Unit 3 - Arthritis Flashcards

Question

Inflammatory Arthritis - Etiology Cause?

Answer 1

exact cause is unknown but thought that infection, possibly viral agents and heredity play a part

Answer 2

starts a faulty immune response that attacks the synovium lining of the joints resulting in destruction of cartilage and bone

Answer 3

attack other tissues in the body

Answer 4

may have a slow or sudden onset may effect several joints at once in a symmetrical pattern, often smaller joints first may be chronic and steady or be more severe at times with periods of remission in between aching, pain, stiffness, warmth, and swelling in joints may have general symptoms of fatigue, fever or weight loss

Answer 5

``` may effect other body systems: cardiac pulmonary renal neurological integumentary ```

Answer 6

history and physical exam bloodwork, often extensive imaging: x-rays, CT scan, MRI synovial fluid analysis often needs referral to a rheumatologist

Answer 7

early diagnosis and treatment to avoid severe damage to the joints

Answer 8

non-steroidal anti-inflammatories (NSAIDs) COX 2 inhibitors corticosteroids disease-modifying anti-rheumatic drugs (DMARDs) biologic response modifiers (“biologics” or BRMs)

Answer 9

ALL can cause GI bleeding or upset e.g. ASA, ibuprofen

Answer 10

e.g. celecoxib (Celebrex)

Answer 11

IV, oral or intra-articular injection IV and oral preparations cause immunosuppression

Answer 12

slows the rate of inflammation | cause immunosuppression

Answer 13

gold therapy (Myochrisine) leflunomide (Arava) azathioprine (Imuran) methotrexate (MTX) hydroxychloroquine (Plaquenil) sulfasalazine (Azulfidine) First line Tx, significant S/E in 25% of people cyclosporine

Answer 14

block specific hormones to control inflammation | cause immunosuppresion

Answer 15

newest drugs and very expensive Remicade Enbrel Humira

Answer 16

gout is a disorder of the body metabolism creating either over production of (10% of cases), or too little excretion of uric acid (90% of cases) normally purine in the diet is broken down by the body’s metabolism into uric acid and excreted by the kidneys

Answer 17

the build up of uric acid in the blood causes | uric acid crystals to deposit in tissue

Answer 18

most common site is the hallux but may affect any joint

Answer 19

may be hereditary ``` or as a result of other disorders e.g. renal disease psoriasis cancer treatment ```

Answer 20

``` pain swelling redness warmth may be accompanied by fever ```

Answer 21

onset is sudden and often effects only one joint

Answer 22

pain is sustained, very intense and will last from 3 to 10 days if untreated

Answer 23

may become chronic causing erosion and severe deformity of a joint similar to rheumatoid arthritis uric acid crystals can form deposits in soft tissue called ‘tophi’ that can irritate and swell locally

Answer 24

blood test for uric acid analysis of aspirated synovial fluid from effected joint 24 hour urinalysis for uric acid

Answer 25

provide symptom relief in acute phase of attack prevent further attacks and joint damage prevent the formation of kidney stones or tophi (uric acid crystal deposits in soft tissue)

Answer 26

NSAIDs e.g., indomethacin steroids oral or intra-articular injection colchicine (causes nausea and diarrhoea)

Answer 27

probenecid or sulfinpyrazone increase the excretion of uric acid by the kidneys allopurinol decreases the over production of uric acid by the body low purine diet (decrease intake of seafood, liver and gravy) to decrease the production of uric acid

Answer 28

pain and swelling leads to decreased range of motion (ROM) disuse leads to stiffness, decreased muscle strength and weakened ligaments prolonged disuse leads to contractures and joint deformities overuse leads to injury of weakened structure

Answer 29

deformities of toes: o claw, hammer or mallet toes o hallux rigidus and hallux valgus o subluxation of metatarsal heads

Answer 30

rear foot and ankle deformities leading to: o pronation o supination

Answer 31

altered or stiff gait can lead to callus formation o medially or laterally o on one or both feet toe deformities can create areas of pressure causing callus or skin breakdown: o tips of toes o metatarsal heads o dorsum of toes (PIPs and DIPs) stiff toes can be hard to dry and lead to maceration and skin breakdown between or under toes

Answer 32

altered areas of pressure can lead to nail thickening and/or deformity

Answer 33

ongoing and progressive

Answer 34

pain and fatigue lead to decrease exercise tolerance joint deformity leads to altered gait and decreased mobility difficulty with ADL can lead to psychological effects of depression and social isolation

Answer 35

control pain prevent or minimize joint deformity maintain function and mobility good nutrition and weight management

Answer 36

use correct body mechanics for joint preservation use splints correctly for joint protection do ROM exercises use heat and cold safely build up endurance and strength pace and arrange activity to conserve energy modify their environment to maximize functioning

Answer 37

stress and emotional needs financial issues transportation or home services needs

Answer 38

any history of arthritic disease client’s understanding of condition and any current treatments if taking med(s) that cause immunosuppression other health care providers involved e.g. rheumatologist, physiotherapist any risk factors or foot abnormalities related to arthritis how well client is coping

Answer 39

realistic goals for treatment in consultation with client and based on their preferences for treatment interventions in consultation with client including education and referrals plan foot care to not interfere with other treatments delay treatment in an acute attack if necessary

Answer 40

refer client to doctor if you identify any joint pain, redness or swelling that has not been diagnosed question the client about any changes

Answer 41

identify any areas of pressure from footwear and work with client to minimize or prevent skin breakdown refer client for footwear or orthotic modification as needed o

Answer 42

exercise particular caution to protect fragile skin during foot and nail care

Answer 43

teach client how to manage self care of feet using creative problem solving as needed (e.g. using reaching aid or q-tips to dry well between toes) consider increased risk of infection with immunosuppression when teaching client to monitor minor injury

Answer 44

evaluate effectiveness of interventions including teaching and referrals identify changes in client’s behaviour or lack of change (e.g. they have new shoes and insoles but aren’t wearing them) document changes to care plan along with any new goals or interventions

Answer 45

``` Supportive Communication Advocating Referrals Follow-Up ```

Answer 46

demonstrate support for whatever treatment and caregivers are currently in place encourage clients to ask questions and be active participants in their own care

Answer 47

if concerns are urgent or more detail is required consider a phone call, letter or fax to clarify communication keep a record of communications

Answer 48

Advocate for: clients to have a family physician to mange degenerative arthritis or gout clients to have a rheumatologist to manage inflammatory arthritis Home Care assessment through family physician if needed call Health Links or Manitoba Medical Association for a list of physicians taking new clients

Answer 49

Family physician - diagnosis and treatment of joint pain, swelling or redness that does not start to resolve in 2 to 3 days, has not been diagnosed or is recurrent - questions about making changes to their medications “The Arthritis Society” - questions about treatment options - financial assistance available locally - programs and services e. g., Arthritis Self-Management classes

Answer 50

document referrals and ask the client about outcomes at subsequent visits