Rheumatic & Allergic Disorders Flashcards Preview

Adult Health II > Rheumatic & Allergic Disorders > Flashcards

Flashcards in Rheumatic & Allergic Disorders Deck (17)
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1
Q

Inflammatory

A

Gout (affects Joints, Bones and Muscles)

Rheumatoid Arthritis (affects Connective Tissue)
Systemic Lupus Erythematosus (affects Connective Tissue)
2
Q

Noninflammatory

A

Osteoarthritis (affects Joints, Bones and Muscles)

Fibromyalgia (affects Joints, Bones and Muscles)

3
Q

Assessments r/t Rheumatic Disorders

A
  • Health History
  • Physical exam (look at joints, note deformities, compare sides, tenderness/pain?)
  • Functional (see how they do with normal ADLs, are adaptive devices necessary; pt may be adapting in unknown ways)
  • Aging Considerations (aging can throw off lab tests; elderly respond to meds different)
4
Q

Diagnostic Tests r/t Rheumatic Disorders

A
  • Radiologic (x-rays)
  • Labs:
    • ESR = Men: 0-15mm/hr (over age 50 is 0-20mm/hr); women 0-20mm/hr (over age 50 is 0-30mm/hr)
    • Antinuclear-Antibody (ANA) = normal is negative; titer is 1:160; low titers are present in the elderly
    • Autoantibodies = negative is 26 U/mL
    • RF = 0 to 20 U/mL negative titer; >1:80 is positive titer
5
Q

Goals of Tx

A
  • Suppress inflammation/autoimmune response
  • Pain control (pharm and nonpharm)
  • Functional Status (OT/PT, splints, adaptive devices)
  • Joint mobility (PT…teaches out to use joints correctly)
  • Pt Compliance (educate about disorder, how to decrease flair ups and preserve function, encourage self-care)
6
Q

Pharm Tx

A
  • Analgesics (usually NSAIDs or acetaminophen….salycilates NOT used d/t GI effects)
  • DMARDs (methotrexate is example; for more serious RA and SLE)
  • Glucocorticoids (use for acute stages usually, but may use for chronic if severe dysfunction/impairment)
  • Biologic agents aka immunomodulators (for severe RA and combo with DMARDs)
7
Q

Nonpharm Tx

A
  • hot/cold application
  • nutrition
  • yoga
  • music therapy
  • joint rest
  • weight reduction
  • massage
  • music therapy
  • exercise
8
Q

Osteoarthritis (OA) - from overuse

A

CARTILAGE

Labs/Dx:

  • X-ray
  • Arthroscopy

S/S:

  • joint stiffness after periods of inactivity but pain AFTER activity
  • bone spurs!

NC:

  • alteration of heat/cold application
  • weight reduction
  • activity designed to promote joint rest
  • splint
  • need 2000mL/day of H20 if on tylenol
  • psychological issues

Medical Mgmt:

  • pain mgmt (acetaminophen originally and then NSAIDs)
  • Surgical
9
Q

Gout

A

Labs/Dx:

  • increase in uric acid levels
  • for dx must have s/s and elevated uric acid (if uric acid is 6.8mg/dL, more prone to get gout)

S/S:
-acute attacks take place at night

NC:

  • nonpham pain mgmt
  • joint rest
  • avoidance teaching - purines and alcohol
  • ice packs
  • diet changes
  • 2000mL/day of H2O with meds!

Medical Mgmt:

  • NSAIDs and corticosteroids (usually for acute flair ups)…also sometimes allopurinol for acute
  • Allopurinol and Probenecid (for Chronic; we want uric acid levels around 6 with probenecid..watch for rash and N with this med)
10
Q

Fibromyalgia

A

this is muscle tenderness at 18 specific points

NC:

  • Emotional support
  • Education on compliance
  • Increase independence
  • Increase physical activity
  • Diet changes

Medical Mgmt:

  • NSAIDS
  • Tramadol (good for photophobia and auditory pain)
  • Pregabalin (good for photophobia and auditory pain)
  • Tricyclic antidepressants
11
Q

Rheumatoid Arthritis (RA) - autoimmune

A

INFLAMMATION

Labs/Dx:
-ESR, ANA, anti-CCP, CRP, RF (RF only present in 70% of pts)

NC:

  • Emotional support
  • Education
  • Independence (functional and nonpharm)

Medical Mgmt:

  • NSAIDS and Salicylates
  • DMARDS…these mute inflame response (AEs include anemia, GI toxicity, birth defects)
  • Glucocorticosteroids (for ACUTE)
  • Blood filtration (in severe cases)
12
Q

Labs for RA

A
  • ESR (see other flash); measures the rate at which red blood cells settle out of unclotted blood in 1 hr)
  • ANA (see other flash)
  • anti-CCP (positive in RA, neg otherwise)
  • CRP (normal is
13
Q

Systemic Lups Erythematosus

A

Labs/Dx:

  • 4/11 on American College of Rheumatology Scales is positive for SLE
  • ESR, ANA, CRP,

S/S:

  • can target any organ
  • variable presentation
  • butterfly rash
  • early photosensitivity

NC:

  • preserve independence
  • avoid sunlight
  • identify stress triggers
  • teaching r/t drug AEs
14
Q

Anaphylaxis - progression

A

Body recognizes foreign substance which is good but the RESPONSE is exaggerated

  1. first exposure
  2. second exposure
  3. recognition of antigen
  4. release of histamine (continuous release)
  5. release histamine is intensified
  6. cell destruction and surround tissue inflammation
  7. increased vascular permeability (allows proteins and larger substances and fluids to get through…which causes tissue inflammation)
  8. failure of compensatory mechanisms
15
Q

Anaphylaxis - S/s

A

MILD

  • watery eyes
  • sneezing
  • swelling of eyes
  • itching

MODERATE

  • flushing
  • itching (can’t STOP)
  • anxiety

SERIOUS

  • hives
  • effects airway at this point
  • significant coughing to get secretions out
  • panicky
  • bronchospasms
  • wheezing

SEVERE:
DON’T DIE

16
Q

Anaphylaxis - Nursing Care

A
  • fluids
  • artificial airways
  • teach progression and s/s and when to call Dr.
  • avoid triggers
  • how to use Epi Pen
17
Q

Allergic rhinitis

A

Dx:

  • skin test
  • nasal smear to know what substance triggers reaction
  • *this usually stays in face and sinuses
  • *it’s an allergic reaction