Rheumatoid Arthritis Flashcards
(101 cards)
1
Q
What is rheumatoid arthritis?
A
Chronic systemic autoimmune disorder
2
Q
How is rheumatoid arthritis described?
A
- Inflammation in connective tissues, primarily in joints
- Course and severity variable
- Most prevalent inflammatory arthritis
- Chronic pain, alterations in body image
3
Q
What are transformed antibodies called?
A
Rheumatoid factors
4
Q
Normal antibodies become what in rheumatoid arthritis?
A
Autoantibodies
5
Q
In rheumatoid arthritis- leukocytes become attracted to what?
A
Synovial membrane
6
Q
In rheumatoid arthritis- what ingests the immune complex to release enzymes?
A
Neutrophils and macrophages
7
Q
What type of immune response occurs in a generally susceptible host resulting in rheumatoid arthritis?
A
Aberrant
8
Q
The inflammation from rheumatoid arthritis causes what?
A
- Hemorrhage
- Coagulation
- Fibrin deposits on synovial membrane
9
Q
The formation of pannus tissue results in an abnormal what?
A
Tissue layer within synovial membrane
10
Q
The formation of pannus tissue leads to what?
A
- Greater loss of bone and cartilage
- Scar formation
11
Q
What is the most common form of arthritis in older adults?
A
osteoarthritis
12
Q
Rheumatoid arthritis affects which gender more?
A
Women
13
Q
What is the typical age for onset of rheumatoid arthritis?
A
Between 40 to 60 years of age
14
Q
Remissions of rheumatoid arthritis most likely occur when?
A
In the first year of the disease
15
Q
What is the cause of Rheumatoid arthritis?
A
It is unknown
16
Q
What are the risk factors of rheumatoid arthritis?
A
- Family history
- Female sex
- Obesity
- Heavy smokers- can be reduced if you stop
17
Q
What are the clinical manifestations of rheumatoid arthritis?
A
- Joint deformity
- Redness, warmth, pain, swelling of affected sites
18
Q
What are the clinical manifestations of the active phase of rheumatoid arthritis?
A
- Fever
- Anorexia
- Fatigue
19
Q
What can be said about the stiffness a patient will experience when they have rheumatoid arthritis?
A
- More pronounced in morning, lasting more than 1 hour
- May occur with prolonged rest during the day
- May be more severe after strenuous activity
20
Q
What are the five ways that the onset of joint issues in rheumatoid arthritis can be described?
A
- Usually insidious with stiffness
- May be acute, precipitated by stressor
- May be preceded by systemic manifestations of inflammation
- Polyarticular, symmetrical
- Rate of development can fluctuate
21
Q
What are the three types of joint manifestations in the hands and fingers due to rheumatoid arthritis?
A
- Ulnar deviation
- Boutonniere deformity
- Swan neck deformity
22
Q
What types of joint manifestations of the knee occur due to rheumatoid arthritis?
A
- Visible swelling
- Instability
- Quadriceps atrophy
23
Q
In rheumatoid arthritis patients what is a nearly universal joint manifestation?
A
Wrist involvement
24
Q
What happens to the spine if you have rheumatoid arthritis?
A
- Usually limited to cervical vertebrae
- Neurological complications
25
What kinds of deformities occur in the feet and ankles of a patient with rheumatoid arthritis?
- Subluxation
- Hallux valgus
- Lateral deviation of toes
26
In a patient with rheumatoid arthritis what causes their ambulation to be limited?
Due to pain especially in ankles and feet
27
What are the extra-articular manifestations of rheumatoid arthritis?
- Systemic disease
- Anemia of chronic disease
- Skeletal muscle atrophy
- Rheumatoid nodules
28
What is the issue with anemia caused by rheumatoid arthritis?
Its resistant to iron therapy
29
What two syndrome's a systemic affect of rheumatoid arthritis?
- Sjogren's syndrome
| - Raynaud's syndrome
30
What are the seven systemic affects of rheumatoid arthritis?
- Fever, weight loss, fatigue
- Lymph node enlargements
- Arteritis
- Neuropathy
- Scleritis
- Pericarditis
- Splenomegaly
31
Why would a patient with rheumatoid arthritis be at an increased risk of coronary heart disease?
It has a direct effect on blood vessels and the medications these patients take have damaging side effects on the heart.
