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NUR 200-Exam 3 > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

What is a chronic inflammatory disorder affecting many joints including those in the hands/feet?

A

Rheumatoid arthritis

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2
Q

What are the hallmark signs of RA?

A

Bilateral pain and stiffness/tenderness that’s worse in morning and persists for 1hr+,

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3
Q

Important diagnostic tests?

A

ESR, C-reactive protein, WBC and rheumatoid factor

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4
Q

What’s the diff b/t RA and osteoarthritis?

A

RA is autoimmune and progressive to other joints

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5
Q

Who is consulted for exercise to keep joints moving early to prevent further progression?

A

PT/OT

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6
Q

DMARDs can cause what? And what should you not mix them w/?

A

Birth defects or hepatoxicity; Aspirin/alcohol

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7
Q

What NSAID is often used in RA? and dosing?

A

Celebex 100mg PO BID

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8
Q

What DMARD is often used in RA? and dosing?

A

Methotrexate 7.5mg PO weekly for 1st 3mon then increase to 10mg weekly

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9
Q

What should you look out for in Celebrex?

A

Can cause heart/weight/stroke issues, watch out for chest pain/SOB

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10
Q

What should you look out for in Methotrexate?

A

Thrombocytopenia- PLT, excess bruise/bleed

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11
Q

When should NSAID/DMARD be contraindicated?

A

Pregnancy, liver disorder or history of ulcers/ulcerative colitis

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12
Q

Pain, impaired mobility, fatigue, and stress, are all what?

A

Diagnosis

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13
Q

What is important to teach in a pt receiving Remicade?

A

Need to get @ infusion center, is a biologic response modifier so can cause severe infections

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14
Q

To avoid an anaphylactic reaction from a Remicade infusion what should you give prior to?

A

Benadryl/tylenol

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15
Q

What 2 NSAIDs are usually used in combo for inflammation/pain in RA?

A

Celebrex/Aspirin

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16
Q

What are common side effects of NSAIDs?

A

GI effects: bleed, ulcers, erosions and stomach lining irritation, so take w/ food

17
Q

What can reduce the risk of GI bleed when taking NSAIDs?

A

Proton pump inhibitors: Protonix, Nexium, Prevacid, Cytotec

18
Q

Complications of NSAIDs?

A

Nephrotoxicity, hepatoxicit and BP alterations causing cardiovascular disorders

19
Q

What corticosteroids are often used for inflammation/pain in RA?

A

Prednisone, methylprednisone or triamcinolone

20
Q

What are some things to consider when taking corticosteroids?

A

Associated w/ poor wound healing, increased risk for infections, osteoporosis, GI bleed, wt. gain and cushingoid effects, don’t stop abrupt, take accu checks

21
Q

What meds are continued w/ Disease-Modifying Antirheumatic Drugs (DMARDs) bc of their anti-inflammatory effect being minimal?

A

NSAIDs

22
Q

What are the diff types of drugs used in DMARD therapy?

A

Immunosuppressants, sulfasalazine, antimalarials, Tumor Necrosis Factor (TNF) inhibitors and gold salts

23
Q

What type of immunosuppressives are used?

A

Methotrexate, Cyclophophamide, azathioprine and monoclonal antibodies

24
Q

What are frequent side effects of methotrexate?

A

Gastric irritation and stomatitis; can be controlled w/ folic acid @ same time

25
Q

Nursing consideratiosn for Immunosuppressives?

A

Monitor CBC, PLT, kidney and LFT, be alert for thrombocytopenia: unusual bleed/bruise

26
Q

Pt teaching for Methotrexate?

A

Avoid folate can alter effects and use contraception during and for 3mon following therapy

27
Q

Nursing considerations for sulfasalazine?

A

(Azulfidine) Monitor CBC and LFT

28
Q

Nursing considerations for antimalarials?

A

(Chloroquine/hydroxychloroquine (Plaquenil)) Monitor for visual changes/weakness, CBC and admin med w/ food or milk to reduce GI effects

29
Q

Nursing considerations for TNF?

A

Etanercept (Enbrel), Remicade (Inflixumab) Adalimumab (Humira) Monitor for infections

30
Q

Nursing considerations for gold salts?

A

Monitor for hypersensitivity, CBC and urinalysis for toxicity; contraindicated in pts w/ renal disease, hepatic dysfunction, CHF and DM

NUR 200-Exam 3 (6 decks)

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