Chapter 87: Lupus Erythematosus, Gout, and Fibromyalgia Flashcards
(141 cards)
1
Q
________ is an autoimmune disorder in which an atypical immune response results in chronic inflammation and destruction of healthy tissue.
A
lupus erythematosus (lupus)
2
Q
Autoimmune disorders
A
rheumatoid arthritis vasculitis multiple sclerosis scleroderma (including Raynaud's phenomenon) psoriasis
3
Q
In autoimmune disorders, small antigens can bond with _______. The body then produces antibodies that attack the healthy tissue.
A
healthy tissue
4
Q
These responses can be triggered by toxins, medications, bacteria, and _____.
A
viruses.
5
Q
______ of manifestations and a decrease in the number and frequency of exacerbations is the goal of treatment, because there is no cure for autoimmune disorders.
A
Control
6
Q
Gout, also known as gouty arthritis, is a systemic disorder caused by _________.
A
hyperuricemia increase in serum uric acid)
7
Q
Urate levels can be affected by medications, ____, and overproduction in the body. This can cause _____ deposits to form in the joints, and a gout attack can occur.
A
diet
uric crystal
8
Q
_____ is a chronic pain syndrome that involves stiffness, sleep disturbance, generalized muscle weakness and chronic fatigue.
A
Fibromyalgia
9
Q
It is estimated that _______ of people who have fibromyalgia have another form of a rheumatologic disorder, such as RA or SLE.
A
25% to 65%
10
Q
The occurrence of autoimmune disorders increases with _____.
A
age
11
Q
Lupus varies in severity and _______.
A
progression
12
Q
Lupus is generally characterized by periods of exacerbations (flares) and _____.
A
remissions
13
Q
______ is classified as discoid or systemic. A temporary form of lupus can be medication-induced.
A
Lupus
14
Q
______ only affects the skin.
A
Discoid lupus erythematosus (DLE)
15
Q
______ affects the connective tissues of multiple organ systems and can lead to major organ failure.
A
Systemic lupus erythematosus (SLE)
16
Q
________ can be caused by medications (procanimide, hydralazine, isoniazid). Findings resolve when the medication is discontinued.
A
Medication-induced lupus erythematosus
17
Q
Lupus can be difficult to diagnose because of the _______ of early manifestations.
A
vague nature
18
Q
One lupus risk factor is women between the age of ________.
A
women between the ages of 20 to 40
19
Q
One lupus risk factor is descent from African American, ____, or Native American.
A
Asian
20
Q
The incidence of lupus ______ in women following menopause but remains steady in men.
A
declines
21
Q
Diagnosis of lupus can be delayed in older adult clients because they mimic other disorders or can be associated with reports common to the _____.
A
normal aging process
22
Q
With older adults a lupus diagnsosis can be delayed. Joint pain and swelling can significantly limit ADLs in older adult clients who have _____.
A
comorbidities.
23
Q
With older adults a lupus diagnsosis can be delayed. Older adult clients are at an increased risk for fractures if ______ therapy is used.
A
corticosteroid
24
Q
An expected finding of lupus is fatigue/_____.
A
malaise
25
Expected findings of lupus include alopecia, blurred vision, and ____.
depression
26
_____ pain is an expected finding of lupus.
pleuritic
27
Anorexia/______ are expected findings of lupus.
weight loss
28
Joint pain, swelling, and ______ are expected findings with lupus.
tenderness
29
______(also a major indication of exacerbation) with lupus.
fever
30
Anemia and _________pathy are expected physical findings.
lymphaden-
31
_____ (presence of a cardiac friction rub or pleural friction rub) is an common physical finding of lupus.
pericarditis
32
_________ (arteriolar vasospasm in response to cold/stress)
raynaud's phenomenon
33
Findings consistent lupus include organ involvement (kidney, heart, lungs, and _______)
vasculature
34
Erythematous ______ rash over the nose and cheeks (raised, dry, and scaly) is an expected finding
butterfly
35
A ______ is used to diagnose DLE by confirming the presence of lupus cells and cellular inflammation.
skin biopsy
36
Immunologic tests are used to diagnose _____.
SLE
37
Antinuclear antibodies (ANAs): antibodies produced against one's own DNA; positive titers in _____ of clients who have lupus.
95%
38
Immunologic Tests
```
SLE prep
SS-A
Anti-DNP
ssDNA
dsDNA (very specific for SLE; assists with differentiation between SLE and medication induced lupus)
```
39
With lupus there will be an elevated ______ rate due to systemic inflammation.
ESR
40
Serum complement C3 and C4 will be _______ as a result of lupus. C3 and C4 are diagnostic for SLE because they decrease due to depletion secondary to an exaggerated inflammatory response.
decreased
41
With lupus BUN and creatinine will be ______ with kidney involvement.
increased
42
With lupus a urinalysis will show up positive for ______ and RBCs (kidney involvement).
protein
43
Pancytopenia will be evident through a ____ with lupus.
