Question | Answer |
S/S of RA | pain in the affected joint; morning stiffness that lasts more than an hour; weakness; fatigue; anorexia; muscle aches, atrophy and tenderess; swelling and pain that comes and goes; fluid on joints |
In RA, _______________ over bony nodules may be present. | rheumatoid nodules |
With RA, flexion _________ can occur. | contractures |
What organ of the body can be affected by RA? | any organ |
With RA, blood vessels may become inflamed, impairing blood flow to organs with possible: | ischemia or infarction of the organ. |
RA may produce inflmmatory changes in the tissues of the: | heart, lungs, kidneys and eyes. |
Pleural effusion and pulmonary fibrosis can lead to: | respiratory impairment, pulmonary HTN, and eventual heart failure |
Medical diagnosis of RA: | S/S along with elevated C-reactive protein levels and ESR |
Medical treatment of RA involves: | medicine, nursing, physical therapy, occupational therapy, and social services |
____________ makes for better results of treament of RA. | Early treatment |
Drugs that provide systemic relief for RA: | aspirin, NSAIDs, gold compounds, antimalarials or sulfasalazine, Cox-2 inhibitors (Celebrex and Vioxx), immunomodulatory agents, steroid injections (3 or 4 times a year) |
Other therapy for RA includes: | supportive treatments, rest, splinting of joints, orthotic devises, assistance in modifying ADL's (activities of daily living) |
Nursing Management of RA includes: | education (about disease and process and meds), pain relief, stress reduction, referral to OT/PT, splints, ROM exercises, nurtition |
Until adolescence, bone formation exceeds: | bone resorption |
Bone formation and resorption remains equal through your: | 20's |
Age at which bone resorption surpasses bone formation: | 30's |
Result of bone resorption happening more than bone formation: | loss of bone mass, making thept more susceptible to fractures |
Age related loss of bone mass without apparent underlying medical causes is called: | primary osteoporosis |
Loss of bone to factors such as hyperthyroidism, long term steroids, or Heparin is called: | secondary osteoporosis |
Levels of estrogen (which inhibits bone breakdown) is decreased in who? | menopausal women |
Greatest risk factors for osteoporosis are: | elderly women with small frame, white, fair skinned, blond or red hair |
S/S of osteoporosis | Back pain from fractures, fractures, loss of height due to vertebral compression, kyphosis or lordosis, poorly fitting dentures (because of lack of calcium and Vitamin D) |
Assessment findings with osteoporosis: | frequent complaint of lumbosacral pain, thoracic pain, or both (may be the result of tiny compression fractures in the vertebrae); pathologic fractures in the long bones (happends because of low-density bones or other bone disease) |
Diagnositic test that measures bone mineral density of the spine and hip: | DEXA |
Diagnostic test that measures heel density and provides baseline information for diagnosing osteoporosis and predicting risk of fractures: | Quantative Ultrasound |
What do post-menopausal women need to help bones? | calcium supplements, estrogen replacement, and Vitamin D (for calcium absorption) |
Drugs like __________ inhibit bone resorption (breakdown) without retarding mineralization. | Fosomax |
What exercise promotes strength of bones? | regular weight-bearing exercise |
Spinal compression fractures are caused when: | the spine press together and fracture. |
Spinal compression fractures are treated with: | percutanious vertebroplasty (when a needle is inserted into the vertebra and a special type of cement is injected) |
Percutanious vertebroplasty is minimally __________, risks are _________,and recovery time is ___________. | invasive; minimized; short |
Painful metabolic disorder involving an inlammatory reaction in the joints, usually affects the feet (esp the big toe), hands, elbows, and knees; it is characterized by the deposition of urate crystals in the joints. | Gout |
Gout is more prevalent among men of what age? | 40's and 50's |
Kidney stones develop in about what percentage of pts with gout? | 20% |
Primary hyperuricemia (uric acid in the blood) occurs from | severe dieting or starvation; excessive ingestion of purines (organ meats, shellfish, sardines); heredity |
Secondary hyperuricemia (uric acid in the blood) occurs from: | abnormal purine metabolism (when the protein is broken down, acid is produced); increased rate of protein synthesis with overprodction or under-excretion of uric acid; increased cellular turnover; altered renal tubular function |
Increased celluar turnover (that can be a secondary cause of gout) can be caused by these diseases: | leukemia, multiple myeloma and other cancers, some anemia, and psoriasis |
Altered renal tubular function can be related to: | use of diuretics and salicylates and excessive alcohol intake |
