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EXAM 5 - MED SURG

RA & SLE

QuestionAnswer
Rheumatoid Arthritis (RA) Assessment Findings Rheumatoid Nodules, Joint Inflammation Detected on Palpation, bilateral and symmetric stiffness, tenderness, swelling, and temperature changes in joints.
Rheumatoid Arthritis (RA) Diagnostic Findings X-Ray, US for baseline joint evaluation/assess erosion and synovitis, Arthrocentesis - synovial fluid cloudy, milky, or dark yellow with inflammatory components
Extra-Articular Changes in RA Weight loss, sensory changes, lymph node enlargement, and fatigue. Raynaud's, arteritis, neuropathy, pericarditis, splenomegaly, and Sjogren's Syndrome (dry eyes & dry mucous membranes)
Rheumatoid Arthritis (RA) Lab Findings Rheumatoid Factor Present in 80-80% - NOT DIAGNOSTIC - ANTI-CCP (Antibodies to cyclic citrullinated peptide) 95% DETECTION OF RA - ESR & CRP significant elevation in acute phase of RA, monitor for active disease and disease progression (NON-SPECIFIC) - CBC - for baseline prior to medications
Autoimmune Disorders Develop antibodies to their own cells or cellular material. Antibodies attack the individual tissues, Destruction of tissue via inflammatory process. Chronic and long standing pain
Rheumatoid arthritis (RA) An autoimmune disease of unknown origin that affects 1% of the population, with females having greater incidence than males. It may occur at any age, but the onset commonly occurs between the third and sixth decade of life. The incidence of RA increases after the sixth decade of life.
Rheumatoid arthritis (RA) Risk Factors Environmental factors such as pollution and smoking, family history of first-degree relatives, and illnesses such as bacterial and viral illnesses.
Nursing Education for Rheumatoid Arthritis (RA) Pain, fatigue, and depressive symptoms can interfere with the patients ability to learn. They should be addressed before education is began.
Azathioprine (Imuran) Decreases the production of antibodies at the cellular level. Directly effects the disease. The one that really makes a difference in the disease process where others just treat symptoms.
Celecoxib (Celebrex) Helps decrease pain and swelling. You know it is working when there is less pain and swelling
Naproxen (Naprosyn) Provides pain relief and decreases joint inflammation. Used with caution in long-term use as they can cause gastric ulcers
Anakinra (Kineret) Self-Administered SubQ
Amitriptyline (Elavil) May be given to help with sleep, as patients can become depressed with the emotional, physical, and financial burden of the disease.
Corticosteroid (Prednisone) Decreases inflammation. Must monitor laboratory results of C-Reactive Protein & Blood Glucose. THEY ARE A BRIDGE - NOT MEANT FOR LONG-TERM USE. Can lead to serious side effects
Methotrexate Preferred nonbiologic therapy. Blood tests liver and kidney function. Serum aspartate amino transferase and CBC. Teratogenic - must use contraception
DMARD The targeted biologic therapy. Prevents inflammation and joint damage. You know it is effective if pain is less and joints are moving easier
System Lupus Erythematous (SLE) An inflammatory, autoimmune disorder that affects nearly every organ in the body. It occurs 6 to 10 times more frequently in women than in men and occurs 3 times more in African American populations than among Caucasians.
System Lupus Erythematous (SLE) Expected Findings Fatigue, malaise, photosensitivity, malar rash (butterfly shaped rash around bridge of nose and cheeks), alopecia, blurred vision, pleuritic pain, anorexia, weight loss, depression, joint pain, swelling, tenderness.
Patient Education in Systemic Lupus Erythematous (SLE) Photosensitivity is common and can cause further complications. Suggest walks in the evening. Use soft toothbrush, as there is a risk for bleeding. Avoid crowds as they are immunocompromised. Allow rest periods to prevent fatigue
Education for Nurses in Systemic Lupus Erythematous (SLE) Provide rest periods to prevent fatigue, creatinine should be monitored to watch for nephritis and neuron damage. Antibodies are produced by B cells. Anti-smith antibody (Anti-Sm) test is used to diagnose. Oral contraceptives can exacerbate lupus. Corticosteroid education about osteoporosis is needed
Corticosteroid Therapy Can be used for severe exacerbations but should not be used long-term. Patients should be educated to report signs of infection, increase calcium in the diet, yearly eye exams are needed, may need to increase dose in times of stress, DO NOT stop abruptly.
Monoclonal Antibodies Decreases Disease Activity by halting production of antibodies
Antimalarial Agents Hydroxychloroquine may be used to treat fatigue and skin/joint problems. However, long-term use may cause retinopathy
Immunosuppressive Agents Such as azathioprine or cyclophosphamide, methotrexate
NSAIDs Used to treat polyarthralgia, (musculoskeletal manifestations), monitor for GI and renal side effects
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