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NURSADN6 Med Surg > Week 3 Chapter 34 Rheumatic Disorders > Flashcards

Week 3 Chapter 34 Rheumatic Disorders Flashcards

1
Q

Encompass autoimmune, degenerative, inflammatory, and systemic conditions

A

Rheumatic Diseases

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2
Q

Affect the joints, muscles, and soft tissues of the body

More than 100 types of rheumatic diseases

A

Rheumatic Diseases

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3
Q

Problems caused by rheumatic diseases include:

A

-Limitations in mobility and activities of daily living
- Pain and fatigue
- Altered self-image
-Sleep disturbances
- Systemic effects that can lead to organ failure and death

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4
Q

How many different arthritis disorders are there?

A

More than 100

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5
Q

Rheumatic diseases affect the primary joints but also what?

A

Muscles, bone, ligament, tendons, and cartilage

Remission and exacerbation

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6
Q

Classification of Rheumatic diseases can be

A

Monoarticular or polyarticular

Inflammatory or noninflammatory

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7
Q

3 distinct characteristics of pathophysiology include

A
  1. Inflammation
  2. Autoimmunity
  3. Degeneration
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8
Q

Most commonly manifest the clinical features of arthritis (inflammation of a joint) and pain

Marked by periods of remission and exacerbation

A

Rheumatic Diseases

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9
Q

Classifications of Rheumatic diseases include

A

Monoarticular or polyarticular

Inflammatory or non inflammatory

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10
Q

What are the 3 distinct characteristics of rheumatologic diseases?

A
  1. Inflammation
  2. Autoimmunity
  3. Degeneration
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11
Q

What is the pathophysiology physical signs of RA?

A

-Presentation of antigen to T cells
- T and B cell proliferation in synovial lining
- Neutrophil accumulation in synovial fluid
Cell proliferation
No cartilage invasion
- Synovitis
Early pannus invasion
Chondrocyte activation
Degradation of cartilage by proteinase
–Subchondral bone erosion
Pannus invasion of cartilage
Chondrocyte proliferation
Laxity of ligaments

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12
Q

Name the common symptoms of Rheumatic Disease

A

Pain
Joint swelling
Limited movement
Stiffness
Weakness
Fatigue

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13
Q

Rheumatic Diseases onset may be what?

A

Acute or Insidious

Periods of remission or exacerbation

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14
Q

Tx of Rheumatic Diseases can be

A

Simple
Complex

Patho- Some degree of inflammation caused by immune system and degeneration -secondary process or both

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15
Q

Manifestations of RA

A

Symmetric joint pain and stiffness lasting for more than a hr

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16
Q

Disease progression of RA includes

A

Swelling
Warmth
Erythema
Lack of function
Palpated joint feels spongy or boggy
Fluid can be aspirated from inflamed joint

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17
Q

RA have deformities of ?

A

Hand - Ulnar deviation and swan neck deformity . Thumb boutonniere

Cause: misalignment, progressive joint destruction, subluxation

Differs from OA’s Heberden’s and Bouchard’s

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18
Q

Characteristic patterns of RA

A

Joint pain in
- Shoulders
- Elbows
- Hands/ wrists
- Hips
- Knee joints
- Foot pain on joints

INFLAMED SYNOVIUM

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19
Q

Manifestations of RA Systemic

A

Fever
Weight loss
Fatigue
Anemia
Lymph node enlargement
Raynaud’s phenomenon
Rheumatoid nodules

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20
Q

RA inflammation can be around

A

Lungs and heart low rbcs

Ray- cold and stress induced vasospasm causing digital blanching or cyanosis

21
Q

Nursing Process The care of patient with Rheumatic Disease Assessment

A

Health History
- onset of evolution of symptoms
- family hx
- past health hx
- contributing factors
- previous tx and effectiveness
- pt support systems

Physical assessment includes -Physical exam and functional assessment

22
Q

Dx of RA

A

Inspect and palpitation
LAB
-RA- 80%
- Antibodies to cyclic citrullinated peptide anti-CCP
-ESR
-CRP
-RBC and C4 complement decreased
-ANA
- Synovial fluid - cloudy, milky, or dark yellow

23
Q

Nursing Process Care of Pt with Rheumatic Disease

A
  • Health Hx: onset and evolution of symptoms, family hx, past health hx, and contributing factors