CBC
44
With lupus you need to assess/monitor pain, ______, and fatigue.
mobility
45
with lupus you need to monitor the vital signs put the _____ especially.
blood pressure
46
With lupus systemic manifestations such as hypertension, _____ and urine output will demonstrate renal compromise.
edema
47
With lupus diminished ______ can demonstrate pleural effusion.
breath sounds
48
With lupus _______ and sharp inspiration chest pain can indicate pericarditis.
tachycardia
49
With lupus you need to monitor/assess rubor, pallor, and ______ of hands/feet with vascultis/vasospasm and raynaud's phenomenon.
cyanosis
50
With lupus you need to assess and monitor arthralgias (joint pain), myalgias (muscle pain), and _______ when there is joint and connective tissue involvement.
polyarthritis (affects more than 4 joints)
51
With lupus changes in mental status that indicate neurologic involvement such as psychoses, paresis, and _____.
seizures
52
With lupus _____ and creatinine will be affected by renal involvement.
BUN
53
With lupus you also need to monitor and assess the patient's _____ status.
nutritional
54
With a lupus patient provide ____, _____ meals if anorexia is a concern. Offer between meal supplements.
small, frequent
55
With lupus encourage the client to limit ____ intake for fluid retention secondary to steroid therapy.
salt
56
With lupus provide emotional support to the client and ____.
family
57
______ are used to reduce inflammation and arthritic pain with lupus.
NSAIDs
58
Do not give NSAIDs to lupus patients who have impaired ____ function.
kidney
59
For lupus patients monitor for NSAID induced ______..
hepatitis
60
______ such as predinsone is used for immunosuppression and to reduce inflammation in lupus patients.
corticosteroid
61
In lupus patients taking corticosteroids monitor for ______, hypertension, and impaired kidney function.
fluid retention
62
In lupus patients taking corticosteroids do not stop taking them _______. Gradually taper the dosage as prescribed.
abruptly
63
Immunosuppressant agents such as methotrexate and _____ are used to suppress the immune response in lupus patients.
azathioprine
64
With Methotrexate or azathioprine (both immunospressants) monitor for toxic effects such as (___________ suppression or increased liver enzymes)
bone marrow suppression
65
In lupus patients who need suppression of synovitis, fever, or fatigue _______ (hyroxycholorquine) are used.
antimalarials
66
When a lupus patient is taking antimalarials such as hyroxycholoquine encourage frequent _____.
eye exams
67
For lupus patients physical and occupational therapy can be used for strengthening exercises and ______ as needed.
adaptive devices
68
Refer lupus patients to ______ as needed.
support groups
69
Lupus patient's should avoid ____ and prolonged sun exposure. Use sunscreen when outside and exposed to sunlgiht.
UV
70
Lupus patient's should use _____ protein shampoo and avoid harsh hair treatments.
mild
71
Lupus patients should use _______ for skin rash.
steroid creams
72
Lupus patients should report peripheral and _______ promptly.
periorbital edema
73
Lupus patients should report evidence of _____ related to immunosuppression.
infection
74
Educate lupus clients of childbearing age regarding risks of _________ and treatment meds.
pregnacy
75
Complications of lupus include lupus nephritis, pericarditis, and ______.
myocarditis
76
Clients whose SLE cannot be managed with immunosuppressants and corticosteroids can experience _______ resulting in the possible need for a kidney transplant.
chronic kidney disease
77
Lupus nephritis is the leading cause of death related to _____.
SLE
78
With _________ monitor for periorbital and lower extremity swelling and hypertension. Monitor renal status with _____ and _____.
lupus nephritis
| BUN and creatinine
79
With lupus nephritis teach the client the importance of taking immunosuppressants and _____ as prescribed.
corticosteroids
80
With lupus nephritis teach the client the importance of avoiding ______ and illness.
stress
81
_______ and myocarditis are complications of lupus.
pericarditis
82
Pericarditis and myocarditis are an inflammation of the heart, its vessels, and the surrounding sac can occur secondary to ______.
SLE
83
With the lupus complications of pericarditis and myocarditis you should monitor for chest pain, fatigue, ______, and fever.
arrhythmias
84
With the complications of pericarditis and myocarditis of lupus instruct the client to report _____, take drugs as prescribed, and try to avoid stress and illness.
chest pain to the provider
85
Gout or ______ is the most common inflammatory arthritis.
gouty arthritis
86
Gout is a ____ disease caused by a disruption in purine metabolism in which uric acid crystals are deposited in joints and body tissues.
systemic
87
Gout can be classified as either _____ or secondary.
primary
88
Primary gout is the ______ common.
most
89
With primary gout uric acid production is _______ than excretion of it by the kidneys.
greater
90
Primary gout can have a ____ gout.
genetic
91
Middle and older adult males )peak onset between or and 50), as well as postmenopausal women are commonly affect with _____.
primary gout
92
_____ gout is caused by another disease or condition (chronic kidney failure, excessive diuretic use) that causes excessive uric acid in the blood.
