Week 3 (exam 1) Flashcards
Methotrexate
DMARDs (disease modifying antirhumatic drug)
Rheumatoid arthritis
autoimmune reaction that effects the synovial tissue causing loss of articular surfaces and joint motion
Symptoms of rheumatoid arthritis
Symmetric joint pain/morning stiffness
Swelling
Warmth
Erythema
Low grade fever
Lack of function
Stages of RA
Stage 1
- the body mistakenly attacks its own joint tissue
Stage 2
- the body make the antibodies and the joints start swelling up
Stage 3
- the joints start becoming bent and deformed, the fingers become crooked. These misshapen joints can press on nerves and cause sever pain
Stage 4
- if not treated the disease will progress into the last stage, in which there’s not joint remaining at all and the joint is essentially fused
Extra Articular features of RA
Weight loss
Fatigue
Anemia
Lymph node enlargement
Raynaud’s phenomenon
Arteritis (inflammation of the arteries)
Neuropathy
Pericarditis
Sjogren’s syndrome (dryness throught the body)
Sjogren’s syndrome
a chronic autoimmune disorder that primarily affects the glands that produce moisture, such as the salivary and lacrimal glands
Assessment findings of RA
Joint inflammation
Tenderness
Temperature changes in joints
Extra articular changes
Lab findings in RA
Rheumatoid factor
Anti-CCP (cyclic citrullinated peptide antibodies)
ESR and CRP
CBC – (baseline)
arthrocentesis
X- ray
Medical management of early RA
Balance of rest and exercise
NSAIDs
DMARDs
Biologic DMARDs
DMARDs
a class of medication used to treat inflammatory and autoimmune diseases
Ex: methotrexate
leflunomide hydroxychloroquine
sulfasalazine
can cause N/V, diarrhea, hair loss, fever, increased risk of infection, lymphoma, kidney damage, and can cause bone marrow suppression
Biologic DMARDs
Rituximab
Etanercept
Adalimumab
Sarilumab
can increase risk of infection
Established RA
Formal occupational and physical therapy program
Addition of an immunosuppressant
Reconstructive surgery
Corticosteroids
Anti depressants
Nutrition
Assessment of pt with a Rheumatic disease
current and past symptoms
patient’s psychological and mental status
social support systems,
ability to participate in daily activities,
compliance with treatment regimen
management of self-care
systemic lupus erythematosus
chronic inflammatory disorder of the connective tissue and it caused wide spread inflammation as well as tissue damage
systemic lupus erythematosus symptoms
Arthralgias (joint pain) and arthritis
Skin manifestations
Pericarditis
Renal involvement
CNS involvement
impacts females more than males
see grid in notes
Dx for systemic lupus erythematosus
- labs will reveal moderate to severe anemia, thrombocytopenia, leukopenia, and positive antinuclear antibodies
- classic sign is the butterfly rash
Medical management of lupus is
Pharmacologic therapy
Corticosteroids
Antimalarials (hydroxychloroquine)
NSAIDs
Immunosuppressants
Monoclonal antibodies
Nursing management of lupus is
- educate pt to avoid sun exposure
- due to the involvement of multiple organ systems, educate pts about the importance of periodic health screenings
- provide support groups
- educate on the importance of sticking to their medication regimen
Causes of thyroid cancer
radiation exposure
3/4 of cases are female
Dx of thyroid cancer
Large or palpable thyroid
Ultrasound, MRI, CT
Thyroid function test
Serum Ca and phosphorous levels
Biopsy once ultrasound confirms mass
Radioactive iodine uptake studies
Signs and symptoms of thyroid cancer
- lesions on thyroid
- recurrent nodules on thyroid
- dysphagia
- hoarseness
- dyspnea
Tx of thyroid cancer
Thyroidectomy
Radioactive Iodine (no chemo)
Thyroidectomy
Depending on where it is, if its to the side it could be a partial
Radioactive iodine
Prior to taking this pill pt will go on a low iodine diet for two weeks (no red meat)
This will cause the thyroid to be craving iodine so that when the pt takes the radioactive iodine pill the thyroid will soak it all up.