-Functional assessment
- Arthrocentesis
- Imaging studies: Xrays, arthrography, CT, MRI

24
Q

Nursing Dx of RA includes

A

Acute and Chronic pain
Fatigue
Disturbed sleep pattern
Impaired physical mobility
Self care deficits
Disturbed body image
Ineffective coping

25
Q

Planning and goals for the pt. with a Rheumatic Disorder major goals include

A

Relief of pain and discomfort
Relief of fatigue
Maintain optimal functional mobility
Performs self care and activities independently
Adapts to physical and psychosocial changes
Effective coping behaviors
Absence of complications

26
Q

Nursing process interventions of pt with Rheumatic disease

A

Pain
- Anti-inflammatory/ analgesic medications
- Comfort measures(heat, positioning, etc)
Heat to joints for pain management
Fatigue
- Explain energy conserving techniques
- facilitate development activity/ rest schedule

27
Q

Interventions for pt with Rheumatic Disorder includes

A
  • Functional mobility
  • Assess for need of PT/ OT
  • Encourage independence in mobility
  • Self- care
  • Assist in self care deficits
  • Provide assistive devices
  • Consult with community agencies
28
Q

Interventions to maintain functional ability

A

-ROM
- Isometric exercise
- Dynamic exercise
- Aerobic exercise
- Pool exercise

29
Q

Interventions for pt with a Rheumatic Disorder

A

Physical and psychological changes
Absence of complications secondary to medications

30
Q

Medications and Tx

A
  • Salicylates and NSAIDs
  • Topical analgesics
  • DMARDs
  • Immunomodulators
  • Corticosteroids
  • Reconstructive Surgery
31
Q

First gen NSAIDs Cox 1 and Cox 2

A

ASA
Ibuprofen
Naproxen
Indomethacin
Diclofenac
Ketorolac
Meloxicam- COX 2

32
Q

DMARDs I are

A

Major nonbiologic

ex: Leflunomide

33
Q

Methotrexate

A

DMARD I-Immunomodulator
- Gold standard start first

34
Q

Hydroxychloroquine

A

Antimalarial
DMARD I

35
Q

Sulfasalazine

A

DMARD I
Antiinflammatory

36
Q

DMARDs II

A

Major Biologic DMARD

37
Q

TNFA meds include

A

Etanercept
Infliximab
Adalimumab

38
Q

B Lymphocyte Depleting agent

A

Rituximab

39
Q

Interleukin 1 receptor antagonist

A

Abatacept

40
Q

DMARDs II target what?

A

Proinflamm mediators

Cost more

tended for most severe patients

41
Q

Janus Kinase

A

New class drugs

  • Binds to active JAK enzyme sites
  • Inhibit cytokine production
  • Used in combo with nonbiologic agents or as monotherapy
42
Q

Prednisone
Prednisolone

A

Glucocorticoids

43
Q

Diffuse connective tissue diseases

A
  1. Group of chronic disorders characterized by diffuse inflammation and degeneration in connective tissue
  2. Cause is unknow but thought to have an immunologic basis
  3. Characterized by a clinical course of exacerbations and remissions
  4. Includes RA, SLE, scleroderma, polymyositis, and polymyalgia rheumatica
44
Q

Lupus is an autoimmune disease which means?

A

Mean’s the body’s natural defense system (immune system) attacks healthy tissues instead of attacking only things like bacteria and viruses. This causes inflammation

45
Q

Systems affected by lupus includes

A

Nervous
Ophthalmologic
Oral
Derm
Cardiopulm
Renal
GI
Repro
Hemat
Musco

46
Q

Name the systemic effects of SLE and the extraarticular features

A

-Fever
- Weight loss
- Fatigue
- Anemia
- Lymph node enlargement
- Raynaud’s and Sjorgens
- RA nodules
Other: arteritis, neuropathy, pericarditis, and splenomegaly

47
Q

management of SLE

A

Pain management
Immunosuppression
Corticosteroids
Antimalarial

48
Q

Home remedies

A

Mediterranean diet
Favor fish omega 3 fatty acids
Colorful produce
Whole grains
Olive Oil

49
Q

How to teach pt self care of SLE

A
  • Explain disease and principles of disease management
    -Medication teaching
  • Monitoring
  • Sources of info
  • Pain management
  • Joint protection
  • Self care assitive devices -Exercise and relaxation

NURSADN6 Med Surg (9 decks)

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