32
What are patients with rheumatoid arthritis at an increased risk for that also increases their risk of coronary heart disease?
- Low HDL levels
- High cholesterol and triglycerides
- Hypertension
- High homocysteine levels
33
What is Juvenile idiopathic arthritis?
A chronic inflammatory autoimmune disorder that is similar to rheumatoid arthritis but diagnosed in children.
34
What is Juvenile idiopathic arthritis characterized by?
Chronic or remittent joint inflammation, swelling, and pain
35
What is the treatment for juvenile idiopathic arthritis similar to?
The treatment of rheumatoid arthritis in adults
36
Juvenile idiopathic arthritis is more prevalent in what gender?
female
37
What are the complications associated with juvenile idiopathic arthritis?
- Eye chronic uveitis
- Interference with normal growth
- Bone growth disturbances
38
What is the main goal for rheumatoid arthritis treatment?
Relieve manifestations
39
What are the interdisciplinary approaches for treatment of rheumatoid arthritis?
- Balance of rest and exercise
- Physical therapy
- Suppression of inflammatory processes
40
What type of fluid needs to be examined to diagnose a patient with rheumatoid arthritis?
the synovial fluid
41
What two types of antibodies are tested to diagnose a patient with rheumatoid arthritis?
- Antibodies to cyclic citrullinated peptide
| - Antinuclear antibody (ANA)
42
What protein should be tested to diagnose a patient with rheumatoid arthritis?
C-reactive protein
43
What type of factor should be tested when diagnosing a patient with rheumatoid arthritis?
the rheumatoid factor
44
What type of erythrocyte testing needs to be evaluated to diagnose a patient with rheumatoid arthritis?
Erythrocyte sedimentation rate
45
Where should you X-ray a patient when trying to diagnose a patient with rheumatoid arthritis?
Xray the affected joints
46
A score of at least what out of seven on the American College of Rheumatology will diagnose a patient with rheumatoid arthritis?
4 out of 7
47
What are the 7 categories from the American College of Rheumatology test that a patient needs to fall into to be diagnosed with rheumatoid arthritis?
- Morning stiffness greater than one hour
- Arthritis of three or more joint areas
- Arthritis of hand joints
- Symmetric arthritis
- Rheumatoid nodules
- Positive rheumatoid factor
- Radiographic changes
48
What medications will a patient with rheumatoid arthritis be placed on within 2 years of diagnosis?
DMARDs
49
What is the Immunosuppressor that falls into the DMARD category?
Methotrexate
50
What is the biologic response modifier that falls in the DMARDs category?
Adalimumab
51
Aside from immunesuppressors and biologic response modifiers what is the other drug falls in the DMARDs category?
Antimalarials
52
What are the 4 rheumatoid arthritic medication categories?
- DMARDs
- NSAIDs, ASA, COX-2 inhibitors
- Corticosteroids
- Antidepressants
53
What is the mechanism of action for antimalarial the DMARD?
Relieves severe inflammation
54
What are the contraindications/cautions for antimalarial the DMARD?
Hepatic or renal disease and alcoholism
55
What are the adverse effects of antimalarial the DMARD?
- Retinopathy
- Anorexia
- GI disturbances
- Loss of hair
- Agranulocytosis
- Unusual Skin Pigmentation
- Thrombocytopenia
56
When does the maximal benefit occur when taking the antimalarial drug?
6 months
57
What does DMARD stand for?
Disease-Modifying Antirheumatic Drugs
58
What is the method of action for Methotrexate?
Immunosupressor and antimitotic
59
What class does Methotrexate belong to?
Immunosupressor
60
What category does Methotrexate belong to?
DMARD
61
What are the contraindications/cautions for Methotrexate?
Hepatic and renal disease, infections, blood dycrasias, very young and very old
62
What are the adverse effects for Methotrexate?
- Hepatotoxicity
- Bone Marrow suppression
- Malaise
- Fetal defects
- Infections
- Sudden death
63
What should you get the baseline of a monitor when they are on Methotrexate?
- CBC
- LFT
- Renal function tests
64
What should you not take with Methotrexate?
-Vitamins with folic acid or PPI
65
What should you make sure to do when taking Methotrexate?
Stay well hydrated
66
What are the two route a patient could take Methotrexate?
Oral and intravenous
67
What is the onset of oral Methotrexate?
Varies
68
What is the peak of oral methotrexate?
