Module 3

Question 1

Osteoarthritis - pathophysiology

Answer 1

Changes within the joint
Unilateral
NOT systemic

Question 2

Osteoarthritis - clinical manifestations

Answer 2

Progressive pain that increases with joint use
Decreased ROM
Tender to touch joints
Bony Swelling
Soft tissue swelling, deformity, instability, crepitus
More pain with activity, pain improves with rest
Heberden’s Node + Bouchard

Question 3

Osteoarthritis - assessment

Answer 3

Unsteady gait
Fatigue
Elevated serum creatinine (NSAID use)
Elevated liver enzymes
Multiple medication use
Vital signs

Question 4

Osteoarthritis - hypothesis (potential client problems)

Answer 4

Pain
Sleep issues
Difficulty caring for self due to pain
Decreased ROM

Question 5

Osteoarthritis - nursing actions

Answer 5

Give medications: Acetaminophen (NSAIDS)
Cold packs
Heating pad

Question 6

Osteoarthritis - teaching

Answer 6

Prescribed medications
PT/OT
Referral to orthopedic sx
Home health referral

Question 7

Osteoarthritis - evaluation

Answer 7

ADLs
Pain goal met

Question 8

Rheumatoid Arthritis - pathphysiology

Answer 8

Chronic systemic autoimmune disease
Bilateral
SYSTEMIC (fever, anemia, malaise, loss of appetite)

Question 9

Rheumatoid Arthritis - clinical manifestations

Answer 9

Joint pain/swelling
Erythema
Morning stiffness
Fatigue
Joint deformity - Swan Neck, Boutonniere, Ulnar deviation

Question 10

Rheumatoid Arthritis - assessment

Answer 10

Unsteady gait
Increased infection
Elevated creatinine/liver enzyme
Fatigue

Question 11

Rheumatoid Arthritis - hypothesis (potential client problems)

Answer 11

Pain
Difficulty sleeping/caring for self
Decreased ROM
Mobility issues

Question 12

Rheumatoid Arthritis - nursing assessment

Answer 12

Labs - CRP/ESR, liver/renal function

Question 13

Rheumatoid Arthritis - nursing actions

Answer 13

Give medications (analgesics, NSAIDS, DMARDS, glucocorticoids)
Frequent rest periods

Question 14

Rheumatoid Arthritis - teaching

Answer 14

Treatment plan
Reporting s/s of infection
Immunosuppressive therapy discontinued if active infection
Keeping up with vaccinations

Question 15

Scleroderma - pathophysiology

Answer 15

Affects skin/organs, autoimmune disease, systemic

Question 16

Scleroderma - clinical manifestations

Answer 16

Thickened hardened skin
Digital ulcers
HTN
Heartburn
Dysphagia
Cough
Pain

Question 17

Scleroderma - assessment

Answer 17

Head to toe assessment - disease affects all major organs

Question 18

Scleroderma - teaching

Answer 18

Disease processes, protecting skin from trauma

Question 19

Lupus - pathophysiology

Answer 19

Autoimmune disease, affects every organ

Question 20

Lupus - clinical manifestations

Answer 20

Vague/diverse manifestations
Butterfly rash across cheeks

Question 21

Lupus - labs

Answer 21

ESP, CRP, ANA, may be elevated with SLE

Question 22

Lupus - medications

Answer 22

Plaquenil (most common)
NSAIDS
Glucocorticoids
Immunosuppressive agents

Question 23

Lupus - nursing assessment

Answer 23

Give medications
Head to toe assessment
Monitor labs - BUN and creatinine, urinalysis, CBC, CRP/ESR

Question 24

Lupus - hypothesis (potential client problems)

Answer 24

Fatigue
Self-image challenges
Altered skin integrity

Question 25

Lupus - nursing actions

Answer 25

Administer analgesics and anti-inflammatory medications

Question 26

Lupus - teaching

Answer 26

Treatment plan/disease process Use sunscreen daily Keep immunizations UTD Avoid oral contraceptives

Question 27

Lupus - evaluation

Answer 27

Medication compliance, pain goal met, able to carry out ADLs

Question 28

Gout - pathophysiology

Answer 28

Uric acid build up in joints, bone, soft tissue caused by inflammation

Question 29

Gout - clinical manifestations/assessment

Answer 29

Severe joint pain (big toe) Tophi in chronic gout Lab values - elevated uric acid Swelling, redness, warmth over affect joint Decreased ROM

Question 30

Gout - hypothesis (potential client problems)

Answer 30

Pain, lack of knowledge

Question 31

Gout - nursing actions

Answer 31

Give uric acid lowering agents, analgesics and steroids

Question 32

Gout - teaching

Answer 32

Avoid foods/drinks high in purines, avoid alcohol (eps. beer), red meat, liver, fish, report flare ups

Question 33

Gout - evaluation

Answer 33

Elimination of gout flare-ups and prevent joint destruction

Question 34

Fibromyalgia -pathophsyiology

Answer 34

Chronic pain disorder

Question 35

Fibromyalgia - clinical manifestations/assessment

Answer 35

Insomnia Fatigue Stiffness Cognitive dysfunction Anxiety

Question 36

Fibromyalgia - hypothsis

Answer 36

Chronic pain Ineffective coping skills Depression/anxiety

Question 37

Fibromyalgia - nursing actions

Answer 37

NSAIDS Antidepressants Antiseizure Heat/cold therapy