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Nursing Semester 3 > Cyndi - Week 16 - Exam 7 > Flashcards

Cyndi - Week 16 - Exam 7 Flashcards

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1
Q

what is scleroderma?

A
  • autoimmune affects connective tissue - inflammation, sclerosis, and fibrosis
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2
Q

what is arthritis?

A

progressive deterioration of synovial joints

  • osteoarthritis
  • rheumatoid arthritis
  • gout
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3
Q

what are the characteristics of osteoarthritis?

A

Occurs in synovial joints:
• Not normal aging process
• Stress on joints – excessive load or damaged joint
• Excessive pressure breaks down cartilage
• Inflammatory response further degrades cartilage
• Chondrocytes (cartilage producing cells) repair
damage, but over time there is erosion of
cartilage, and bone beneath becomes exposed
• Osteocytes deposited – bony spurs
• Heberden’s and Bouchard’s nodes
• Usually asymmetrical

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4
Q

what are the risk factors of OA?

A
  • Age
  • Gender
  • Obesity
  • Sedentary lifestyle
  • Occupational
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5
Q

what are the causes of OA?

A
  • Trauma
  • Mechanical stress
  • Inflammation
  • Joint instability
  • Neurological disorders
  • Skeletal deformities
  • Hematologic/endocrine
  • Medications
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6
Q

what are the clinical manifestations of OA?

A

No systemic involvement – symptoms are joint‐specific
• Pain – from bone against bone, bone spurs, nerve impingement
• Especially after exercise or weight bearing, relieved with rest
• Sleep disturbances from pain
• Crepitation
• Asymmetrical
• Fingers, hip, knee, spine, and cervical joints most common
• Bouchards and/or Heberden’s nodes
• Movement increases pain
• Joint stiffness, decreased ROM in joint

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7
Q

what are the labs used for OA?

A 
**Biochemical markers
• Serum osteocalcin
• Hyaluronic acid levels (component of syn. fluid)
**Rule out rheumatoid arthritis
• Rheumatic Factor  ‐ negative
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8
Q

what are the radiology used for OA?

A

• X‐ray ‐– confirmation and staging
• Degree of disease seen may not correspond to degree of symptoms
Bone scan, CT, MRI – for diagnosis

**Synovial Fluid Analysis ‐ differentiate OA from RA

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9
Q

TEACHING POINT: what are the goals for OA tx?

A

Goals –manage pain, prevent disability, improve joint use

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10
Q

what are the different methods of pain control for OA?

A
  • Salicylates
  • NSAIDs
  • Hyaluronic acid
  • Glucosamine, chondroitin, MSM
  • Topical
  • Cortisone
  • Heat and ice
  • Alternative therapies
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11
Q

what is the pt education for OA?

A
  • Balance of rest and joint protection
  • Nutrition
  • Weight reduction
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12
Q

is surgery possible for OA?

A

yes!

- replacement of degenerative joint and arthroscopy

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13
Q

what are the complications of OA?

A

usually just local joint breakdown causing

decreased mobility

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14
Q

what is rheumatoid arthritis?

A

Chronic autoimmune, inflammatory disorder that affects the joints and may have systemic affects

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15
Q

what are the characteristics of RA?

A
  • Inflamed connective tissue in synovial joints
  • Extra‐articular (systemic) symptoms may occur
  • Process of destruction
  • Exacerbations and remissions
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16
Q

what are the risk factors for RA?

A
  • Any age
  • Women 2‐3x more
  • Cause unknown
  • Genetic – 50% of risk?
  • Hormones?
  • Infection?
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17
Q

what are the 4 stages of RA?

A

Stage 1 - mild; early, beginning, not ID’d on XRay
Stage 2 - moderate, joint stiffness, swelling
Stage 3 - severe; subluxation (stretching), risk for infection d/t bump
Stage 4 - terminal; bony growth, results in fusion of joint, immobility

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18
Q

what are the RA joint specific symptoms? TP*

A

• Symmetrical
• Inactivity causes stiffness
• Pain lessens with movement (but
worsens with overuse)
• Pain, stiffness, limited motion, heat, swelling
• Frequently small joints, but can include large joints and
cervical spine
• Severe results in distortion, subluxation,
dislocation
• Sometimes have “swan neck” deformity TP

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19
Q

what are the RA non-joint specific symptoms?

A

Fatigue, anorexia, wt. loss, stiffness – insidious onset
• Rheumatoid nodules
• Cardiopulmonary effects (pericarditis → late stages)
• Sjogren’s syndrome (↓ lacrimal/saliva secretion → dry)
• Felty syndrome (severe nodules → splenacromegy → leukopenia)
• Cataracts
• Depression

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20
Q

what are the complications of RA?

A
  • Increased deformity, infection/sore from nodules
  • Dec ability to perform ADLs
  • Visual changes/loss
  • Cardiovascular disease, vasculitis
  • Pulmonary changes – Pulmonary HTN, pleural effusion
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21
Q

what are the diagnostics for RA?

Study These Flashcards
A 
• X‐ray – can be inconclusive, but if seen:
- Joint narrowing, erosion
- Baseline comparison
- Subluxation, dislocation
• Labs
• Synovial fluid analysis
• Biopsy of synovium
• Bone scan
• Diagnostic criteria for RA
22
Q

what labs are used for RA?

