Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
70 Cards in this Set
- Front
- Back
OA is a disorder of the?
|
Diarthrodial (synovial) joints
|
|
True or False
OA is slowly progressive, non- inflammatory, and not systemic. |
True
|
|
What was OA previously known as? why was it changed?
|
- Degenerative joint disease
- Now known to involve the formation of new joint tissue in response to cartilage destruction |
|
What are the 2 types of OA? cause of each?
|
- Idiopathic OA: cause unknown
- Secondary: caused by a known event or condition |
|
What are the risk factors of OA?
|
- Growing older
- Gender - Genetics - Obesity - Trauma - Mechanical stress - Joint instability - Inflammation - Skeletal deformaities - Medications |
|
Relating to age and gender who is at risk for OA?
|
- < 50 years: more common in men
- > 50 years: more common in women |
|
Why is it more common in women over 50?
|
Estrogen production
|
|
Essentially OA is?
|
The progressive degeneration of joints that causes the formation of bony bulidup and the loss of articular cartilage
|
|
What kind of joints does OA affect?
|
Supporting
|
|
Clinical manifestation of OA are?
|
- Joint pain
- Increasing disability and loss of function - Stiffness after rest periods that resolves in 30 mins - Crepitus - ASYMMETRICAL joint involvement - Deformity - Bony enlargement of some joints |
|
What is crepitus?
|
Grating sensation caused by irregular and loose particles of cartilage in the joint
|
|
OA joint pain increases with?
|
- May increase with weather changes
- With joint use - In advanced disease, pain is present at rest |
|
Joint deformities associated with OA?
|
- Heberden's nodes
- Bouchard's nodes - Knee malalignment due to cartilage loss |
|
True or False
Patient with OA can have serious deformities but not be in too much pain and vice versa. |
True
|
|
Heberden's nodes are located?
|
Distal finger joints
|
|
Bouchard's nodes are located?
|
Proximal finger joints
|
|
What kinds of diagnostics are used to dx OA?
|
- Bone scan
- CT scan - MRI - X ray ( used to confirm disease and monitor progression) |
|
What does the care of OA focus on?
|
- Pain management
- Maintaining/ improving joint junction - Prevention of disability |
|
What are some nursing interventions for a patient with OA?
|
- Rest
- Joint immobilization - Moderate exercise - Nutritional support - Application of heat or cold - Acupuncture, yoga, massage - Assistive devices |
|
What are the meds used for OA?
|
- Acetaminophen (1000 mg q6hr, do not exceed 4 g/ day)
- Topical agents (Capsaicin) - ASA - NSAIDS - Intraarticular injections of corticosteriods - Intraarticular injections of Hyaluronic acid |
|
Hyaluronic acid is also called?
|
Viscosupplemenation
|
|
3 names of hyaluronic acid meds are?
|
- Orthovisc
- Synvisc - Hyalgan |
|
What are the nursing goals for a patient with OA?
|
- Successful pain management through use of pharmacologic and non- pharmacologic ways
- Maintentance/ improvement of joint function - Use of joint protection measures to improve activity - Independence in self care activities |
|
True or False
RA is chronic, systemic, and inflammatory. |
True
|
|
What is the cause of RA?
|
Cause is unknown but autoimmune is the most widely accepted at the present
|
|
In simple terms, what is the pathophysiology of RA?
|
- The body' immune system attacks cells at the joint.
- Swelling occurs in the joint due to the inflammatory response. - Synovitis occurs - The synovial fluid thickens and forms an invasive pannus. - The pannus then destroys cartilage and bone. |
|
What is a pannus?
|
Highly vascular granulation tissue
|
|
True or False
RA occurs symmetrically. |
True
|
|
What are the criteria for classification of RA?
|
- Morning stiffness lasting for at least one hour
- Swelling of 3 or more joints - Hand joint involvment - Symmetric swelling - Rheumatoid nodules - Serum rheumatoid factor positive - Radiographic changes |
|
What 4 criteria for RA have to be present for 6 weeks before dx can be given?
|
- Morning stiffness lasting for at least one hour
- Swelling of 3 or more joints - Hand joint involvement - Symmetric swelling |
|
RA S/S?
|
- Fatigue and weakness
- Inflammation - Joint stiffness after inactivity - Pain and morning stiffness lasting longer than 60 minutes - Joint deformities - Decrease ROM |
|
What are the 3 extraarticular manifestations of RA?