S/S of gout: | elevated blood uric aid level; severe crushing pain in one joint; hypersensivity to touch (cannot bear even the bedsheets); skin turns red and joint swells; may have tophi (deposits of sodium urate crystals under the skin) |
The onset of gout is _________ and usually occurs at __________. | abrupt; night |
A gout attack may last how long? | 1-2 weeks |
Repeated episodes of gout in the same joint may cause: | deformity of the joint |
Medical diagnosis of gout is determined by: | history and physical exam; elevated uric acid level (in blood and urine); x-rays; urate crystals in the synovial fluid |
Salt of uric acid crystalizes in the body tissue and deposits in soft and bony tissues. These deposits accumulate and produce a: | swollen, deformed appearance |
Drug that treats initial attack of gout and abort impending attacks: | colchicine |
Drugs used during asymptomatic periods to prevent uric acid synthesis: | Allopurinol, Probenecid, indomethacin, and sulfinapyrazone. |
When should Colchicine be discontinued and the doctor called? | if there is nausea, vomiting, or intestinal cramping. |
Diet for gout should be high in: | proteins and carbs (to increase urate excretion), low fat (fats retard urate excretion; low in purines |
Surgery may be performed to remove large _________ and correct ____________. | tophi; deformities |
Nursing care with gout - the extremity should be ___________. | elevated |
Nursing care with gout includes: | administering prescribed medications, using a bed cradle, encourage bed rest, sift urine for stones, do 24-hour urine exams |
Chronic, multisystem autoimmune disease that takes its name from the characteristic hardening of the skin: | progressive systemic sclerosis (also called scleroderma) |
Organs affected by scleroderma: | blood vessels, gastrointestinal tract, lungs, heart, kidneys |
Death can occur due to what with scleroderma? | infection, kidney or heart failure |
S/S of scleroderma | Raynaud's phenomenon; symmetric painless swelling or thickening of skin; taut and shiny skin; morning stiffness; frequent reflux or gastric acid; difficulty swallowing; weight loss; dypsnea; pericarditis; renal inusufficiency |
spasm of the digital arteries with blanching and numbness or pain in the fingers - causes variably red, white and blue fingers | Raynaud's phenomenon |
affects blood vessels in gastric area | frequent reflux of gastric acid |
inflammation of pericardium | pericarditis |
Medical diagnosis of scleroderma is made by: | positive ANA; elevated ESR; increased serum muscle enzyme levels |
Medical treatment of scleroderma: | high doses of steroids or other immunosuppressants; medical management of symptoms to prevent complications |
Cure for scleroderma: | has no cure |
An inflammation of the bursa | bursitis |
fluid filled sac that cushions bone ends to enhance a gliding movment | bursa |
What causes bursitis? (pathophysiology) | Most often result of trauma; infection, secondary effects of gout and RA |
common symptom of bursitis | pain and sweling with compromised function |
Assessing for bursitis: | Lump seen on x-ray. Aspiration reveals what fluid is composed of. |
Treatment for bursitis: | joint rest; salicylates or NSAIDs; corticosteroid may be injected into the joint; ROM exercise |
Chronic connective tissue disorder of the spine and surrounding cartilaginous joints. Causes progressive immobility and fixation of the joints (ankylosis) in the hips and ascends the vertebrae. | Ankylosing spondylitis |
Ankylosing spondylitis is also called: | Marie-Strumpell disease. |
Characteristics of ankylosing spondylitis are: | spondylosis and fusion of the vertibrae |
Ankylosing spondylitis usually begins at what age? | early adulthood |
AS is more common in ________. | men |
AS may be automimmune and have ___________ tendencies. | heredity |
In ankylosing spondylitis, respiratory function may be compromised if ___________ is present. | kyphosis |
In a few cases of ankylosing spondylitis, inflammation of _________ may occur. May also have ______________. | the aorta, iris, and ciliary body of the eye; pulmonary fibrosis |
S/S of ankylosing spondylitis: | low back pain and stiffness; spind and hip become immobile; lumbar curve may be flattened; neck may become permanently flexed; lung sounds may be reduced, especially in the apical areas; aortic regurgitation or AV node conduction problems |
Ankylosing spondylitis is diagnosed by: | Elevated ESR (indicates inflammation); negative culture of synovial fluid (autoimmune); elevated alkaline phosphatase and creatinine phosphokinase; x-rays and CT scan show erosion, ossification, and fusion of joints in spine and hip |
Ankylosing spondylitis is treated by: | administering prescribed meds: anti-inflammatory, Indomethacin (an NSAID), NSAIDs; mild exercise to reduce stiffness and pain; back brace; hip replacement |
Goal of treatment of ankylosing spondylitis: | to maintain functional posture |