Study These Flashcards
A
  • WBC, ESR, CRP
  • RF positive (80%)
  • ANA
  • Biomarkers – ACPA positive (70%)
23
Q

TP: if an RA med is given and there is improvement, which lab would go down?

Study These Flashcards
A

CRP → inflammation is ↓

24
Q

look at tx for RA

25
look at differences between OA and RA
READ
26
what is gout?
Joint disorder of recurrent inflammation that is triggered by hyperuricemia • Uric acid comes from purine catabolism, and is excreted by the kidneys • 5% of those with hyperuricemia develop gout
27
what are the causes of gout?
* Increase in uric acid production * Decrease in uric acid excretion (80‐90%) * Increase in uric acid consumption (food)
28
what are the causes of the joint inflammation?
Joint inflammation: • Uric acid crystals deposited within joint • 1 to 4 joints in acute attacks – especially great toe **Primary versus secondary gout
29
what are the risk factors of primary gout?
* Obese * Middle‐aged male * AfricanAmerican men 2 x Caucasian men * Rare in premenopausal females * HTN * Prolonged fasting * Excessive alcohol drinking * Heavy purine intake (diet of meat, seafood) * Long term thiazide diuretic use – side effect
30
what are the risk factors of secondary gout?
– due to complications of other problems • Chemo, medications, trauma, chronic illness
31
what are the diagnostic tests used for gout?
* Serum uric acid levels above 6 mg/dL * 24 hour urine uric acid * X‐ray * Synovial fluid aspiration – urate crystals * Rule out other causes, ie:“pseudo gout”
32
what are the sxs of gout?
* Sudden onset of pain in affected joints * Especially the joint of the great toe * Swelling * Tophi (stone, other growth of joint space) * Dusky or reddened appearance (looks like infection)
33
what is the tx for acute attacks of gout?
* NSAIDS * Colchicine + NSAIDs * Corticosteroids
34
what is the ongoing tx for gout and the patient education?
• Dietary changes and avoidance of alcohol • Allopurinol: xanthine oxidase inhibitor (blocks uric acid production) • Probalan: improves uric acid removal • Heat or cold treatment • Immobilization of joint • Treat pain
35
what is systemic lupus erythematosus? SLE
Multi‐system auto‐immune disease characterized | by autoantibodies
36
what are the characteristics of SLE?
* Sudden or insidious onset * Chronic and unpredictable * Exacerbations and remissions * Symptoms and severity varies * Large variety of antibodies involved * Human Leukocyte Antigen positive * Increased risk of infection
37
what are the risk factors of lupus (SLE)?
* Genetically linked * Women 10 x men, esp. in the childbearing years * Ethnicity – African and native American, Asian, Hispanic * Others: * Hormones * Environment
38
what are the complications of lupus (SLE)?
* Kidney failure * Brain and nervous system problems * Anemia, vasculitis * Pleurisy, pneumonia * Pericarditis, cardiovascular disease * Pregnancy complications * Psychosocial issues
39
what are the exacerbation and remission pattern of lupus?
* Fever, fatigue, anorexia & wt loss | * Arthralgia – swollen, reddened joints
40
what are the skin sxs of lupus?
* Red rash, often on face, sun‐sensitivity, often butterfly rash **TP*** * Mouth ulcers, patchy hair loss w/rash on scalp
41
what are the musculoskeletal sxs of lupus?
– Arthritis 90%, bone deformities
42
what are the cardiopulmonary sxs of lupus
advanced disease – dysrhythmia, HTN, cough, tachypnea, | cholesterol elevation
43
what are the renal sxs of lupus?
nephritis – 40% progress to renal failure
44
what are the hematologic sxs of lupus?
anemia, coagulopathies, leukopenia
45
what are the nervous system sxs of lupus?
seizures, headaches, neuropathy, cognitive dysfunction, mood disorders, anxiety, psychosis, memory deficits, disordered thoughts
46
what are the diagnostic tests of SLE?
* No specific test ‐ Diagnostic Criteria * Clinical picture * Labs:
47
what are the labs for Lupus?
* ANA – Anti‐nuclear antibodies (97%) * ESR * CRP * LE cell prep test * Anti‐Smith antibodies (30‐40%) * Anti‐DNA antibodies (HLA attack “self”) * CBC shows anemia, leukopenia, thrombocytopenia * Serum creatinine to monitor renal function
48
what are the ACR diagnostic criteria?
- skin criteria (butterfly rash, discoid rash, photosensitivity, oral ulcers) - systemic criteria (arthritis, serositis, kidney disorder, neuro disorder) - lab criteria (hematologic abnormalities, immunologic disorder, antinuclear antibody)
49
what is the tx for SLE?
• NSAIDS – joint pain, inflammation • Antimalarial drugs ‐ hydroxychoroquine • Corticosteroids – limited to exacerbations • Immunosuppressants ‐ methotrexate • Topical immunomodulators for skin conditions • Combinations of medications • Other supportive care for goals of pain relief, maintaining independent functioning and quality of life
50
what is the pt education for SLE?
– identify triggers, compliance with | plan of care, support system

Nursing Semester 3 (29 decks)

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