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Self esteem care for patient with Rheumatoid Arthritis (list 6)

1: Allow to vent & express feelings or concerns 2: Diversional activities appropriate for joint function 3: Focus on abilities 4: Anticipatory guidance to prepare for Rx & interventions 5: Help organize ADL's 6: Social Services

A nurse working in an outpatient clinic is assessing a client who has rheumatoid arthritis (RA). The client reports increased joint tenderness and swelling. Which of the following findings should the nurse expect? (Select all that apply.) A. Recent influenza B. Decreased range of motion C. Hypersalivation D. Increased blood pressure E. Pain at rest

A. CORRECT: Exacerbating factors, such as a recent illness like influenza, are indicative in clients who have RA. B. CORRECT: A decrease in range of motion is indicative in clients who have RA. E. CORRECT: Pain at rest is indicative of RA.

A nurse is caring for a client who has rheumatoid arthritis. Which of the following laboratory tests are used to diagnose this disease? (Select all that apply.) A. Urinalysis B. Erythrocyte sedimentation rate (ESR) C. BUN D. Antinuclear antibody (ANA) titer E. WBC count

B. CORRECT: ESR is a laboratory test used to diagnose RA. This laboratory test will show an elevated result in clients who have RA. D. CORRECT: ANA titer is a laboratory test used to diagnose RA. This laboratory test will show a positive result in clients who have RA. E. CORRECT: WBC count is a laboratory test used to diagnose RA. This laboratory test will show a decreased result in clients who have RA.

How would the nurse identify rheumatoid nodules in a client with rheumatoid arthritis? A: The nodules usually are tender and red. B: The nodules usually are nontender and movable. C: The nodules usually are red and movable. D: The nodules are miniscule and occur over nonbony areas.

B: The nodules usually are nontender and movable. In some clients, subcutaneous nodules, known as rheumatoid nodules, develop. Appearing in more advanced stages of RA, they usually are nontender and movable and evident over bony prominences, such as the elbow or the base of the spine.

Pattern for Rheumatoid Arthritis

Remissions & Exacerbations (aggravated by emotional or physical stress)

Medications for Rheumatoid Arthritis

1: ASA (high dose, enteric coated) 2: NSAIDS 3: Cox-2 inhibitors (Celebrex) 4: DMARDs 5: Prednisone (last resort) 6: Analgesics (chronic pain team)

Clinical manifestations of Rheumatoid Arthritis (list 8)

1: Anorexia 2: Weight loss 3: Look & feel sick 4: Afternoon fatigue 5: Depression 6: Low grade fever 7: Malaise 8: Red skin or skin nodules

Characteristics of Rheumatoid Arthritis (list 3)

1: Chronic systemic disease affecting any or all body systems. 2: Recurrent inflammation involving the linings of the joints. 3: Ankylosis (joint fusion occurs)

Client education for Rheumatoid Arthritis (list 6)

1: Disease process 2: Nutrition 3: Medications 4: Treatment 5: Good general health 6: Stress avoidance

Risk factors for Rheumatoid Arthritis (list 4)

1: Genetic predisposition 2: Female > Male 3: 20-40 years old 4: All racial & ethnic groups

DMARDs (list 5)

1: Gold injections 2: Penicillamine 3: Methotrexate 4: Immunosuppressants 5: Chemotherapeutics

When does the patient use heat vs cold

1: Heat - Chronic pain (moist packs, paraffin baths, whirlpool) 2: Cold - Acute pain (massage, ice pack)

Collaborative management of Rheumatoid Arthritis (list 2)

1: Meds 2: Total lymph node irradiation

Systemic manifestations (list 6)

1: Muscle atrophy 2: Vasculitis of small peripheral vessels → skin ulcerations 3: Inflammation of tissue overlaying sclera 4: ↓ salivary & lacrimal function 5: Carpal tunnel 6: Pulmonary nodules or fibrosis

Nursing assessment for Rheumatoid Arthritis (list 7)

1: Pain 2: Effects of disease on ADL's 3: Lifestyle 4: Social 5: Emotional 6: Coping mechanisms 7: Support system

What should the nurse assist the patient with Rheumatoid Arthritis with (list 4)

1: Pain alternatives 2: Relaxation, deep breathing, imagery, distraction 3: Stress reduction 4: Prescribed exercise

Nursing interventions for patient with Rheumatoid Arthritis (list 6)

1: Refer to support group 2: Handle gently & carefully 3: Caution not to get up without help during exacerbation 4: Warm bath or shower in AM to decrease pain & stiffness 5: rest, splints & gadgets from OT 6: Prevent hazards of immobility

Types of deformities (list 3)

1: Swan neck - hyperextension of proximal & fixed flexion of distal finger joints 2: Boutonniere - Persistant flexion proximal & hyperextension of distal fingers 3: Ulnar deviation

Characteristics of joint deformities (list 2)

1: Symmetricals 2: Red, swollen, shiny, painful (worse in AM)

Patho for Rheumatoid Arthritis (list 5)

1: Unknown - Autoimmune? 2: Antibodies attack & destroy the joints & connective tissue (including heart, lung, muscles) 3: Synovium becomes inflammed 4: Synovial fluid increases 5: Eventually connective tissue becomes fibrous, leaving joints very painful → ↓ ROM

A nurse is teaching a client who has a new diagnosis of rheumatoid arthritis. Which of the following statements should the nurse include in the teaching? A. "You can experience morning stiffness when you get out bed." B. "You can experience abdominal pain." C. "You can experience weight gain." D. "You can experience low blood sugar."

A. CORRECT: The nurse should include in the teaching that the client who has RA can experience stiffness in her joints upon rising.

What do DMARDs do

Disease modifying anti-rheumatic drugs work in various ways to slow progression of RA and suppress immune system's reaction to RA that causes pain & inflammation.