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NURSING 3 > Rheumatic disorders > Flashcards

Rheumatic disorders Flashcards

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1
Q

Rheucmatic disorders affect what?

A

Affect joints, bones, skeletal muscles, and connective tissues

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2
Q

Rheumatic disorders: pain

A

Subtle - pain, weakness, fatigue, insomnia, disturbed body image, joint stiffness

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3
Q

Rheumatic disorders: general onset

A

acute or insideous with periods of remission

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4
Q

Rheumatic disorders: general treatment

A

aimed at localized relief

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5
Q

Rheumatic disorders: gerontological considerations

A

Rheumatic disorders are often consequences of aging

Many do not seek help thinking it’s a normal part of aging

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6
Q

Rheumatic disorders: gero considerations - support system

A

Need adequate support system

  • Exercise
  • Nutrition
  • General health maintenance
  • Pharmacotherapy
  • Nonpharmacologic
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7
Q

Why might the gero population experience failure to follow treatment regimens for rheumatic disorders?

A

hearing
visual acuity
memory loss
depression

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8
Q

What serologic studies can be age related for rheumatic disorders?

A

ESR

ANA

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9
Q

What are anti-arthritic drugs

A

NSAIDs
Disease-modifying antirheumatic drugs (DMARDs)
Glucocorticoids

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10
Q

What are non-pharmacologic treatment regimens for arthritis

A 
Heat or cold
Weight reduction
Joint rest and avoidance of join overuse
Orthotic devices
Exercise Regimen
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11
Q

How does the sed rate test work

A

Phlebotomist draws blood
Test measures how fast RBC fall to bottom of tube in an hour
Inflammation causes red blood cells to stick together and sink faster

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12
Q

Management Goals and strategies Rheumatic disorders: Suppress inflammation and the autoimmune response

A

Optimize pharmacologic therapy (anti-inflammatory and disease-modifying agents)

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13
Q

Management Goals and strategies for Rheumatic disorders: pain control

A

Project joints

Ease pain with splints, thermal modalities, relaxation techniques

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14
Q

Management Goals and strategies for Rheumatic disorders: maintain or improve joint mobility

A

Implement exercise programs for joint motion, muscle strengthening, weight loss as appropriate, and overall health

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15
Q

Management Goals and strategies for Rheumatic disorders: maintain or improve functional status

A

make use of adaptive devices and techniques

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16
Q

Management Goals and strategies for Rheumatic disorders: increase patient knowledge of disease process

A

provide and reinforce patient education

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17
Q

Management Goals and strategies for Rheumatic disorders: promote self management by patient adherence with the therapeutic regimen

A

Emphasize compatibility of therapeutic regiment and lifestyle

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18
Q

What is Osteoarthritis?

A

Degenerative joint disease
A chronic non-inflammatory progressive disorder

Erosion of articular cartilage combines with hypertrophy of bone at joint margins

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19
Q

Osteoarthritis risk factors

A

age and obesity

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20
Q

Osteoarthritis affects which joints (most of the time)

A

weight bearing joitns

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21
Q

Osteoarthritis s/s

A

pain, stiffness, and functional disability
Pain is worse with activity and alleviated by rest
Morning stiffness usually resolves after less than 10 minutes
May report limited ROM and patient report of limited ability to do daily activities.
Crepitus is heard or felt

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22
Q

Osteoarthritis: diagnostics

A

Xray is often used to diagnose, monitor and watch the progression of the disease

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23
Q

osteoarthritis: management

A

pharmacological and non-pharmacological

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24
Q

Osteoarthritis: education

A

Need education, reduce pain and inflammation, optimize physical function and attempt to prevent or slow progression

