pn 141 test 1 book: med surg nursing pg 1060
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| def of RA | a chronic, systemic inflammatory disorder that primarily affects the joints
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| does is affect women more then men or men more then women | women more then men
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| at what age does it usually develop | between age 30 -50
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| it has periods of remission followed by ________ | exacerbations
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| it is an autoimmune disorder, what is the cause | unknown
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| what do the T lumphocytes (tcells) do? | they migrate to the joint and infiltrate the synovial membrane, causing an immune resonse
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| what is produced when the immune response is initiated | IgG immunoglobulin
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| 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)
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| the rheumatoid factor bind with what to form immune complexes | the IgG
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| 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
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| the distruction of joint tissue causes what | inflammation
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| what are s/s of inflames joints | they are swollen red and painful
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| what is pannus | vascular granulation tissue (new blood vessels), in the synovial membrane- it destroys joint tissue
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| is RA systemic | Yes - it effects other tissues along with joint
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| systemic s/s | anorexia, weight loss, and nonspecific aching and sitffness, fatigue, anemia, low grade fever, rheumatoid nodules
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| do joint manifestations develop slowly or fastly | slowly
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| 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,
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| are multiple joint effected or just one | usually multiple joints
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| def of polyarticular | involving multiple joints
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| are joints effected symetrically yes or no | yes
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| def of swan neck deformity | flexion of DIP joint with hyperextension of PIP joints
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| def of boutonnieres deformity | hyperextension of DIP joint with flexion of PIP joint
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| what are rheumatoid nodules | firm subcutaneous tissue nodules over elbow, MCP joints, toes
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| when does pain occur and how long does it last | occur in the morning and lasts more than an hour
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| what are the primary complcations of RA | destruction of effected joints and problems of immobility
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| three complications of pt with severe RA | vasculitis, pleuritis, pericarditis
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| def of vasculitis | blood vessel inflamation
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| what is the Dx based on | H & P, diagnostic tests
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| can it be cured | no
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| what are Treatment goals for RA | relieve s/s, stop or reduce joint destruction, and maintain function
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| diagnostic tests: what is the Rheumatoid factor? | it will be present in most people with RA
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| diagnostic tests: what will the ESR be | typically it is elevated
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| diagnostic tests: why is an xray done, and where | at the effected joints and is done to show characteristic joint changes of the disease
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| rest: when is it needed | during acute flare ups (both joint and total body rest)
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| why does splinting inflamed joints help | to provide local joint rest
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| why is physical therapy and exercise done | to maintain muscle strength and joint mobility
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| Why should ROm be done | to maintain joint function and prevent contractures
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| meds: why are NSAIDS and aspirin given | to reduce inflammation
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| meds: why are corticosteroids used | to reduce acute pain and inflammation
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| meds: what do dmards do | they alter the disease course and reduce obstruction
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| meds: why are immunosuppressants used | to manage RA when the disease is aggressive or unresponsive to other meds
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| meds: what is the most commonly used immunosuppresant | methotrexate
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| 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.
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| meds- aspirin: what is a good daily dose for anti inflamatory effects | 2.6-4.8 G/day
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| meds- aspirin: nursing implications | assess for contraindications (allergies, bleeding disorders), stop drug if rash,hives, or signs of gastrointestinal bleeding develop
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| meds- aspirin: administration | give crushed or whole with food or milk to prevent gastric irratation
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| 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
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| meds- aspirin: why shouldn't the pt take alcohol with aspirin | it greatly increases the risk for gastrointestinal bleeding
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| meds- other NSAIDS: names | ibuprophin (motrin), Naprixin (anaprox), tolmetin (Tolectin)
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| meds- other NSAIDS: what do they do | used to manage arthritis and other causes of inflamation, they all inhibit prastaglandin synthesis reducing inflammation.
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| meds- other NSAIDS: administration | give with food or milk to minimize gastric effect
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| meds- other NSAIDS: nursing implications | obtain baseline weight and VS, carefully monitor elderly or pt with reduced kidney function for toxicity
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| 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
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| meds- second generation NSAIDS- COX-2 inhibitors: names | celecoxib (celebrex), rofecoxib (vioxx)
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| meds- second generation NSAIDS- COX-2 inhibitors: what do they do | they are NSAIDS that suppress inflammation and pain
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| 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
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| meds- second generation NSAIDS- COX-2 inhibitors: client teaching | notify doctor of tarry stools, rash edema, or unexplained weight gain
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| Surgery: why is it done | to relieve pain and repair or replace joints damaged by RA
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| Surgery: what is arthrodesis; why is it done | joint fusion; used to stabilize joints
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| Surgery: why is arthroplasty done | for cases of gross deformity and joint destruction
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| what is plasmapherisis | used to remove circulating antibodies , moderating the autoimmune response
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| what is total lymphoid irradiation | it decreases the total lymphocyte levels
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| 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)
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| what magor joints are effect | hands wrist, feet
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| what is the goal | keep pt out of exasterbations
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| med: methotrexate (rheumatrex): use | RA ( slow disease, decrease joint damage, prevent deformities)
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| med: methotrexate (rheumatrex): adverse reactions | N, stomatitis, alopecia
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| med: methotrexate (rheumatrex): action | it immunosuppresses the body which in turn decreases the body's autoimmune response
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| med: methotrexate (rheumatrex): what does it increase the risk for | infections, b/c immunity is suppressed
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| med: methotrexate (rheumatrex): s/s of infection | increased temp and WBC, more fatigue
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| what time of day is pain the worse | in the AM for >1 hour
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| when are steroids used | when in exasterbation
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| what is a normal BS while on steroids | around 200 mg/dL
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| 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
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| vit D- how much should be given daily | 800-3,00 untis day
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| calcium: should calcium corbenate (TUMS) be given with or w/out food | with food b/c it is an ant acid
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| calcium: should calcium citrate be given with or without food | w/ out food
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| does temp increase or decrease in flair up | it increases
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| when should RA pt begin to take DMARDS | ASAP
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| do DMARDS work immediately | no, thakes a while so bridge with anti-inflamatories
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| med- methotrexate: how long does it take for it to work | 3-6 weeks
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| med: plaquenil (Hydroxyxhloroquine): use | RA and LUpes, antimalarial
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| med: plaquenil (Hydroxyxhloroquine): class | DMARDS
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| med: plaquenil (Hydroxyxhloroquine): adverse reactions | irritability nervousness, retinal and corneal changes, anorexia, N/V,
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| med: plaquenil (Hydroxyxhloroquine): what type of exam should be done periodically with this drug | and eye exam
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| med: TNF blockers: what are they | cancers meds used for more severe s/s of RA
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