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med/surg 2 > class 3 immunity > Flashcards

class 3 immunity Flashcards

arthritis & lupus

1
Q

commonalities between Rheumatoid Arthritis (RA) and Juvenile Idiopathic Arthritis (JIA)

A

-chronic, inflammatory, autoimmune
-progressively worsens w/ each flare
-primarily synovitis
-secondary degeneration of cartilage, muscles, tendons, and ligaments
-remissions & exacerbations

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2
Q

RA onset age

A

20-50 yrs
-mostly women

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3
Q

JIA onset age

A

<16 yr age

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4
Q

RA clinical manifestations

A

-symmetric joint pain that resolves hours after waking
-swelling, warmth, and erythema of joints
-progressive deterioration to larger joints, pannus formation
-extra-articular involvement(plerua, pericardium, fever, weight loss, fatigue, anemia)
-rheumatoid nodules(indication of rapid progress, “lumpy joints”)

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5
Q

assessments for rheumatoid nodules

A

-visual assessment
-lumpy joints= + for rheumatoid factor needed
-swan neck & bationniere derformities in hands
-non-tender & moveable nodules
-can spontaneously disappear

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6
Q

clincial manifestations for JIA

A

insidious or abrupt onset
-arthritis for 6w
-may refuse to use limb/limp
-may see stiffness or swelling
-child may be reluctant to do passive ROM in affected joint
90% are not pos for rheumatoid factor

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7
Q

symptoms of oligoarthritis in JIA

A

enlarged joints in 4 or less
-eyes commonly affected (uveitis) in 8-20% can cause blindess

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8
Q

symptoms of polyarthritis in JIA

A

5 or more joints affected
-smaller joints bilaterally

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9
Q

symptoms of systemic JIA

A

one or more joints affected + 2 weeks of fever,
evanescent rash on trunk & extremities
, lymph node enlargement, hepatosplenomegaly, serositis
-fever typically comes at the same time every day and lasts 3 days for 2 weeks
-pain for ~6weeks
-lymph node enlargement

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10
Q

clinical evaluation to diagnose RA and JIA

A

history
head to toe exam

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11
Q

labratory tests to diagnose RA and JIA

A

-rheumatoid factor (RF) assay (70-80% in RA have it)
-erythrocyte sedimentation rate (ESR) & C-reactive protein(CRP)(inflammation)
-anti-cyclic citrullinated peptide (anti-CCP) assay (protein associated with RA)
-antinuclear antibody (ANA) assay (autoimmunity)
-CBC(inc WBC, platelets, dec hemoglobin in active flare)

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12
Q

imaging to diagnose RA and JIA

A

ultrasound
MRI

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13
Q

arthrocentesis for diagnosis of RA or JIA

A

-milky, cloudy, dark yellow fluid + indication for inflammation

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14
Q

slit lamp exam to diagnose RA and JIA

A

tests for uveitis in JIA

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15
Q

major goals of therapy in RA and JIA

A

control pain
preserve joint range of motion and function/ADLs
minimize effects of inflammation, such as joint deformity
promote normal growth and develop

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16
Q

NSAIDs for RA and JIA

A

reduce pain and inflammation
e.g.ibuprofen, naproxen, indomethacin, COX-2 inhibitors

17
Q

Nonbiologic DMARDs for RA and JIA

A

first line
prevents joint damage, obtain remission
-slow the attack of immune system
-methotrexate is most common, hydroxychloroquinine(off label use)

18
Q

biologic DMARDs for RA and JIA

A

block tumour necrosis factor a and interleukin-1 “security guards for the joints”
“-mabs”
-TNF-a: adalimumab(humira), etanercept(enbrel), infliximab(remicade)
-IL-1 blocker: anakinra(kineret)

19
Q

corticosteroids for RA and JIA

A

-severe systemic disease
-used to bridge the time it takes for DMARDs to work or fpr active systemic disease
-temporary
-topical, PO, IV, direct joint injection

20
Q

physical management of RA or JIA

A

-relieve pain (non-pharmacologic)
-exercise
-ADLs

21
Q

nutrition management for RA and JIA

A

well-balanced diet
iron supplementation

22
Q

surgery management for RA and JIA

A

arthroscopy
joint replacement
arthrodesis
synovectomy
eye surgery

23
Q

what is systemic lupus erythematosus (SLE)

A

-chronic, inflammatory, autoimmune disease
-multi-system disorder
-remissions and exacerbations
-onset common in 20s-30s

24
Q

cutaneous manifestations of SLE

A

butterfly rash
oral ulcers
Raynaud’s syndrome

25
Q

joint manifestations of SLE

A

arthralgias
arthritis/synovitis

26
Q

cardiac manifestations of SLE

A

pericarditis
hypertension
atherosclerosis
valve insufficiency

27
Q

CNS manifestations of SLE

A

psychosis
cognitive impairment
seizures
strokes

28
Q

diagnosis for SLE

A

-assess for typical manifestations
-blood work: anemia, thrombocytopenia, leukocytosis, leukopenia, positive ANA’s

29
Q

corticosteroids for SLE

A

topical, low dose oral, high dose oral/IV

30
Q

antimalarials for SLE

A

cutaneous, MSK, mild systemic

31
Q

pharmacological interventions for pain for SLE

A

NSAIDs
Immunosuppressive agents (DMARDs)

32
Q

nursing management for SLE

A

-hospitalization for severe flares
-monitor for side effects of medications
-education: rest and exercise, nutrition, skin protection, coping, reproductive issues

med/surg 2 (17 decks)

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