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