Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
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 |
Created by:
ginnyfoscue
Popular Nursing sets