where is the joint pain located?

A

OA: Usually effects eight-bearing joints, such as the knees and hips, but also effects the ginger joints, pain is often on 1 side of the body only

RA: Usually effects small joins, such as the hand, foot, wrist, elbow, shoulders or ankle usually on both sides of the body

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3
Q

OA vs. RA What is the appearance of the joints?

A

OA: Usually cool, not red or swollen

RA: Inflammatory causes joints to be warm, red, swollen.

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4
Q

OA vs RA: Length of morning joint stiffness?

A

OA: Lasts only a few mins

RA: Lasts for at least 60 mins and can persist for hours

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5
Q

OA vs. RA: What are the symptoms besides joint pain stiffness?

A

OA: Usually does not affect overall health

RA: May be accompanied by fatigue, weight loss and fever.

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6
Q

OA vs. RA: What is the disease progression like?

A

OA: Symptoms gradually worsen over periods of year

RA: Symptoms worsen over a period of weeks to months

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7
Q

OA vs. RA: What eases pain or stiffness?

A

OA: Pain subsides with rest and worsens w/activity

RA: Stiffness decreases w/activity

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8
Q

What is rheumatoid arthritis?

A

Chronic, systemic autoimmune disease that causes inflammation of connective tissue in joints.

Usually exhibits extraarticular manifestations (outside of the joints)

There are periods of remission and exacerbation

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9
Q

True or False: There is a genetic link with RA?

A

True

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10
Q

What is the etiology of RA?

A

Autoimmune- combination of genetics and environmental triggers

  1. Antigen triggers formation of abnormal immunoglobulin (IgG)
  2. Autoantibodies develop against the abnormal IgG
    -RF factor
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11
Q

What are the 5 stages of RA?

A

1.Healthy joints
2. Synovitis
3. Pannus
4. Fibrous ankylosis
5. Bony Ankylosis

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12
Q

What should we know about stage 2 of RA- Synovitis?

A
  1. Synovial membrane inflamed and thickened
  2. Bones and cartilage gradually erode
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13
Q

What should we know about stage 3 of RA- Pannus?

A
  1. Excessive cartilage loss; exposed and pitted bones
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14
Q

What should we know about stage 4 Fibrous ankylosis of RA?

A
  1. Joint invaded by fibrous connective tissue
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15
Q

What should we know about stage 5 RA bony ankylosis?

A
  1. Bones fused
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16
Q

What is the onset of RA?

A

Typically insidious- slow and sneaky

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17
Q

What are some clinical manifestations of RA?

A
  1. Fatigue
  2. Anorexia
  3. Weight loss,
  4. generalized stiffness
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18
Q

True or False: some patients may report a history of precepting event that triggers there RA?

A

True- Some examples are infections, stress, exertion, childbirth, surgery, emotional upset

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19
Q

Symptoms of RA typically occur asymmetric or symmetric?

A

Symmetrical

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20
Q

How long can morning RA stiffness last

A

60mins.

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21
Q

How will the joints present in RA?

A

Tender, painful and warm to touch

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22
Q

True or false: Skin might get tight around a joint with RA?

A

True

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23
Q

What is Tenosynovitis?

A

Inflammation of the tendon sheath where muscle connects to bone

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24
Q

True or false: Deformity and disability are not common in RA?

A

False

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25
Q

What are the typical deformitites of RA?

A
  1. Ulnar deviation
  2. Boutonniere
  3. Bunions
  4. Swan neck
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26
Q

What is ulnar deviation?

A

Also known as ulnar drift. This hand condition occurs when your knuckle bones or metacarpophalangeal (MCP) joints, become swollen and cause your fingers to bend abnormally toward your little finger.

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27
Q

What is Boutonniere?

A

Flexion of the proximal interphalangeal and the distal interphalangeal joint

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28
Q

What is swan neck deformity?

A

Characterized by proximal interphalangeal (PIP) joint hyperextension and flexion of the distal interphalangeal (DIP) joint

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29
Q

What are the extraarticular manifestations of RA?

A
  1. Rheumatoid nodule
  2. Sjogren’s syndrome
  3. Felty syndrome
  4. Flexion contractures
  5. Depression
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30
Q

What are we concerned about when a person with RA presents with Rheumatoid nodules?

A

Our concern is skin breakdown. These nodules are not usually painful– as they are just inflamed tissue that hardens over time. But overall this increases the risk of skin breakdown.

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31
Q

What is important to know about Sjogren’s syndrome?

A
  1. Can happen on its own or as a part of RA
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32
Q

What does Sjogren’s syndrome effect?

A
  1. Targets salivary and tear glands which leads to dry mouth and eyes.
  2. Patients may have difficulty swallowing and may be more prone to injections due to dry eyes and dental carriers.
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33
Q

Review: These are the systems in the body that RA effects.

