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Rheumatoid Arthritis
Auto Immune Disease Chronic 2
| Question | Answer |
|---|---|
| Pathophysiology of Rheumatoid Arthirtis | From longterm exposure to unknown antigen, genetically. They target synovial membranes, Then leukocytes- go to area and degrade synovial tissues and cartilage. Immune response is↑, |
| Rheumatoid Factors | Antibodies that present in RA |
| Pannus | An abnormal tissue layer that includes new formed blood vessels, that may develop within the synovial membrane, leading to greater loss of bone and cartilage. This leads to scar tissue. |
| Risk Factors for RA | Family HX, smoking, obesity, physical, emotional trauma, air pollution, insecticides, and occupational exposure, |
| Manifastations | Elderly- hard to distinguish between osteoarthritis and RA. redness, warmth, pain welling and deformities, ↓appetite, fever, fatigue, anemia, sleep patterns, quality of life, emotional. |
| Swan Neck Deformity | Hyperextension of the PIP joints, Boutonniere Deformity |
| Respiratory | pleural disease, interstitial fibrosis, pneumonitis |
| Cardiovascular | Vasculitis, Pericarditis |
| Metabolic | Fatigue, weakness, anorexia, weight loss, ↓ fever |
| Integumentary | Rheumatoid Nodules |
| Exocrine | Dry eyes/mouth |
| Musculoskeletal | joint swelling, redness, warmth, pain, tenderness, morning stiffness, cervical pain, neuro. , limited ROM, Deformity, carpal tunnel syndrome, Ulnar deviation, swam-neck deform, joint effusion (Fluid in joint area) unstable, pain from moving |
| Concept of RA | Immunity |
| Interrelated Concepts | Confort, Pain, Clotting |
| Typical Age Ranges | 40-60 . |
| Epstein Barr Virus | Highest link between that and RA |
| Genetics | 50% RISK, 60% with the disease have Human Leukocyte Antigen (HLA)-DR4 |
| Assessment: Noticing | Look for signs; joint swelling, pain, warmth, deformity . Also look for fever, anorexia, fatigue Psychosocial, Labs- RA factor, antinuclear-antibody titer, ESR, serum complement, serum protein, immunoglobulins, CT, Xray, arthrocentesis, bone scan |
| Most Commonly Effected | Hands and Feet |
| Not limited to Joints | Anemia, multisystem effects, Can have periods of remission |
| Complications | weight loss, fever, fatigue, periods of exacerbations, subQ nodules, Resp. & cardiac complications, Vasculitis (inflammation of the blood vessels), periungual (lesions on finger/toenails), paresthesia (burning hands/feet) |
| Associated Syndromes | Sjogren's Syndrome (dry eyes/mouth) Felty's Syndrome Caplan's Syndrome |
| Analysis: Interpreting | Chronic Inflammation,↓ mobility, potential for↓self-esteem |
| Planning and Implementation: Responding | Management of chronic inflammation and pain by meds, and supplements |
| Pharm Therapy | DMARDS- disease modifying anti-rheumatic drugs (methotrexate), NSAIDS, BRMS- biological response modifiers (Humara- helps with↓signals of inflammation. |
| Other Pharm Therapy | Glucocorticoids, immunosuppressive agents, Supplements- calcium, omega 3, linolenic acid, WATCH for kidney stones from calcium, omega 3- can interfere with clotting |
| Non Pharm Interventions | Rest, proper positioning, ice/heat, plasmapheresis (helps with↑ levels of CRP, surgery, complementary and integrative therapies, promotion of self-care, management of fatigue,↑body image . Hydrotherapy |
| Promote Mobility | Independence- adaptive devices, splints/braces, walkers/canes wheelchair, Encourage movement . Combat Fatigue- physical therapy, conserving energy |
| Juvenile Idiopathic Arthritis | Unknown Cause in children, Inflammation lasting longer than 6 weeks, and one or more joints. Dx ↓ 16 |
| Pathophysiology JIA | unknown but thought to have a autoimmune link joint inflammation that leads to scar tissue and limited ROM. Altered growth of the epiphyseal plates |
| Incidence of JIA | onset between 3-6 years of age & around puberty. occurs more often in males than females. 1-1000 kids in the US |
| Manifestations of JIA | Symptoms- fever, rash, lymphadenopathy (swollen lymph nodes), Splenomegaly/Hepatomegaly (enlarged spleen/liver), Joints-↓ mobility, swelling, pain, gait differences |
| Tests for JIA | No definitive confirmation for it, ESR and CRP are beneficial for determining amount of inflammation; RA, ANA X-rays, r/o other causes (fractures) Monitor joint damage and bone development |
| Treatment:Planning | Control Inflammation (also pain), Pain, Preserve function, Prevention of deformities, Remission, ↓side effects of disease, splints for promoting bone growth |
| Pharm Therapy for JIA | NSIADS -(↓inflammation/pain), Ibuprofen, naproxen, Indomethacin, Meloxicam DMARD- methotrexate Steroids- Prednisone, methylprednisone |
| Nursing Care | Promote mobility, ROM with Stretching/hydrotherapy Encourage adequate nutrition Educate the PT |
Created by:
harley_chevy_girl