NUR 216F 20

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Author:
TomWruble
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250170
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NUR 216F 20
Updated:
2013-12-02 22:22:42
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Care Patients Arthritis Other Connective Tissue Diseases
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Care of Patients with Arthritis and Other Connective Tissue Diseases
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  1. A most common connective tissue disease and the most destructive to the joints
    Rheumatoid Arthritis

    Autoantibodies (rheumatoid factors) formed that attack healthy tissue
  2. Heberden’s Nodes
    Inflammation of the first joint of the fingers
  3. erythrocyte sedimentation rate
    a non-specific measure of inflammation, a lab value indicator for arthritis.

    When an inflammatory process is present, the high proportion of fibrinogen in the blood causes red blood cells to stick to each other. The red cells form stacks called 'rouleaux,' which settle faster.
  4. C-reactive protein
    is an acute phase protein produced by the liver during an inflammatory reaction (arthritis). Since C-reactive protein levels in the blood rise more quickly after the inflammatory or infective process begins, ESR is often replaced with C-reactive protein measurement. There are specific drawbacks, so BOTH are used.
  5. Pain management for arthritis
    Pain control may be accomplished at home with drug and nonpharmacologic measures.

    Surgery may be performed to reduce pain. Comprehensive pain assessment should be performed before and after implementing interventions

    Rest, positioning, thermal modalities, weight control, TENS, complementary and alternative therapies, stem cell therapy Surgical management
  6. RA Physical assessment/clinical manifestations: Early
    joint stiffness, swelling, pain, fatigue, generalized weakness
  7. RA Physical assessment/clinical manifestations: Late
    joints become progressively inflamed and quite painful
  8. RA Systemic Complications
    • Weight loss
    • fever
    • extreme fatigue
    • Exacerbations
    • Subcutaneous nodules
    • Respiratory
    • cardiac complications
    • Vasculitis
    • Periungual (fingernail...) lesions
    • Paresthesias - tingling, tickling, prickling
  9. Sjögren’s syndrome
    a systemic autoimmune disease in which immune cells attack and destroy the exocrine glands that produce tears and saliva
  10. Felty’s syndrome
    is characterized by an abnormally enlarged spleen (splenomegaly) and abnormally low levels of certain white blood cells (neutropenia) in addition to RA.
  11. Caplan’s syndrome
    is a combination of rheumatoid arthritis (RA) and pneumoconiosis that manifests as intrapulmonary nodules, which appear homogenous and well-defined on chest X-ray.
  12. RA Lab assessments...
    • rheumatoid factor
    • antinuclear antibody titer
    • ESR
    • serum complement (C3 & C4)
    • serum protein electrophoresis
    • serum immunoglobulins

    Thrombocytosis (high platelet count) can occur with late RA
  13. R788 (fostamatinib disodium), a AAA, for Tx of RA did not pass a 3-month study
    syk kinase inhibitor
  14. AAA refers to inflammation of the serous tissues of the body, the tissues lining the lungs (pleura), heart (pericardium), and the inner lining of the abdomen (peritoneum) and organs within.
    Serositis
  15. CREST Syndrome
    • C—calcinosis
    • R—Raynaud’s phenomenon
    • E—esophageal dysmotility
    • S—sclerodactyly
    • T—telangiectasia

    —Hands and forearm edema with bilateral carpal tunnel syndrome usually first symptoms to occur
  16. a systemic disease in which urate crystals deposit in the joints and other body tissues, causing inflammation
    Gout or gouty arthritis
  17. Gout Interventions
    • Drug therapy
    • Nutrition therapy
    • —Limit proteins
    • —Avoid trigger foods
    • —Plenty of fluids
    • —pH increased with alkaline foods—
    • Low purine diet
  18. Fibromyalgia Syndrome
    Chronic pain syndrome, not an inflammatory disease

    Pain typically located at trigger points

    Physical therapy treatment

    Drug therapy with NSAIDs

    Muscle relaxants

    Home exercises, including walking, swimming, rowing, biking, and water exercise
  19. The patient is a 63-year-old woman admitted to the acute medical care unit. She is 5’4” and weighs 211 lb. Her medical history includes hypertension and GERD. On admission, she reports pain in her hands and joints that is unrelieved by OTC medications.