A
  1. Pleura: Effusions
  2. Lymph nodes: Reactive lymphadenopathies
  3. Kidney: amyloidosis
  4. Gut: Amyloidosis
  5. Bone marrow: anemia, thrombocytopenia
  6. Nervous system: peripheral neuropathy (mononeuritis multiplex)
  7. Eye: scleritis keratoconjunctivitis
  8. Pericardium: Effusions
  9. Lung: Fibrosis nodules effusion (these pts can be diff. to get off vents) TCDB important because lungs harden
  10. Spleen: Splenomegaly
  11. Muscle: wasting
  12. Skin: Thinning–> ulceration
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34
Q

True or false: RA can effect any body system… usually the higher the inflammation in the body the more likely you are to have a systemic impact?

A

True

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34
Q

What is some subjective data you may collect on your RA patient?

A
  1. Presence of precipitating factor
  2. Patter of remission and exacerbation of
  3. Use of medications (current and past)
  4. Family hx
  5. Impact on functional ability
  6. Anorexia, weight loss, malaise hx.
  7. Stiffness and joint swelling, muscle weakness, difficulty walking hx.
  8. Paresthesia of hands and feet.
  9. Systemetric joint pain and aching
34
Q

How often might an RA patient see the doctor?

A

every 3m to assess function w/extensive questionare

35
Q

What objective data might you collect from your patients RA history?

A
  1. Lymphadenopathy, fever?
    2.Rheumatoid nodules
  2. Skin ulcers- more prone
  3. Shiny, taught skin over joints
36
Q

What cardiovascular objective data might you collect from your RA pt history?

A
  1. Do they have Raynaud’s phenomenon
  2. Do they have dysrhythmias
37
Q

What is Raynaud’s phenomenon?

A

Extreme vasodilation when patient is exposed to cold temp– usually in hands and feet but can occur on ears and nose.

Typically treated with BB or CCB

38
Q

What respiratory objective data might you collect from your RA pt?

A
  1. history of chronic bronchitis or TB
39
Q

Why is important to ask your RA patient about TB?

A
  1. Because you are immunosuppressed with RA you have an increased risk of catching.
40
Q

What GI objective data might you collect from your RA pt?

A
  1. Splenomeglary (felty syndrome)
41
Q

What is felty syndrome using the acronym S-A-N-T-A?

A

S- Splenomegaly
A- Anemia
N- Neutropenia (decreased WBC)
T- Thrombocytopenia
A- Arthritis (RA)

42
Q

What Musculoskeletal objective data might you collect from your RA patient?

A
  1. What Systemic joints are involved (small joints typically but can affect larger joints)
  2. Is there swelling or erythema
  3. Hot? or Tender?
  4. Deformities (boney developement)
  5. Joint enlargement (hard to touc)
43
Q

What lab valves might we expect to see for an RA patient?

A
  1. Positive + Rheumatoid factor
    -(not all patients will have a + RF, those who do not tend to have a lesser case of RA)
  2. Increased ESR and CRP
    • Not specific for RA, just tells us that the body has inflammation somewhere/somehow
  3. Increased WBC in synovial fluid
    -must rule out RA vs. Infection etc.
44
Q

What might we expect to see on an xray of an RA patient?

A
  1. Joint space narrowing
  2. Bone erosion
  3. Deformity
  4. Osteoporosis
45
Q

What will our patient teaching include for a patient with RA?

A
  1. Drug therapy
  2. Disease process
  3. Home management strategies
  4. PT/OT therapy
  5. Individualized treatment plan
46
Q

What are the goals of drug therapy for RA?

A
  1. Relieve symptoms
  2. Maintain joint function & ROM
  3. Manage systemic involvement
  4. Delay disease progression: No cure, NO prevention
47
Q

What are different classes of antiarthritic drugs?

A
  1. NSAIDS
  2. DMARDS: Disease modifying antirheumatic drugs
    -non biologic
    -biologic
  3. Glucocorticoids
48
Q

What is another name for Nonbiologic DMARDS?

A
  1. Traditional
49
Q

What kind of effect does a non biologic dmard have?

A

Shot gun effect– broader

50
Q

What kind of effect does a biologic dmard have?

A

Sniper effect

51
Q

Methotrexate (MTX) is what class of medication?

A
  1. Immunosuppressant DMARD nonbiologic
52
Q

What are the uses of Methotrexate (MTX)

A

RA and Psoriasis

53
Q

What is the responsibility of Methotrexate (MTX)?

A

Hard on liver, monitor cbc, wbc, liver fxn studies, assess pain and ROM

54
Q

What are the side effects of methotrexate (MTX)?

A

Gi upset, anemia, thrombocytopenia, may cause fetal harm.