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25
Osteoarthritis: non pharm tx
– rest and joint protection – heat with some cold, weight reduction and exercise
26
Osteoarthritis: pharm tx
NSAIDs Corticosteroids surgery - arthroplasty
27
Osteoarthritis: monitor
Check Liver, CBC – Tylenol – caution with alcohol and OTC products
28
gout
Most common of the inflammatory arthritides Monosodium urate crystal deposits into joints & tissues Increased serum uric acid levels
29
Gout risk factors
males
30
Gout s/s
– excruciating pain and inflammation in joints. Trauma, alcohol ingestion, dieting, medications, surgical stress or illness = triggers Abrupt onset occurs at night Pain, redness,
31
Gout medications for tx
NSAIDs Colchicine Corticosteroids Allopurinol
32
Gout: nursing considerations
``` Rest & elevate Ice – NOT heat Avoid alcohol, smoking Avoid foods high in purine Drink 2000mL daily ```
33
Gout education (diet)
Restrict consumption of foods high in purines, especially organ meats and shellfish; others believe that limiting protein foods such as red meats, lamb and pork or avoiding trigger foods are sufficient. 
34
Gout: phase 1
asymptomatic hyperuricemia, is when the serum urate level is high, but gout manifested by arthritis or nephrolithiasis has not yet occurred. People can remain asymptomatic throughout their lifetimes. The subsequent development of gout is directly related to the duration and magnitude of the hyperuricemia. Therefore, the commitment to lifelong pharmacologic treatment of hyperuricemia is deferred until there is an initial attack of gout (phase 2)
35
Gout: early attacks
Early attacks tend to subside spontaneously over 3 to 10 days even without treatment. The attack is followed by a symptom-free period (the intercritical stage or phase 3) until the next attack, which may not come for months or years. However, with time, attacks tend to occur more frequently, to involve more joints, last longer, and lead to long-term sequelae (phase 4).
36
Gout diagnostics
clinically relevant to use the biologic value of 6.8 mg/dL or 408 μmol/L, a level of serum uric acid above the saturation point for crystal formation
37
Fibromyalgia:
Chronic pain, exxagerated tenderness at 18 specified tender points
38
Fibromyalgia: s/s
– sleep disturbances, fatigue, morning stiffness, muscle weakness, paresthesia, cognitive dysfunction, chronic headaches, mood disturbances, irritable bowel syndrome
39
Fibromyalgia: treatment
Based on s/s - NSAIDs - Tramadol - Pregabalin - SNRI (Duloxetine) - nonpharm.
40
Fibromyalgia: nursing considerations
holistic approach | Safety
41
What is a hallmark of fibromyalgia
that individuals display diffuse hyperalgesia (increased pain to normally painful stimuli) and/or allodynia (pain to normally nonpainful stimuli). This suggests that these individuals have a fundamental problem with central dysfunction (pain processing mechanisms) that results in central pain sensitization.
42
What is rheumatoid arthritis
Autoimmune disease occurring in synovial joint Rheumatoid arthritis affects joint linings, causing painful swelling. Over long periods of time, the inflammation associated with rheumatoid arthritis can cause bone erosion and joint deformity.
43
What are risk factors to rheumatoid arthritis?
pollution smoking family history bacterial and viral diseases
44
rheumatoid arthritis: lab values
``` Rheumatoid Factor (RF) Anticitrullinated peptide antibody (ACPA) Erythrocyte sedimentation rate (ESR) C-reactive protein (CRP) CBC TB Hepatitis B & C Liver & Kidney Functions X-ray Ultrasound Arthrocentesis ```
45
Rheumatoid arthritis: clinical manifestations
``` Symmetric joint pain Morning joint stiffness lasting longer than 1 hour Swelling Warmth Erythema Lack of function Joints feel spongy Fluid can be aspirated Bilaterally and symmetric ```
46
RA is a systemic disease with multiple extra-articular features, such as
``` Fever weight loss fatigue anemia lymph node enlargement Raynaud's disease ```
47
What is raynaud's disease?
cold- and stress-induced vasospasm causing episodes of digital blanching or cyanosis
48
What is the goal of treatment with RA
decrease joint pain and swelling achieve clinical remission decrease the likelihood of joint deformity minimize disability
49
RA: early medical management medications
medication Methotrexate Hydroxychloroquine NSAIDS
50
What is medical management for someone with moderate RA?
OT/PT | Cyclosporine
51
RA medical management for someone with persistent RA
Reconstructive surgery | Corticosteroids
52
RA: nutrition therapy
Anorexia Weight loss Anemia Food high in vitamins, protein, and iron
53
RA potential complication
``` Cardiovascular disease Elevated lipid values Chronic inflammation Dysfunction of the endothelium Abnormal homocysteine levels ```
54
What is systemic lupus erythematous?
Inflammatory, autoimmune disorder | Body’s immune system inaccurately recognizes the cell’s nucleus as foreign
55
SLE triggers?
``` Cigarette smoke UV rays Medications Viral Infections Emotional Stress Stress on the body Dust exposure ```
56
SLE s/s
``` Systemic Symptoms Fever Malaise Weight loss Anorexia Joint pain ```
57
SLE: cutaneous s/s
Butterfly-shaped erythematous rash bride of nose and cheeks | Rashes
58
SLE: assessment
Cardiovascular Joint Swelling Neurologic Kidney it can impact any organ in the body
59
SLE labs
ANA Anti-DNA CBC
60
the labs and what they mean are on this ppt
go look if you ned
61
SLE: pharm therapy -- monoclonal antibodies
Example: Belimumab education: No live vaccines
62
SLE: corticosteroids
education about the complications that can arise such as osteoporosis and fractions
63
SLE: example of antimalarial agents for tx
Hydroxychloroquine
64
SLE treatment: NSAIDS
just know this is a treatment options
65
SLE pharm therapy: examples of immunosuppressive agents
Cyclophosphamide | Azathioprine
66
SLE medical and nursing management
Interventions are directed at controlling exacerbations Body image Skin integrity medication education
67
What is Sjogren's syndrome
progressively affects the lacrimal and salivary glands
68
Sjogren's syndrome s/s
``` dry eyes dry mouth lesions trigeminal neuralgia sensory neuropathy ```
69
Sjogren's syndrome: diagnostics
Histopathy of salivary glands
70
Sjogren's syndrome: medical management
No cure Treat symptoms Cholinergic agents
71
What is scleroderma
begins with changes in the skin | cause is unknown
72
What are the 3 cardinal features of scleroderma
Vascular injury and damage Activation of innate and adaptive arms of the immune system autoimmunity Generalized interstitial and vascular fibrosis
73
Scleroderma: management
depends on the clinical manifestations
74
The limited symptoms of scleroderma are referred to as CREST
Calcinosis: calcium deposits in skin Raynaud's phenomenon Esophageal dysfunction: acid reflux and decrease in motility of esophagus Sclerodactyly: thickening and tightening of the skin on the fingers and hands Telanglectasis: dilation of capillaries causing red marks on surfaces of the skin

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