Pts taking this pill should…
- flush toilet twice
- no pregnant visitors
- no bed sharing
- wash clothes separate
Pre operative education for pts having thyroidectomy
- educate how they should support the neck with their hands after surgery to prevent stress on the incision
typical post op care (monitor for any complications, assess airway and stay on top of pain meds)
Potential complications to monitor after thyroidectomy
hematoma
injury to laryngeal nerve
hypocalcemia
*life long thyroid hormone replacement (thyroxine) (Synthroid levothyroxine) *
Gastric cancer risk factors
Diet
- smoked, salted, and pickled foods
Poor prognosis
- asymptomatic in early stages
Typically adenocarcinomas
- a type of cancer that arises from mucus producing cells of inner-most lining of stomach
Gastric cancer manifestations
Few symptoms early stages
Indigestion
Early satiety (feeling of fullness)
Weight loss
Abdominal pain
Bloating after meals
Decrease appetite
N/V
Gastric cancer assessments
Palpable mass (late)
Ascites (metastasis)
Palpable lymphnodes around the umbilicus
Diagnostics of gastric cancer
Esophagogastroduodenoscopy (EGD)
Barium x-ray
CBC
Tumor marker - CEA
Tx of gastric cancer
Billroth I- Gastroduodenostomy
Billroth II- gastrojejunostomy
Priority problems w gastric cancer
Anxiety
Impaired nutritional intake
Acute pain
Grief
Lack of knowledge
Potential complications of bilroth
Hemorrhage
Dietary deficiencies
- B12 deficiency (pernicious anemia)
Bile reflux
Dumping syndrome (review chart in notes)
Dumping syndrome symptoms
- occurs 15-30 min after eating
- epigastric fullness
- weakness
- dizziness, vertigo
- diaphoresis
- tachycardia
- abdominal cramping
- self limiting
Dumping syndrome management
- no fluids w meals
- no high carbs
- no high sugars
Colorectal cancer (the third most common cause of cancer death) Risk factors
Smoking
family Hx
Lynch syndrome (hereditary disorder that increases the risk of cancer)
Alcohol consumption
High fat, Low fiber diet
Sally Has Lunch After Highs & Lows
Ross **Lynch ** has colorectal cancer
should have colonoscopy once a year once you turn 50
Manifestation of colorectal caner
change in bowel habits; blood in stool
- tarry
- bleeding
- tenesmus (feeling of needing to have a bowl movement even when there is little to no stool present)
symptoms of obstruction;
- pain, either abdominal or rectal
- feeling of incomplete evacuation
Dx of colon cancer
- colo guard
- conoloscopy
- biopsy
- CEA (tumor marker)
- contrast CT scans
Tx of colorectal cancer
surgery, aka colectomy (remove portion where cancer is) they will either reconnect the bowl, or the pt will get an ostomy
radiation and chemo
Patho of pancreatitis
the digestive enzymes produce by the pancreas specifically trypsin starts to digest itself
causes of pancreatitis
typically alcohol abuse
bacterial or viral infections
gall stones
Dx of pancreatitis
Lab values (serum amylase and lipase levels are most indicative)
Scans (CT, MRI, Ultrasound)
ERCP (Endoscopic Retrograde Cholangiopancreatography)
Tx of pancreatitis
- NPO (monitor their fluid and electrolyte balances) (monitor their glucose)
- NG suction
- Medications such as opioids for pain, PPIs, and H2 receptor blockers to decrease hydrocloric acid secretion
- ERCP- can remove gallstones, blockages, and help treat infection
Cullens sign
bruising or swelling around the belly button or umbilicus indicating sever pancreatitis symptoms. Can be a sign of internal bleeding.
Grey turner sign
a rare bruise-like discoloration of the lower abdomen and flanks that can indicate serious abdominal issues. It’s often a sign of acute pancreatitis and can indicate hemorrhage
Inflammatory bowl disease
a group of chronic disorders: Crohn’s disease and ulcerative colitis that result in inflammation or ulceration (or both) of the bowel.
Ulcerative colitis
Immune system dysfunction that results in inflammation of the mucosa of the colon and the formation of continuous ulcerations throughout the colon
Ulcerative colitis S&S
Diarrhea (10-20 liquid stools per day)
Fever
Abdominal pain
Fecal urgency
Weright loss
Anemia
Dehydration
Hypokalemia
Labs increase in WBC, ESR, and CRP
Ulcerative colitis Dx
Colonoscopy w biopsy
Tx of ulcerative colitis
sulfasalazine (GI anti inflammatory medication)
Corticosteroids – prednisone
Immunosuppressant- Cyclosporine
Antidiarrheals
Surgical tx:
Proctocholectomy – removing entire colon and rectum
Pt teaching w ulcerative colitis
NPO during exacerbations
High calorie diet w low fiber
Pt should avoid caffeine, alcohol, and lactose
eat smaller more frequent meals
Crohn’s disease
autoimmune disorder that is characterized by periods of exacerbation and remission. inflammation of the GI tract through all layers.
the entire GI tract can be involved, with ulcerative colitis it is just the colon
S&S of Crohn’s disease
Formation of patchy ulcerations or skip lesions (ulcerations will be sporadic)
formation of fistulas
diarrhea (5-6 loose stools a day)
Steatorrhea (high content in the stool)
RLQ plain
Weight loss
Anemia
Fever
Fatigue
Abnormal labs in Crohn’s disease
Elevation of WBCs, ESR, and CRPs
Dx of Crohn’s disease
Endoscopy (can include colonoscopy, and an EGD)
Medications for Crohn’s disease
sulfa sulfasalazine (GI anti inflammatory medication)
Immunosuppressant- Cyclosporine
Antidiarrheals
Surgical interventions for Crohn’s disease
Small bowel resection
colectomy
ileostomy
Pt education w Crohn’s disease
- during exacerbations pts should be NPO
- if they have a serious exacerbation they may require TPN
- high calorie low fiber diet
- smaller more frequent meals
Ileana Anastomosis
a surgical procedure that involves connecting the ileum (the last part of the small intestine) to the anus
stoma appearance
should look beefy and red
if it looks dusty and pale we are concerned that there is not enough blood flow to the site
Ostomy education
1/8th inch around the stoma
stool should not be on the abdomen at all bc that can cause skin breakdown
empty ostomy when 1/3 to 1/2 full
first goal is to have them acknowledge the stoma then they will learn how to take care of it