55
Q

What education should be given for the medication Methotrexate (MTX)

A

1.Risk of infection,
2. use of birth control,
3. photosensitivity

56
Q

Biologic response modifiers (BRM’s) are also known as

A

Biologics or immunotherapy

57
Q

What is the MOA of BRM’s aka biologic response modifiers (biologics)

A

Slows progression of disease. Used to treat moderate to severe RA in patients who have not responded to DMARDS. Can be used alone in combination with DMARDS

58
Q

What is the class of Etanercept (ENBREL)

A

Biologic DMARD (TNF inhibitors)

59
Q

What is the MOA of Etanercept (ENBREL)

A

Disrupts at the TNF inhibitor which inhibits the inflammatory response.

60
Q

What are the uses of Etanercept (enbrel)

A

RA and Psoriatic arthritis

61
Q

What responsibility does the RN have with of Etanercept (enbrel)

A

Assess
1.pain
2. Swelling,
3. ROM
4. Monitor CBC, esp. wbc
5. TB testing

62
Q

What side effecs of Etanercept (Enbrel)

A
  1. URI
  2. Injection site rxn
  3. Risk for tb and malignancies
63
Q

Why are patients who take etanercept (Enbrel) at risk for tb and malignancies?

A

They are immunosuppressed

It is recommended to tb test prior to start of medication and during current tb not good candidates.

64
Q

What education needs to be taught to a patient taking etanercept (enbrel)?

A
  1. how to self admin – sub q injection
  2. risk of adverse rxn to live virus-vaccine– still recommend the flue
65
Q

What other drug therapy is used for RA?

A

Corticosteroid
1. Intraarticular injections- directly in joint
2. low dose oral for limited time.

NSAIDS & Salicylates
1. Anti-inflammatory, analgesic and antipyretic
2. May take up to 2-3wks, for full effectiveness
3. Does NOT stop the progression of RA

66
Q

What diet is recommended for a patient with RA?

A

No special diet– balanced

67
Q

For every 5lbs of weight it adds how much pressure to the hips, knees and back?

A

20lbs

68
Q

True or false: Corticosteroid therapy can cause weight gain?

A

True

69
Q

What is the benefit of surgical therapy for RA patients?

A
  1. Relieves severe pain
  2. Improves function
70
Q

What is a synovectomy?

A

Removal of synovial fluid

71
Q

What should we know about total joint replacement with RA patient?

A
  1. By the time surgery is an option, the joints have already atrophied. So it is hard/close to impossible to get ROM back to normal
  2. Joint replacement in the wrist and fingers are not as effective as replacement in larger joints
72
Q

What are the overall goals of RA management?

A
  1. Satisfactory pain management
  2. Minimal loss of functional ability
  3. Maintain positive self-image.
73
Q

What health promotion do we do for RA patients?

A
  1. Encourage early treatment to prevent further damage
  2. Inform them of community education programs
  3. Symptom recognition to promote early dx and treatment
74
Q

What are our primary goals RA treatment?

A
  1. Reduce inflammation
  2. Manage pain
  3. Maintain joint function
  4. Prevent or correct joint deformity
75
Q

What interventions could you suggest to help with joint stiffness and increase ability to perform ADL’s?

A
  1. Sit or stand in warm water
  2. Sit in tub w/ warm towels around shoulders
  3. Soak hands in warm water
76
Q

What should we educate our RA patient on as far as rest goes?

A
  1. Alternate rest periods w/activity
  2. Helps relieve pain and fatigue
  3. Amount of rest varies
  4. AVOID total bed rest
  5. 8-10 hours of sleep + daytime rest PRN
  6. modify activities to avoid overexertion
77
Q

What are some body alignment teaching we could tell our patient with RA about?

A
  1. Firm mattress or bed board
  2. Encourage positions of extension
  3. AVOID position of flexion
    • no pillows under knees
    • small, flat pillow under head and shoulders
78
Q

What are some joint protection tips we could teach our patients with RA about?

A
  1. Modify tasks for less stress on joints
  2. Energy conservation
    -work simplification techniques
    -Pacing and organization
    -Delegation
  3. Occupational therapy for assistive devices
79
Q

True or false: it is best to avoid any unwanted stress on the joints?

A

True

80
Q

What should we know about ICE therapy with RA patients?

A
  1. Beneficial during periods of exacerbation
  2. Application 10-15 mins at one time
81
Q

What should we know about HEAT therapy with RA patinets?

A
  1. Moist hot packs, paraffin baths, warm baths, or showers are good choices
  2. Relieves stiffness
  3. 20 mins at a time.
  4. Be alert for burn potentials
82
Q

What should we teach our RA patient about exercise?

A
  1. Need recreational and therapeutic exercise
  2. Gentle ROM exercise done daily (THIS IS A MUST)
  3. Weight limit to one or two reps during acute inflammation
83
Q

What should we be looking at or teaching patients in terms of psychologic support in RA patients

A
  1. We need to evaluate if they have family or a support system– this dx can be upsetting
  2. finical planning
  3. Consider community resources
  4. Self- help groups
  5. Strategies to decrease depression. due to limited function and fatigue, loss of self-esteem, altered body image and fear of disability/deformity.

Module 4 (29 decks)

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