    What additional assessment data should you collect from the patient at this time?
    Based on her age and reports of pain, the patient is most likely experiencing osteoarthritis, which may be precipitated by her weight. It is important to know when the pain started, and she should be asked to rate her pain on a 0-10 scale. Which OTC medications has she taken? How long has she experienced this pain? Does she have a family history?
  20. A nursing assistant (NA) is assigned to care for a client who has a CPM machine in place after a total knee arthroplasty. Which statement by the NA indicates a need for further teaching and supervision by the nurse?

    A. “I will turn off the machine if the client has any pain.”
    B. “I will store the machine on a chair when not used.”
    C. “I will check to make sure the client’s leg is correctly placed.”
    D. “I will turn off the machine when the client eats.”
    A. “I will turn off the machine if the client has any pain.”

    The movement of the knee after surgery may cause the client pain. The nurse should administer pain medications to assist with the discomfort while the client is using the device.

    The nurse or NA should turn off the CPM machine while the client is having a meal in bed.

    When the machine is not in use, it should not be stored on the floor.

    The nurse or NA should ensure that the joint being moved is properly positioned on the machine.
    (this multiple choice question has been scrambled)
  21. Which assessment findings will the nurse expect for the client with late-stage rheumatoid arthritis? Select all that apply.

    A. Heberden’s nodes
    B. High erythrocyte sedimentation rate (ESR) values
    C. Positive antinuclear antibody (ANA) titer
    D. Subcutaneous nodules
    E. Anemia
    F. Red, swollen joints
    B, C, D, E and F

    Heberden’s nodes are commonly seen in osteoarthritis.
  22. What health teaching by the nurse is the most important for clients diagnosed with discoid lupus erythematosus and managing the disease using topical steroid cream?

    A. “Take calcium supplements to prevent osteoporosis from the steroid.”
    B. “Use heavy powder makeup to cover skin lesions.”
    C. “Stay away from crowds and people with infections.”
    D. “Avoid being in the sun to prevent disease flare-ups.”
    D. “Avoid being in the sun to prevent disease flare-ups.”

    a chronic skin condition of sores with inflammation

    Teach clients techniques to protect the skin. Instruct clients to avoid prolonged exposure to sunlight and other forms of ultraviolet lighting, including certain types of fluorescent light. Remind them to wear long sleeves and a large-brimmed hat when outdoors. Clients should use sun-blocking agents with a sun protection factor (SPF) of 30 or higher on exposed skin surfaces.

    Side effects from topical steroid creams include thin skin, red lesions, and acne.

    Immunosuppression and calcium loss are associated with oral, not topical, steroids. Excess powder and other drying substances should be avoided; cosmetics must be carefully selected.
    (this multiple choice question has been scrambled)
  23. gout - Mx?
    Allopurinol (Zyloprim)
  24. Osteoarthritis - Mx?
    celecoxib (Celebrex)
  25. Acute gout - Mx?
    colchicine (Colsalide)
  26. Systemic lupus erythematosus - Mx?
    prednisone (Deltasone)
  27. AAA are hard, bony outgrowths or gelatinous cysts on the proximal interphalangeal joints (the middle joints of fingers or toes.) They are a sign of either osteoarthritis or Rheumatoid arthritis. Seen commonly in osteoarthritis, they are caused by formation of calcific spurs of the articular (joint) cartilage. Not often seen in Rheumatoid arthritis, they are caused by antibody deposition to the synovium. Bouchard's nodes are comparable in presentation to Heberden's nodes, similar osteoarthritic growths on the distal interphalangeal joints, but are significantly less common.
    A) Bouchard's nodes
  28. A 52-year-old woman with RAhas been controlled with methotrexate and Celebrex for 10 years. Recently she has experienced increased joint pain and swelling and rheumatologist plans to add adalimumab (Humira) to her drug regimen. Issues:
    1) before starting Humira, coverage by this patient’s insurance company will need to be explored.

    2) Serious infections have occurred in people taking Humira, including tuberculosis and infections caused by viruses, fungi, or bacteria that have spread throughout the body. Determine whether the patient has had a recent negative purified protein derivative (PPD) test. If not, a PPD skin test is typically administered and the selected BRM is not started until the results are known to be negative. Collaborate with the health care provider to ensure that this process is complete.

