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NUR 211
RA
Question | Answer |
---|---|
what differentiates RA from osteoarthritis | RA is autoimmune |
what part of the body do rheumatoid factors typically attack | synovium |
what happens when synovium thickens? | synovial fluid accumulates and pannus forms |
what is a pannus | an abnormal tissue layer that includes newly formed blood vessels |
what does a pannus cause | scar tissue formation, cartilage erosion ,and bone destruction |
Is RA more likely in men or women? | 3x more likely in women |
age onset of RA | 30-50 y/o |
risk factors for RA | family history, presence of genetic markers, heavy smokers, obesity, physical/ emotional trauma, environmental exposure to mineral oil/ silica, insecticides, air pollution |
what are the s/s of RA? (think RHEUM PAINS) | R-really fatigued,weak H-heat to the touch E-effed up joints U-unusually large lymphs M-multiple joints affected P-pain, continuous A-low grade fever I-inflammation N-nodules/ effusion (joint swell) S-symmetrical sx,sunrise stiffness |
What are rheumatoid nodules? | firm, non tender, moveable masses over extensor surfaces of joints (bony prominences like fingers) |
What is Sjogren's syndrome? | diminished lacrimal and salivary gland secretion (dry eyes, dry mouth, vagina) |
What is felty syndrome? | an inflammatory eye disorder that includes: RA, splenomegaly, lymphadenopathy, pulmonary disease, and blood dyscrasias |
What are the complications of RA? (think CLIPSS) | C- contractures L- limitations in function I- increased risk of heart disease (pericarditis) P- pleural effusions S- soft tissue deformities S- side effects of medications (immunosuppressants) |
Why would a pt with RA experience a pleural effusion? | substances get deposited in the lungs experience painful breathing problems |
what does fibrotic lung disease cause? | stiffness in the lungs/ makes it hard to breathe |
what is uveitis | inflammation of the middle layer of the eye; most commonly a complication of JIA |
Pt education for uveitis | frequent eye exams |
why are RA patients at increased risk for heart disease? | 1. chronic inflammation/ pericarditis/ HTN 2. damaging side effects of methotrexate and steroids on coronary vessels |
how does chronic inflammation increase the risk for heart disease? | thought to accelerate the progression of atherosclerosis |
Will the erythrocyte sedimentation rate (ESR) of someone with RA be normal, high or low? | high, elevated ESR indicates inflammation |
What is anti- cyclic citrullinated peptide (anti-CCP)? | autoantibodies only seen in RA (most definitive blood test); can detect disease before symptoms occur |
What is C- reactive protein? | inflammatory marker highly sensitive (Better indication than ESR) |
What color should normal synovial fluid be? | straw colored or clear |
what will an arthrocentesis show with RA? | aspiration of synovial fluid will show increased turbidity (cloudiness), decreased viscosity, and increased protein and WBC levels. |
What will an xray show in person with RA? | narrow joint space, destruction of articular cartilage |
During an exacerbation of RA what medication might be given to the patient? | IV or oral corticosteroids |
what NSAIDs are often utilized in RA? What are the side effects? | COX2 (celecoxib), ibu sometimes to in adjunct. ASA GI upset/bleeding/ulcers Cardiac problems (from cox2) Nephrotoxicity |
contraindication for NSAIDS | renal impairment |
what is typically administered with NSAIDS/ COX2 inhibitors | PPIs to prevent gastric issues |
what drug is the combination of Misoprostol (PPI) and Diclofenac (NSAID) | Arthrotec |
what should be avoid with arthrotec | pts with renal impairment because it contains an NSAID |
long term side effects of corticosteroids | -fatality if stopped suddenly -infection risk -adrenal gland hormone suppression -cataracts -hyperglycemia -osteoporosis -bruising/thin skin |
What is the DMARD drug of choice for aggressive sx tx? | methotrexate (rheumatrex) |
what are the other 4 DMARD choices? (other than methotrexate) | Gold salts/compounds Sulfasalazine (Azulfidine) Hydroxychloroquine (Plaquenil) Tumor necrosis factor inhibitors (TNF) |
What are the side effects of methotrexate (rheumatrex)? (think Bone GaS) | Bone marrow suppression (w/⇣ WBCs & Plts) GI irritation Stomatitis |
What do you need to monitor for in a pt on methotrexate? | Anemia, infection, bleeding, bruising Increases liver enzymes and Cr. levels Monitor for hepatotoxicity and seizures |
What should be avoided while taking methotrexate? | alcohol and pregnancy |
What dietary supplement is good to take while on methotrexate? why? | folic acid (folicanic rescue) ⇡ RBC production |
Pt education for Hydroxychloroquine (Plaquenil) | high risk of eye injury; need vision exams every 6 months |
Gold salts toxicity s/s | dermatitis/ stomatitis bone marrow suppression proteinuria |
what are the Tumor necrosis factor inhibitors (3)? | etanercept (enbrel) infliximab (Remicabe) adalimumab (Humira) |
intended effect of adalimumab (humira) | reduction of inflammatory events; slows progression of joint damage |
pt education for adalimumab (humira) | cannot be taken with acute on chronic infection; must be tested for TB prior to taking |
What are some good non-pharm management techniques of RA? | -balance rest and isotonic/ROM exercise- walking, swimming -moist heat (pain) and cold( swelling) -Omega 3 fatty acids/fish oils (⇣ inflammation) -adequate nutrition (vits (ca/vit) & pro) -PT and OT for assistive devices |
What is a swans neck deviation? | finger looks like a swans neck |
When would a pt with RA have a low grade fever? | during flares and exacerbations |
what is iron resistant anemia? is this an early or late sx? | RBC ⇣, iron doesn’t help because bone marrow cannot produce enough healthy RBCs Typically late manifestation |
what body exam is important for people with JIA to have done frequently? how often? ***** | eye exams q 3-6mos |
complications of JIA | Chronic uveitis (=EYE EXAMS) Interference with normal growth d/t contractures and effusions |
what are the three types of juvenile idiopathic arthritis | -pauciarticular arthritis -systemic arthritis -polyarticular arthritis |
when is uveitis most common in JIA | in polyarticular arthritis |
how can you differentiate the three types of JIA | -pauciarticular arthritis (PAUCI = a few joints) -systemic arthritis (SYSTEMIC = in the vasculature) -polyarticular arthritis (POLY = many joints >5) |
what are the considerations for RA during pregancy? | -Experience remission during and then relapse -Meds to tx may cause risk to fetus -May have prolonged preg |
What are the side effects of sulfasalazine? what are the implications with these SEs? | sulfa taste, bloating/gas, stomach discomfort monitor CBC/WBC frequently, watch for cross allergy to sulfa products and ASA |
what med is used to tx JIA? what is a deadly complication? what are contraindications? | ASA reyes disease/syndrome varicella/flu like sx |