Secondary
93
With secondary gout treatment is based on treating the _____.
underlying condition
94
Secondary gout can affect people of any ____.
age
95
Risk factors for gout
```
obesity
cardiovascular disease
trauma
alcohol ingestion
starvation dieting
diuretic use
some chemotherapy agents
chronic kidney failure
```
96
Expected findings of gout include
```
sever joint pain
especially in the metatarsophalangeal joint of the great toe
redness
swelling
warmth of affected joint
```
97
Expected physical findings of gout
painful, swollen joint that is very painful if touched or moved
appearance of tophi (chronic gout)
98
Lab Tests for Gout
ESR - elevated
Urinary uric acid - elevated
BUN and Creatinine - elevated
Serum uric acid: consistent elevation above 6.5 mg/dL - repeated measurements are needed due to the effect of dietary intake on results.
99
With gout you need to assess/monitor pain, redness/swelling of affected joints and the _____.
serum uric acid levels
100
With acute gout there are 3 med options
antigout agent
NSAIDs
Corticosteroids
101
An antigout agent such as ______ (PO or parenteral) is used to decrease pain and inflammation for acute gout.
colchicine
102
Antigout agents such as colchicine should be used cautiously in clients who have impaired _____.
kidney functions
103
NSAIDS such as indomethacin or ibuprofen is used to decrease pain and _____ with acute gout.
inflammation
104
NSAIDS should not be given to clients who have impaired _____.
kidney function
105
Do not take NSAIDs on an ______.
empty stomach
106
Corticosteroids such as predinsone is used to treat ______.
inflammation
107
With corticosteroids monitor for fluid retention, hypertension, and impaired _____,
kidney dysfunction
108
Do not stop taking _____ abruptly. Gradually taper dosage as prescribed.
corticosteroids
109
For chronic gout what two meds are prescribed.
xanthine oxidase inhibitor
| uricosuric
110
Xanthine oxidase inhibitor such as _____ is used as a maintenance medication to promote uric acid excretion and decrease its production.
allopurinol
111
With allopurinol you need to ______ fluid intake.
increase
112
Allopurinol should be taken ____ meals and with a full glass of water.
after
113
Uricosuric (probenecid) is used as a maintenance medication to promote uric acid _______.
excretion
114
With uricosuric you need to monitor _____ levels.
uric acid
115
When taking uricosuric do not use ______ because it will decrease the effectiveness of the medication.
aspirin
116
Gout patients should remind the client to stay on a ______ diet, which includes no organ meats or shellfish.
low-purine
117
Gout patients should limit _____.
alcohol intake
118
Gout patients should avoid starvation diets, aspirin, and ______.
diuretics
119
Gout patients should limit physical or _______.
emotional stress
120
Gout patients should have ____ fluids.
increased
121
Gout patients should _____ medications.
adhere to their
122
Fibromyalgia also known as fibromyalgia syndrome is a chronic pain syndrome which manifests as pain, stiffness, and tenderness at certain _______ in the body.
"trigger points"
123
The pain experienced with Fibromyalgia is typically described as a _____ a gnawing pain that can be elicited by palpating "trigger points."
burning
124
Fibromyalgia patients can experience chronic fatigue, sleep disturbances, and ___________
functional impairment.
125
Fibromyalgia Risk Factors
Female between 30-50
Hx of rheumatolgoic condition, chronic fatigue syndrome, or Lyme disease
Deep sleep deprivation
126
Expected findings of Fibromyalgia
mild to severe fatigue
sleep disturbances
numbness/tingling of extremities
sensitivity to noxious smells, loud noises, and bright lights
headaches
jaw pain
depression
concentration and memory difficulties
GI manifestations: abdominal pain, heartburn, constipation, diarrhea
Genitourinary manifestations: frequency, urgency, dysuria, pelvic pain
visual changes
127
With Fibromyalgia assess/monitor pain, mobility, and _____.
fatigue
128
With fibromyalgia provide ____ support to the client and family.
emotional
129
Medications for fibromyalgia
serotonin-nonrepinephrine reuptake inhibitors (SNRIs) and anticonvulsants
NSAIDS
Tricyclic antidepressants
130
Pregabalin (anticonvulsant) and duloxetine (SNRI) are used to increase the release of serotonin and norepinephrine, resulting in decreased ______ pain.
nerve
131
SNRIs and anticonvulsants can cause drowsiness/_______.
sleepiness
132
When taking SNRIs and anticonvulsants dont' drink _____.
alcohol
133
NSAIDs are used to decrease pain and _____.
inflammation
134
NSAIDs are contraindicated for clients who have impaired _______. Don't take on an empty stomach.
kidney function
135
Tricyclic antidepressants (amtitriptyline, nortriptylline and trazodone are used to help induce _____ and decrease pain.
sleep
136
______ and nortiptyline can cause confusion and orthostatic hypotension in older adult clients.
amitriptyline
137
Trazodone is often the medication of choice for the older adult clients due to ______ adverse effects.
decreased
138
Physical therapy can be helpful with ______ to decrease pain.
fibromyalgia
139
Complementary and alternative therapies can be helpful with ______. (acupuncture, stress management)
fibromyalgia
140
Teach the client to limit the intake of _____, alcohol, and other substances that interfere with sleep with fibromyalgia.
caffeine
141
A client suffering from ______ should teach the client to develop a routine for sleep.
fibromyalgia