    3) What health teaching will she need before starting Humira?The signs and symptoms of an allergic reaction should be reviewed (rash, swollen face, difficulty breathing), with the patient told to seek emergency care immediately if these occur. Injection site reactions (e.g., redness, rash, swelling, itching, and bruising) may occur but are usually mild and transient. Apply a towel soaked with cold water to the injection site if it hurts or remains swollen. Call the provider immediately if the reaction does not disappear or seems to worsen. Tuberculosis may occur during adalimumab therapy. Report persistent cough, wasting or weight loss, and low-grade fever to the provider. The patient must be taught to recognize evidence of infection and bleeding disorders and to tell the provider if they occur; the drug may need to be stopped. Avoid people with infections and keep follow-up appointments for all prescribed laboratory tests.
  29. The nurse is developing a teaching plan for a client diagnosed with osteoarthritis (OA). The nurse plans to include which instructions in the teaching plan?

    A .Begin a running program.
    B. Take up knitting to slow down joint degeneration.
    C. Eat at least two cups of yogurt per day.
    D. Wear supportive shoes.
    D. Wear supportive shoes.

    Wearing supportive shoes will help to prevent falls and damage to foot joints, especially metatarsal joints.

    No one food can cure OA. A well-balanced diet is recommended.

    Repetitive stress activities such as knitting or typing should be avoided for prolonged periods.
  30. The client diagnosed with rheumatoid arthritis (RA) is started on methotrexate (Rheumatrex). Which statement made by the client indicates to the nurse that further teaching is needed regarding drug therapy?

    A. "Drinking alcoholic beverages should be avoided."
    B. "The health care provider should be notified 3 months before a planned pregnancy."
    C. "Rheumatrex should be taken at mealtimes."
    D. "I will avoid any live vaccines."
    C. "Rheumatrex should be taken at mealtimes."

    Rheumatrex should be taken 1 hour before or 2 hours after a meal to prevent vomiting

    Alcoholic beverages increase the risk for hepatotoxicity

    Strict birth control is recommended for any client of childbearing age because of the possibility of birth defects

    Severe reactions may occur when live vaccines are given because of the immunosuppressive effect of Rheumatrex
    (this multiple choice question has been scrambled)
  31. Which instructions for joint protection will the nurse recommend for the client with a connective tissue disease?
    The doorknob should be turned counterclockwise to avoid twisting an arm and promoting ulnar deviation.

    I suppose this assumes you are right-handed, and if you were left-handed you would want to turn it clockwise to achieve the same "motion" as a right-handed counterclockwise turner. 
  32. Lyme Disease Notes:
    Burning a tick could spread infection. Flushing it down the toilet is the recommended disposal method

    If bitten, testing is not reliable until 4 to 6 weeks later
  33. The client who recently has had a total hip arthroplasty is preparing for discharge from the hospital. Which information is most important for the nurse to provide to the client and caregiver?

    A. Reorient frequently.
    B. Avoid using a straight razor.
    C. Keep heels off the bed.
    D. Use an abduction pillow between the legs.
    B. Avoid using a straight razor.

    The client will be on anticoagulants for 4 to 6 weeks at home and should avoid any injury to the skin, including when shaving.

    Abduction pillow is usually done immediately after surgery, especially if the client is confused or restless and cannot maintain proper joint positioning.

    Ther other two are in-hospital, post-op, not at home.
    (this multiple choice question has been scrambled)
  34. T/F: "RA is inflammatory. OA is degenerative."
    True
  35. T/F: "The risk factors or causes of RA are probably autoimmune, whereas OA may be caused by age, obesity, trauma, or occupation."
    True
  36. T/F: "The typical onset of RA is seen between 35 and 45 years of age, whereas the typical onset of OA is seen in clients older than 60 years."
    True
  37. T/F: "The disease pattern of RA is usually unilateral and is seen in a single joint, whereas OA is usually bilateral and symmetric, and is noted in multiple joints."
    False: OA is unilateral and usually affects a single joint, whereas RA is bilateral and affects multiple joints
  38. Positive total antinuclear antibody (ANA) elevations are common in AAA, BBB and CCC.
    • A) systemic lupus erythematosus (SLE)
    • B) systemic sclerosis (SSc)
    • C) RA.
  39. The nurse is caring for a postoperative client with a total joint arthroplasty. What actions will the nurse take to prevent venous thromboembolism (VTE) postoperatively? Select all that apply.

