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Rheumatoid arthritis

pn 141 test 1 book: med surg nursing pg 1060

QuestionAnswer
def of RA a chronic, systemic inflammatory disorder that primarily affects the joints
does is affect women more then men or men more then women women more then men
at what age does it usually develop between age 30 -50
it has periods of remission followed by ________ exacerbations
it is an autoimmune disorder, what is the cause unknown
what do the T lumphocytes (tcells) do? they migrate to the joint and infiltrate the synovial membrane, causing an immune resonse
what is produced when the immune response is initiated IgG immunoglobulin
what does the body see as a foreign substance; what does it make inresponse to the foreign substance the IgG immunoglobulin; IgG immunoglobulin autoantibodies (aka rheumatoid factor)
the rheumatoid factor bind with what to form immune complexes the IgG
Because of this WBCs are atracted to the area; what do the WBCs do to the joint tissue they release enzymes that distroy the joint tissue
the distruction of joint tissue causes what inflammation
what are s/s of inflames joints they are swollen red and painful
what is pannus vascular granulation tissue (new blood vessels), in the synovial membrane- it destroys joint tissue
is RA systemic Yes - it effects other tissues along with joint
systemic s/s anorexia, weight loss, and nonspecific aching and sitffness, fatigue, anemia, low grade fever, rheumatoid nodules
do joint manifestations develop slowly or fastly slowly
s/s of joint involvement swelling, stiffness, warmth, tenderness, pain, limited ROm, morning stiffness, swan neck deformity, bautonnieres, ulnar deviation, carpel tunnel syndrome, hammer toe,
are multiple joint effected or just one usually multiple joints
def of polyarticular involving multiple joints
are joints effected symetrically yes or no yes
def of swan neck deformity flexion of DIP joint with hyperextension of PIP joints
def of boutonnieres deformity hyperextension of DIP joint with flexion of PIP joint
what are rheumatoid nodules firm subcutaneous tissue nodules over elbow, MCP joints, toes
when does pain occur and how long does it last occur in the morning and lasts more than an hour
what are the primary complcations of RA destruction of effected joints and problems of immobility
three complications of pt with severe RA vasculitis, pleuritis, pericarditis
def of vasculitis blood vessel inflamation
what is the Dx based on H & P, diagnostic tests
can it be cured no
what are Treatment goals for RA relieve s/s, stop or reduce joint destruction, and maintain function
diagnostic tests: what is the Rheumatoid factor? it will be present in most people with RA
diagnostic tests: what will the ESR be typically it is elevated
diagnostic tests: why is an xray done, and where at the effected joints and is done to show characteristic joint changes of the disease
rest: when is it needed during acute flare ups (both joint and total body rest)
why does splinting inflamed joints help to provide local joint rest
why is physical therapy and exercise done to maintain muscle strength and joint mobility
Why should ROm be done to maintain joint function and prevent contractures
meds: why are NSAIDS and aspirin given to reduce inflammation
meds: why are corticosteroids used to reduce acute pain and inflammation
meds: what do dmards do they alter the disease course and reduce obstruction
meds: why are immunosuppressants used to manage RA when the disease is aggressive or unresponsive to other meds
meds: what is the most commonly used immunosuppresant methotrexate
meds- aspirin: what does it do they inhibit prostaglandin synthesis and activity,reducing inflammation. It also has an analgesic and antipyretic effect. It inhibits platelet aggregation and normal blood blotting.
meds- aspirin: what is a good daily dose for anti inflamatory effects 2.6-4.8 G/day
meds- aspirin: nursing implications assess for contraindications (allergies, bleeding disorders), stop drug if rash,hives, or signs of gastrointestinal bleeding develop
meds- aspirin: administration give crushed or whole with food or milk to prevent gastric irratation
meds- aspirin: pt teaching always take with food or milk, do not substitute acetaminophen for aspirin because it doesn't have the antiinflamatory effect, report dark stools, vomiting of blood, abnormal bleeding, blurred vision, rashes, do not take alcohol with it
meds- aspirin: why shouldn't the pt take alcohol with aspirin it greatly increases the risk for gastrointestinal bleeding
meds- other NSAIDS: names ibuprophin (motrin), Naprixin (anaprox), tolmetin (Tolectin)
meds- other NSAIDS: what do they do used to manage arthritis and other causes of inflamation, they all inhibit prastaglandin synthesis reducing inflammation.
meds- other NSAIDS: administration give with food or milk to minimize gastric effect
meds- other NSAIDS: nursing implications obtain baseline weight and VS, carefully monitor elderly or pt with reduced kidney function for toxicity
meds- other NSAIDS: pt teaching taje as ordered to maintain constant blood levels, may take several weeks for full effect to occur, take with food or milk, weigh weekly, avoid aspirin and alcohol
meds- second generation NSAIDS- COX-2 inhibitors: names celecoxib (celebrex), rofecoxib (vioxx)
meds- second generation NSAIDS- COX-2 inhibitors: what do they do they are NSAIDS that suppress inflammation and pain
meds- second generation NSAIDS- COX-2 inhibitors: adminstration by mouth w/o regard to meals, take with full glass of water stay upright fot 15-30 minutes after taking
meds- second generation NSAIDS- COX-2 inhibitors: client teaching notify doctor of tarry stools, rash edema, or unexplained weight gain
Surgery: why is it done to relieve pain and repair or replace joints damaged by RA
Surgery: what is arthrodesis; why is it done joint fusion; used to stabilize joints
Surgery: why is arthroplasty done for cases of gross deformity and joint destruction
what is plasmapherisis used to remove circulating antibodies , moderating the autoimmune response
what is total lymphoid irradiation it decreases the total lymphocyte levels
what happens to the synovial fluid (synovium) it thickens and it builds up on the joints and the joints then fuse together (this is the pannus)
what magor joints are effect hands wrist, feet
what is the goal keep pt out of exasterbations
med: methotrexate (rheumatrex): use RA ( slow disease, decrease joint damage, prevent deformities)
med: methotrexate (rheumatrex): adverse reactions N, stomatitis, alopecia
med: methotrexate (rheumatrex): action it immunosuppresses the body which in turn decreases the body's autoimmune response
med: methotrexate (rheumatrex): what does it increase the risk for infections, b/c immunity is suppressed
med: methotrexate (rheumatrex): s/s of infection increased temp and WBC, more fatigue
what time of day is pain the worse in the AM for >1 hour
when are steroids used when in exasterbation
what is a normal BS while on steroids around 200 mg/dL
calcium supplement: why should no more than 600 mg be given at a time because that is all that can be absorbed in one day
vit D- how much should be given daily 800-3,00 untis day
calcium: should calcium corbenate (TUMS) be given with or w/out food with food b/c it is an ant acid
calcium: should calcium citrate be given with or without food w/ out food
does temp increase or decrease in flair up it increases
when should RA pt begin to take DMARDS ASAP
do DMARDS work immediately no, thakes a while so bridge with anti-inflamatories
med- methotrexate: how long does it take for it to work 3-6 weeks
med: plaquenil (Hydroxyxhloroquine): use RA and LUpes, antimalarial
med: plaquenil (Hydroxyxhloroquine): class DMARDS
med: plaquenil (Hydroxyxhloroquine): adverse reactions irritability nervousness, retinal and corneal changes, anorexia, N/V,
med: plaquenil (Hydroxyxhloroquine): what type of exam should be done periodically with this drug and eye exam
med: TNF blockers: what are they cancers meds used for more severe s/s of RA
Created by: jmkettel
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