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Module 4 (MedSurg 2) > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

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1
Q

Immune system main functions

A

fight disease and foreign invaders
constant surveilance
distinguish between normal and foreign (self and non-self)
attach, destroy, and get rid of

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2
Q

Why elderly are more prone to immune diseases and CA?

A

The body can no longer distinguish between self and nonself (DM and CA)

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3
Q

Onset difference between RA and OA

A

RA: < 50 y/o
OA: > 40 y/o

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4
Q

Location of joint pain difference between RA and OA**

A

RA: small joints (hands) on both sides of the body
OA: weight-bearing joints (one-sided)

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5
Q

Joint Appearance difference between RA and OA**

A

RA: inflammation causing warmth, red and swollen
OA: cool not red or swollen

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6
Q

Morning stiffness difference between RA and OA**

A

RA: > 60 mins persist for hours
OA: few minutes

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7
Q

S/S besides the joint difference between RA and OA

A

RA: fatigue, weight loss, and fever
OA: none

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8
Q

Progression difference between RA and OA

A

RA: worsens over weeks or months
OA: Over years

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9
Q

Easing pain and stiffness difference between RA and OA**

A

RA: decrease with activity
OA: rest and worsens with activity

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10
Q

Rheumatoid Arthritis def

A

Chronic, systemic autoimmune disease
Inflammation of connective tissue in joints

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11
Q

RA has what type of manifestations

A

extraarticular

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12
Q

RA has periods of

A

remission and exacerbation

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13
Q

Is there a possible genetic link to RA

A

YES

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14
Q

Causes of RA needs to be a combination of

A

genetics and environmental triggers

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15
Q

Antigen triggers the formation of what in RA

A

abnormal IgG

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16
Q

What develops against the abnormal IgG?

A

autoantibodies

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17
Q

What percentage of people with RA test positive for the Rheumatoid factor in the blood?

A

85

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18
Q

What are the stages of RA?

A

Synovitis
Pannus
Fibrous Ankylosis
Bony Ankylosis

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19
Q

Order of RA onset Patho

A

combination of genetic and environmental triggers
IgG forms
RF forms (autoantibodies against abnormal IgG)
RF and IgG combine
- deposits on synovial joints
- activation of inflammatory response
Neutrophils release damaging cartilage
- Thickening of synovial lining
- Cytokines drive inflammatory response in RA
If untreated goes into the 4 stages

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20
Q

What drives the inflammatory response in RA?

A

Cytokines

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21
Q

Stage 1 RA - Early

A

Synovitis
synovial swelling with excess blood
lymphocyte infiltration
High WBCs
no destructive change; swelling and osteoporosis

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22
Q

Stage 2 RA - Moderate

A

Pannus
increase inflammation
no deformities
muscle atrophy
possible lesions
signs of gradual destruction in the joint, narrowing from a loss of cartilage
osteoporosis

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23
Q

Stage 3 RA: Severe

A

Fibrous Ankylosis
form of pannus
cartilage eroded and bone exposed
possible deformities

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24
Q

Stage 4 RA: End - stage

A

inflammation subsides
bony ankylosis
loss of joint function
subcut nodules
bone forms in between the joint