1-4 hours
69
What is the onset of IV Methotrexate?
Rapid
70
What is the peak of IV methotrexate ?
0.5-2 hours
71
What class does Adalimumab belong to?
Biologic response modifiers
72
What category of drugs does Adalimumab belong to?
DMARD
73
What is the mechanisms of action for Adalimumab?
Inhibits tumor necrosis factor which is a cytokine thereby blocking the normal inflammatory and immune response controlled by TNF
74
What are the contraindications/cautions for Adalimumab?
- Active infection
- Neoplastic disease
- CV disease
- Neuro disease
- Active or latent TB
75
What are the adverse effects for Adalimumab?
- Infections
- Fatigue
- Hypertension
- Injection site irritation
76
If a patient is on Adalimumab what should you not give them?
live vaccines
77
What drug class does Celecoxib belong to?
COX-2 inhibitor
78
What is the method of action for celecoxib?
-Inhibits prostaglandin synthesis by inhibiting COX-2
79
What are the contraindications/cautions for Celecoxib?
- Advanced renal disease
- Hepatic failure
- Anemia
- GI bleed
80
What are the adverse effects of celecoxib?
- CV events
- Dizziness
- Sinusitis
- Edema
- Nausea
- Flatulence
- Diarrhea
- Rash
81
What should you monitor on a patient on celecoxib?
- Fluid retention in those with HTN or CHF
- Black tarry stools
- CBC
- LFT
- BUN
- Creatinine
82
What class does Prednisone belong to?
Systemic Corticosteroid
83
What is the mechanism of action for prednisone?
Suppress histamine and prostaglandins
| -Immunosuppressant and anti-inflammatory
84
What are the contraindications/cautions for Prednisone?
- Systemic infections
- Cataracts
- Peptic Ulcer Disease
- Osteoporosis
- Hypertension
- Renal disease
85
What should you give prednisone with?
food
86
Why should you not abruptly withdrawal prednisone?
To give adrenals a chance to recover
87
what are the serious adverse effects of systemic corticosteroids?
- Suppression of adrenal gland function
- Hyperglycemia
- Long-term therapy may result in Cushing syndrome
- Mood changes
- Cataracts
- Peptic ulcers
- Hypokalemia
- Osteoporosis
88
What may systemic corticosteroids mask?
Infections
89
If a systemic corticosteroid masks infections what can this lead to?
-Existing infections to grow rapidly and undetected
90
What is the route of prednisone?
PO
91
What is the onset of prednisone?
Varies
92
What is the peak of prednisone?
1-2 h
93
What is the duration of prednisone?
1-1.5 days
94
What are the nonpharmacologic therapies for rheumatoid arthritis?
- Rest and exercise
- Physical and occupational therapy
- Heat and cold
- Orthotic and assistive devices
- Nutrition
- Plasmapheresis and irradiation
95
What are the complementary and alternative therapies for rheumatoid arthritis?
- Acupuncture
- Hydrotherapy
- Nutritional supplements (fish oils)
- Nontraditional treatments such as diets, hormones, and plant extracts
96
Why are nontraditional treatments such as diets, hormones, and plant extracts not typically recommended for patients trying to manage their rheumatoid arthritis?
Because they are often costly and non have shown to be effective
97
Upon assessment of a patient with rheumatoid arthritis what should you include in your health history?
- Pain, stiffness, fatigue
- Joint problems
- Fever
- Sleep patterns
- Past illnesses
- Surgery
- Ability to carry out ADLs
98
Upon assessment of patient with rheumatoid arthritis what should you include in your physical assessment?
- Height
- Weight
- Gait
- Joints
- Skin
- Respiratory
- Cardiovascular
99
What planning should be included for a patient with rheumatoid arthritis?
- Client will report effectiveness of pain management
- Client will perform ADLs independently or with minimal assistance
- Client will express feelings about diagnosis
100
What implementations will the nurse do for a patient with rheumatoid arthritis?
- Monitor and treat chronic pain
- Prevent fatigue
- Teach use of heat and cold applications
- Teach use of medications
- Encourage use of nonparmacologic pain relief
101
What evaluations will the nurse do for a patina tight rheumatoid arthritis?
- Client maintains joint mobility
- Client expresses comfort and freedom from pain
- Client develops or maintains positive body image
- Client is free from infection
- Client, family display adequate understanding, support management of therapeutic regimen
