OA And RA

Question 1

Rheumatoid Arthritis

Answer 1

-Chronic, systemic autoimmune disease
-Women are 2-3 times more likely to have RA
-Cause is unknown

Question 2

RA ; CM

Answer 2

Joints
-Articular involvement manifested by pain, stiffness, limitation of movement, signs of inflammation
-As disease progresses, leads to deformity disability

Question 3

RA; Collaborative care

Answer 3

-A comprehensive program of education and drug therapy
-Physiotherapy
-Occupational therapy
-Long-term relationship with an arthritis health care team
-Balanced nutrition

Question 4

Joints;
CM

Answer 4

-Onset insidious
-Non-specific fatigue, anorexia, weight-loss and stiffness
-Limited motion
-Pain

Question 5

Extra-Articular manifestations

Answer 5

-Rheumatoid nodules-25% of patients
-Sjorgens nodule, 10-15% of patients
-Decreased lacrimal and salivary secretion
-Feltys syndrome-inflammatory eye diseases, blood dyscrasias

Question 6

Nursing interventions focus on

Answer 6

-Pain management
-Exercise therapy; joint mobility
-Self care assistance

Question 7

Diagnostics

Answer 7

-History and physical
-RF found in 80%
-ESR elevated
-C-reactive protons elevated
-Synovial fluid analysis
-X-ray non conclusive in early stages

Question 8

Pharmacological therapy RA

Answer 8

-Non-biologic DMARDs
-Biologic DMARDs
-NSAIDs
-Steroids
-Analgesics (Tylenol, Tramacet)
-Hyaluronic acid injections IA

Question 9

Disease-modifying antirheumatic drugs (DMARDs)

Answer 9

-Modify the disease of RA
-Exhibit anti-inflammatory, antiarthritc, and immunomodulating effects
-Inhibit the movement of various cells into an inflamed, damage area, such as a joint
-Slow onset of action of several weeks versus minutes to hours for NSAIDs

Question 10

Nonbiological disease-modifying antirheumatic drugs

Answer 10

-Methotrexate
-Leflunomide
-Hydroxychloroquine sulphate
-Sodium aurothiomalate
-Cyclosporine
-Azathioprine
-Sulfasalazine

Question 11

Biological disease-modifying anti-rheumatic drugs

Answer 11

-Humira
-Tofacitinib
-Anakinra
-Certolizumba
-Etanercept
-Golimumab
-Infliximab
-Adalimumab
-abatacept
-Rituzab
-Tocilizumab

Question 12

Etanercept (enbrel)

Answer 12

-used to treat rheumatoid arthritis (including juvenile RA) and moderate severe chronic plaque psoriasis
-Patients must be screened for latex allergy (some dosage forms may contain latex)
-Onset of action: 1-2 weeks
-Contraindicated in presence of active infections
-Reactivation of hepatitis and TB has been reported

Question 13

Nursing implications DMARDs

Answer 13

-Asses for contraindications
-Baseline bloodwork
-Monitor therapeutic responses
-Observe for and monitor adverse effects

Question 14

Patient teaching key points

Answer 14

-Maintaining neutral joint position
-Use strongest joint available for tasks
-Distribute weight over multiple joints
-Change positions frequently
-Avoid repetitious movement
-Avoid heavy lifting
-sit vs standing for long periods

Question 15

Osteoarthritis (OA)

Answer 15

-Most common form of joint disease in North America
-Slowly progressive noninflammatory disorder of the synovial joints
-3 million Canadians affected
-Also called degenerative joint disease

Question 16

Primary OA

Answer 16

-Primary OA results from cartilage damage that triggers a metabolic response at level of chondrocytes
-Fee patient experience symptoms before age 50 or 60
-More than half >65 years have radiographic evidence of disease in at least one joint
-OA is more sever in women

Question 17

Secondary OA: Risk factors

Answer 17

-Infection in a joint
-Trauma (including surgical intervention)
-Obesity

Question 18

Osteoporosis; assessment

Answer 18

-Back pain
-Pelvic or hip pain
-Problems with balance
-Decline in height
-Kyphosis or dorsal spine
-Pathological fractures

Question 19

Clinical manifestation

Answer 19

Systemic
-No systemic symptoms
-No fatigue, fever, or organ involvement

Joints
-Range from mild discomfort to significant pain and disability; localized pain and stiffness, crepitation

Deformity
-Specific to joint involved
-Can appear as early as 20 years of age

Question 20

Diagnostics

Answer 20

-Bone scan, CT and MRI can detect early changes
-No lab tests for dx

Question 21

Collaborative care focuses on

Answer 21

-Managing pain and inflammation
-Preventing disability
-Maintaining and improving joint function
-Foundation for OA management is nonpharmacological interventions
-Drug therapy serves as an adjunct
-Rest and joint protection (knee brace)
-Heat (muscle spasm) and cold (joint swelling) applications
-Nutritional therapy and exercise
-Complementary and alternative therapies
-Drug therapy

Question 22

Drug therapy

Answer 22

-Acetaminophen
-NSAIDs - Oral and topical
-Intra-articular steroid Injections
-Visco-supplementation therapy

Question 23

Nursing management: osteoarthritis

Answer 23

-Acute and chronic pain
-Insomnia
-Impaired physical mobility
-Self-care deficits
-Imbalanced nutrition: more than body requirements
-Chronic low self-esteem

Question 24

Nursing management: osteoarthritis (overall goals)

Answer 24

-Maintain or improve joint function through a balance of rest and activity
-Use joint-protection measures to improve activity tolerance
-Achieve independence in self-care and maintain optimal role
-Pharmacological and nonoharmacological pain management

Question 25

Nursing management: osteoarthritis (evaluation)

Answer 25

-Experience adequate amounts of rest and activity
-Achieve satisfactory pain management
-Maintain joint flexibility and muscle strength through joint protection and therapeutic exercise
-Verbalize acceptance of OA as a chronic disease, collaborating with HCP in disease management

Question 26

Nursing management: osteoarthritis (health promotion)

Answer 26

-Prevention is not possible
-Community education should focus on alteration of modifiable risk factors
-Athletic instruction and physical fitness programs should include safety measures

Question 27

Osteoporosis

Answer 27

-Chronic, progressive metabolic bone disease
-Characterized by low bone mass and deterioration of bone tissue
-Increased bone fragility predisposes individual to fractures (hip,wrist,spine)
-More common in women

Question 28

Osteoporosis: clinical manifestaitons

Answer 28

-“Silent” disease until sometimes a sudden fracture
-Back pain
-Loss of height
-Spinal deformities - kyphosis

Question 29

Osteoporosis: collaborative care

Answer 29

-Diet high in calcium
-Calcium supplements
-Vitamin D supplements
-Expecise program
-Estrogen replacement therapy
-Focused on prevention of fractures and drug therapy

Question 30

Drug therapy osteoporosis

Answer 30

-Hormone therapy
-Calcium
-Biphosphonates
•Work by inhibiting osteoclast-mediated bone resorption, which in turn indirectly enhances bone mineral density
•Strong clinical evidence indicates bisphosphonates can reverse lost bone mass and reduce fracture risk
-Selective estrogen receptor modulators
•Stimulate estrogen receptors on bone and increase bone density

Question 31

Bisphosphonates: adverse effects

Answer 31

-Headache, GI upset, joint pain
-Risk of esophageal burns if medication lodges in esophagus before reaching the stomach
-Risk of osteomecrosis of the jaw
-Possible severe (incapacitating) bone, joint or muscle pain; energy fractures
-Hypocalcemia
-inability to sit or stand straight for at least 30 min after taking the medication