    A. Massage the legs.
    B. Keep the legs slightly abducted.
    C. Use the knee gatch on the bed.
    D. Apply elastic stockings.
    E. Administer anticoagulants.
    D and E

    Legs are kept slightly abducted to prevent adduction not VTE

    Using the knee gatch can constrict circulation in the popliteal area and should be avoided
  40. Before administering prednisone IV push to the middle-aged adult with rheumatoid arthritis (RA), the nurse notes that the client's random Accu-Chek is 139. Which action is most important for the nurse to take?

    A. Review the client's antinuclear antibody (ANA) level.
    B. Notify the health care provider of the random Accu-Chek result.
    C. Instruct the client to drink diet soda to prevent elevation of blood sugar.
    D. Administer the prescribed prednisone on schedule.
    D. Administer the prescribed prednisone on schedule.

    Accu-Cheks are performed and parameters are set as to when the health care provider should be notified, but usually this is done only if the random Accu-Chek is greater than 150.

    For this client, giving the medication per schedule is essential in treating the disease.

    The client's ANA is elevated because of the RA.
    (this multiple choice question has been scrambled)
  41. Before administering low-molecular weight heparin (LMWH) to the older adult client after total knee arthroplasty, the nurse notes that the client's platelet count is 50,000/mm3. What action is most important for the nurse to take?

    A. Administer the prescribed LMWH on schedule.
    B. Notify the health care provider of the platelet count.
    C. Assess the international normalized ratio (INR).
    D. Assess the activated partial thromboplastin time (aPTT).
    B. Notify the health care provider of the platelet count.

    If the platelet count falls below 20,000/mm3, spontaneous bleeding could occur. Notifying the health care provider before the LMWH is given is essential.
    (this multiple choice question has been scrambled)
  42. The client diagnosed with exacerbation of systemic sclerosis (SSc) asks the nurse why a foot board and a bed cradle have been placed on the bed. The nurse explains that the foot board and the bed cradle are used for what purpose?

    A. To inspect skin for lesions or changes
    B. To prevent foot drop and contractures
    C. To promote comfort from Raynaud's phenomenon
    D. To decrease chilling of the extremities
    C. To promote comfort from Raynaud's phenomenon

    Acute pain occurs during Raynaud's phenomenon (the first symptom that occurs with SSc), and avoiding pressure from bed linens is a comfort measure.
    (this multiple choice question has been scrambled)
  43. In teaching the client with acute secondary gout, which instruction about preventing recurrence is most important for the nurse to include?

    A. "Discuss with your health care provider about having your estrogen and progesterone levels checked to see where you are in menopause."
    B. "Weight Watchers has healthy meal plans."
    C. " Limit your intake of fruits and vegetables."
    D. "Limit fluid intake to 1500 mL/day."
    B. "Weight Watchers has healthy meal plans."

    Crash diets and obesity are causes of secondary gout. Avoiding crash diets and keeping fit will prevent recurrence.

    Eating plenty of fruits and vegetables should be encouraged because they are low in purines.

    Fluids dilute urine and prevent the formation of urinary stones.

    Primary gout affects postmenopausal women.
    (this multiple choice question has been scrambled)
  44. Sjögren's syndrome. The nurse anticipates that the client will have which common condition?
    dry eyes (keratoconjunctivitis [KCS])

    dry mouth is commonly described.
  45. The nurse is reviewing the medication history for a client diagnosed with rheumatoid arthritis who has been ordered to start sulfasalazine (Azulfidine) therapy? The nurse plans to contact the health care provider if the client has which condition?

    A. Hypertension
    B. Glaucoma
    C. Hypothyroidism
    D. Sulfa allergy
    D. Sulfa allergy

    Sulfasalazine (Azulfidine) contains sulfa and is contraindicated in clients with sulfa allergies.

    Dooooh!
    (this multiple choice question has been scrambled)

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