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25
RA S/S: Joints
Fatigue, anorexia, weight loss, generalized stiffness **(morning > 60+ mins)** **symmetrically** tender, painful, swollen, pain with motion, and varies with the intensity **skin is stretched tightly**
26
The onset of RA is usually
insidious and sneaky **don't feel good but don't know why**
27
Common areas of RA
wrist MCP (metacarpophalangeal joint) - knuckle of thumb PIP (proximal interphalangeal joint) - knuckle of pinky big tow
28
May Report precipitating triggers such as
infection stress exertion childbirth surgery emotional upset
29
Tensynovitis
inflammation of the fluid-filled synovium within the tendon sheath.
30
Subluxation
inflammation of tendons/joints shifts the alignment of bones (spine)
31
Joint RA manifestations result in what complications
Tenosynovitis Deformity and disability Subluxation Walking disability Deformities in the hands
32
Typical deformities of RA
Ulnar deviation Boudamire (button-hole) Bunion Swan-neck
33
Ulnar deviation
hand drifts out to the pinky side
34
Boudamire
button-hole usually middle joint can't straighten out
35
Bunion (hallux valgus)
the base of big to joint shifts and the toe goes inward
36
Swan-neck deformity
middle joint goes down and the top joint goes up palmar side injury
37
RA S/S Extraarticular
Rheumatoid nodules Sjogren's syndrome Felty syndrome Flexion contractures (low mobility and ADLs) Depression (chronic pain)
38
Extraarticular s/s will show on someone without
treatment, uninsured, or money
39
What happens to the salivary and tear glands with RA?
DRY UP hard to swallow, infection in dry eyes, and dental hygiene decrease in dry mouth
40
Rheumatoid nodules
skin breakdown main concern painless, inflamed tissue get hard over time
41
Sjogren's syndrome
separate or combination with RA salivary and tear glands become dry and hard to swallow dry eyes = infection dry mouth = dental
42
Felty syndrome
enlarged spleen
43
S/S of RA - Lungs
pleura effusions - stiffness lung fibrous nodules effusions
44
S/S of RA - Eyes
scleritis keratoconjunctivitis
45
S/S of RA - Lymph nodes
lymphadenopathies
46
S/S of RA - Pericardium
effusions
47
S/S of RA - Kidney/Gut
amyloidosis
48
S/S of RA - Spleen
splenomegaly
49
S/S of RA - Bone marrow
anemia thrombocytosis
50
S/S of RA - Muscle
wasting/atrophy
51
S/S of RA - Nervous System
peripheral neuropathy
52
S/S of RA - Skin
thinning ulcerations
53
HIgher the inflammation = higher
systemic impact
54
With pleural effusion, what nursing management needs to be done?
TCDB IS harder to get off the ventilator
55
Subjective Nursing Assessment of RA
The presence of precipitating factors, **Pattern of remissions and exacerbations** **H&P (medications (current and past))** - ADLs 3-6 months through questionnaire of activity Impact on functional ability - Anorexia, weight loss, malaise - Stiffness and joint swelling, muscle weakness, difficulty walking - Paresthesia of hands and feet Symmetric joint pain and aching, and temp
56
Extraarticular means
outside the joint
57
Objective Data of RA
Lymphadenopathy, fever Rheumatoid nodules Skin ulcers Shiny, taut skin over joints **Raynaud's phenomenon Dysrrthrmias chronic bronchitis TB Splenomegaly**
58
RA pts are more prone to
swollen lymph nodes skin ulcers
59
Raynaud's phenomenon
exaggerated/severe vasoconstriction when pt is exposed to the cold **think of tip of finger is white while the others are red**
60
Raynould's phenomenon is commonly located in
hands feet ears nose
61
What med is used to help prevent Raynould's phenomenon?
mild beta-blocker, Ca channel blockers, ACE, Alpha-blockers (gloves)
62
RA pts are more susceptible to TB because
immunosuppressants allow for dormant TB to become active
63
S/S of felty syndrome
S – Splenomegaly A – Anemia N – Neutropenia T – Thrombocytopenia A – Arthritis (Rheumatoid)
64
How does dysrhythmias occur in RA pts?
scaring of AV or SA node in a regular pt
65
S/S of felty syndrome mnemonic
SANTA
66
Decrease WBC means increase in
infection
67
Objective Data RA M/S
Symmetric joint involvement Swelling, erythema Heat, tenderness Deformities Joint enlargement
68
RA Labs
**+ RF increase ESR and CRP** increase of WBC in synovial fluid SFA
69
RA Xray findings
Joint space narrowing Bony erosion Deformity Osteoporosis type
70
ESR means
erythrocyte sedimentation rate - the amount of inflammation
71
CRP means
C-reactive protein made in the liver and increase with inflammation
72
If not + RF,
A lesser degree of RA can still be dx with it s/s not as severe 85% of people who do have RA will have + RA factor
73
Pt teaching of RA
drug therapy - Individualized PT and OT - NSAIDs, DMARDs, AND glucocorticoids - delay progression and relieve symptoms disease process - build up over time Mgmt - Joint function and ROM - **manage systemic involvement**