|
- Rheumatoid nodules
- Sjogren syndrome - Felty syndrome |
|
Define Rheumatoid nodules
|
- Firm, non tender nodules
- Usually over extensor surfaces of joints - Can be anywhere, lungs, eyes, etc. |
|
Define Sjogren syndrome
|
- Decreased lacrimal and salivary gland secretion
- 10- 15 % of patients |
|
Define Felty syndrome
|
- Inflammatory eye disorders, splenomegaly, lymphadenopathy, pulmonary disease, and blood dyscrasias
|
|
What are 3 lab tests used to dx RA?
|
- Positive Rheumatoid Factor
- Anti- CCP Antibody - ESR |
|
What is a Rheumatoid factor test? what does it show?
|
- An antibody that activates the inflammatory processes within the body
- Titers generally rise during active disease - May be misleading as other conditions also commonly present RF positive |
|
What is Anti- CCP Antibody test? what does it show?
|
- New test, improvement over RF for the dx of RA
- Anti- cyclic citrullinated peptide antibody - Particularly useful in evaluating early inflammatory arthritis |
|
What are the main therapeutic goals of RA?
|
- Satisfactory pain relief
- Minimal loss of functional ability - Patient participation in therapeutic regimen - Maintenance of positive attitude |
|
True or False
Early dx of RA and treatment are imperative because irreversible joint damage can occur within the first year. |
False, occurs within the first 2 years
|
|
What 5 types of meds are used for RA?
|
- NSAIDS
- Salicylates (aspirin) - Corticosteroids - DMARDS - Biologics |
|
True or False
For RA a combination of different types of drugs is most effective. |
True
|
|
Why are NSAIDs used for RA?
|
Antiinflammatory, analgesic, and antipyretic properties
|
|
What is the difference with a selective NSAIDs?
|
- Selectively blocks the COX- 2 pathway
- Does not block COX -1 so there should be no gastric irritation |
|
What is an example of a COX- 2 inhibitor used for RA?
|
Celebrex
|
|
What are DMRDs?
|
- Disease modifying anti- rheumatic drugs
- slow acting - Can diminsh progression of disease |
|
What are 3 examples of DMARDS?
|
- Arava (leflunomide)
- Plaquenil (hydroxychloroquine) - Rheumatrex (methotrexate) |
|
What was Plaquenil first used for?what can it cause?
|
- Malaria
- Vision changes |
|
What DMARD is the initial one for most patients?
|
Rheumatrex
|
|
What are the side effects of Rheumatrex?
|
- Depresses immune system
- Liver damage |
|
What are Biologics?
|
- "Big guns"
- Biologic response modifiers - Often combined with DMARDs to improve efficacy |
|
What are 2 examples of biologics?
|
- Enbrel
- Humira |
|
What are some ways to preserve joint function in a patient with RA?
|
- ROM exercises
- Alternate rest and activity - May splint joints during acute inflammation - Apply heat or cold - Paraffin baths/ massage - Relaxation techniques |
|
What are some complications associated with RA?
|
- Contractures
- Cataracts - Nodular ulceration leading to open wounds - Fatigue: monitor for s/s of anemia - Cardiopulmonary effects |
|
Exacerbations of RA are increased by?
|
Physical and emotional stress
|
|
What are some surgical interventions for RA? what do they do?
|
- Synovectomy: surgical removal of the synovia to maintain joint function
- Arthrodesis: surgical fusion of a joint to attempt to relieve pain and stabilize the joint - Arthroplasty: restores function |
|
OA or RA?
Involves only the joints |
OA
|
|
OA or RA?
Stiffness lasts for 30 mins or less |
OA
|
|
OA or RA?
Systemic disease |
RA
|
|
OA or RA?
Pattern may be asymmetrical |
OA
|
|
OA or RA?
Stiffness that lasts for 1 hr or more |
RA
|
|
OA or RA?
Pattern is symmetrical |
RA
|
|
OA or RA?
Metacarpal and proximal interphalanges joints |
RA
|
|
OA or RA?
Heberden's and Bouchard's nodules |
OA
|
|
OA or RA?
Bony enlargements of joints |
OA
|
|
OA or RA?
Boutonniere and Swan neck deformities |
RA
|
|
OA or RA?
Distal and proximal interphalanges joints |
OA
|
|
OA or RA?
Treatment involves managing symptoms |
OA
|
|
OA or RA?
Swollen joints |
RA
|
|
OA or RA?
Treatment involves disease modifying drugs |
RA
|