74
PT works on
mobility and larger muscle groups
75
OT works on
fine motor skills ADLs - hands, adaptive devices
76
Is there a cure for RA?
NO
77
DMARDs types
non bio (traditional chem based) bio (genetic base)
78
What drugs are used in RA pts?
NSAID DMARD Glucocorticoid
79
DMARDs do what
disrupt inflammatory process
80
Non-biologic DMARD has what type of effect
shotgun (overall) 1st to be used chemical base
81
Biologic DMARD has what type of effect
genetic base Sniper approach in one area
82
Methotrexate (MTX) class
DMARD immunosuppressant
83
Methotrexate (MTX) use
RA psoriasis leukemia CA
84
Methotrexate (MTX) assess and monitor
CBC WBC Liver Function pain and ROM
85
Methotrexate (MTX) side effects
GI upset anemia thrombocytopenia fetal harm
86
Methotrexate (MTX) eduation
risk of infection birth control needed photosensitivity
87
All DMARDs are toxic to what organ and can cause infection-type
liver (hepatotoxic) opportunistic
88
Methotrexate (MTX) is what DMARD type
NON-BIOLOGIC common because cheap and form differences
89
BRMs (biologic and immunotherapy)
slow progression mech of action used to treat moderate to severe diseases alone or combination
90
Biologic DMARDs adverse effects
Injection site irritation, pain, redness Risk for serious infections Heart failure Liver failure Hematologic disorders Neurologic Disorders Severe allergic reactions Cancer
91
Etanercept (Enbrel) class
biologic DMARD (specific TNF inhibitor)
92
Etanercept (Enbrel) use
RA psoriatic arthritis
93
Etanercept (Enbrel) assess and monitor
pain, swelling, and ROM Monitor CBC, WBC and TB
94
Etanercept (Enbrel) side effects
URI injection site reaction risk of TB and malignancies
95
Etanercept (Enbrel) education
self admin SQ injection risk of adverse reaction to live-virus vax case manager on support for money (Expensive)
96
TB testing needs to be done when
before med and during
97
Corticosteroid Therapy
intraarticular injections low dose oral for a limited time
98
NSAID and salicylates
anti-inflammatory, analgesic, and antipyretic 2-3 weeks for full effectiveness **DO NOT STOP or progression of RA and flareups occur
99
Corticosteroids
100
TB testing in what conditions
dormant to active crowded areas
101
Nutrition Therapy for RA
balanced loss of appetite leads to wt loss corticosteroids = wt gain
102
Surgical Therapy for RA
if nothing else works relieve severe pain improve function synovectomy total joint replacement
103
Arthroplasty
joint replacement
104
Health Promotion for RA
prevention early id and treatment to prevent further damage s/s recognition
105
What is the 1st to be stopped when the RA pt has an infection
immunosuppressant
106
Acute Care of RA
decrease inflammation manage pain and function prevent deformities
107
OT can provide what to RA pts
lightweight splints -plan care around morning sytiffness
108
How to relieve joint stiffness and increase ability to perform ADLs?
sit/stand in warm shower sit in tub with warm towels around the shoulders soak hands in warm water
109
Ambulatory Care: RA rest
Alternate rest periods with activity helps relieve pain and fatigue 8-10 hours of rest and daytime rest PRN modify activities to avoid overexertion plan out activites
110
For every 5 lbs of weight gain =
20 lbs of weight on the lower body
111
Body Alignment of RA for sleeping
firm mattress encourage extension avoid flexion positions **no pillows under knees, small,flat pillow under head and shoulders**
112
Cold Therapy of RA
Beneficial during periods of exacerbation** Application 10–15 minutes at one time Helps with swelling to decrease blood flow
113
Moist Heat Therapy of RA
Moist hot packs, paraffin baths, warm baths, or showers Relieve stiffness 20 minutes at a time Be alert for burn potential parastesia Everyday stiffness
114
Exercise of RA
need gentle ROM daily wt limit to one or two reps during acute inflammation (same reps diff weights)
115
Psychologic of RA
SUPPORT Patient is constantly challenged by problems Limited function and fatigue Loss of self-esteem* Altered body image* Fear of disability or deformity Evaluate family support system**** Financial planning****** Consider community resources*** Self-help groups are helpful Strategies to decrease depression*
116
Etanercept (Enbrel) is prescribed for a patient with stage II rheumatoid arthritis. The nurse determines that the medication is effective if which of the following is observed? A) Decreased lymphocyte count B) Absence of Rh factor in the blood C) Decreased C-reactive protein (CRP) D) Increased serum immunoglobulin G
C) Decreased C-reactive protein (CRP) higher RH factor = more inflammation, severity, and increase of RA never absent of antibodies

Module 4 (MedSurg 2) (36 decks)

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