MS Exam 3: Chapter 18

what are the non-pharmacologic interventions for RA?

-Adequate rest -Proper positioning -Ice and heat application -Plasmapheresis: patient's plasma is treated to remove the antibodies causing the disease -Complementary and alternative therapies -Promotion of self-management (contact PT and OT; use adaptive devices) -Management of fatigue -Enhance body image

what is gout?

-Also called gouty arthritis -Urate crystals deposit in joints and other body tissues, causing inflammation -First metatarsal phalangeal joint is the most common joint involved -Pain gets so bad they seek medical attention

what are the clinical manifestations of scleroderma?

-Arthralgia -Renal involvement: malignant hypertension (watch BP and monitor urinary output) -Cardiac involvement: myocardial fibrosis (presents as irregular heart rate, c/o CP) -Problems with GI tract: GERD and diarrhea -Lung involvement: fibrosis of alveoli and interstitial tissues

what are the chronic complications of Lyme's disease?

-Arthralgias -Fatigue -Memory/thinking problems

what is Lyme's disease?

-Caused by spirochete Borrelia burgdorferi, resulting from bite of infected deer tick -Sometimes first and only sign/symptom is arthritis -May not always have a rash, many times this is missed if no rash

what are the primary problems for patients with OA?

-Chronic pain related to joint swelling and deterioration -Potential for decreased mobility related to joint pain and muscle atrophy

what is scleroderma (systemic sclerosis)?

-Chronic, inflammatory, autoimmune connective tissue disease -Not always progressive -Hardening and tightening of the skin, causes pain -Classifications: diffuse cutaneous and limited cutaneous -Affects women more than men (ages 25-55) -might see fever and fatigue

what is Systemic Lupus Erythematosus?

-Chronic, progressive, inflammatory connective tissue disorder -Can cause major body organs/systems to fail -Spontaneous remissions and exacerbations -Autoimmune process -Autoimmune complexes tend to be attracted to glomeruli of the kidneys -Often some degree of kidney involvement -Usually happens in women ages 20-40, no classic presentation

what is RA (rheumatoid arthritis)?

-Common connective tissue disease, destructive to joints -Chronic, progressive, systemic inflammatory autoimmune disease; affects primarily synovial joints -Transformed autoantibodies (rheumatoid factors) form and attack healthy tissue, causing inflammation -May be correlated with the Epstein Barr virus -Joint changes are usually bilateral and symmetric

what is the drug therapy for RA?

-DMARDs (Methotrexate) -NSAIDs -BRMs & Humira -Glucocorticoids

what are the other OA post-op precautions?

-Do not get your patient up unless you know their weight bearing status (usually have orders to get out of bed on POD1) -Generally see 24 hours of antibiotics -PT, OT will get a walker and a reacher (cannot bend down to get something), may need a shower chair, need a raised toilet seat -CPM (continuous passive motion)

what are the interventions for scleroderma?

-Drug therapy to control disease process (usually treat with systemic steroids- prednisone and immunosuppressants) -Identify early organ involvement -Skin protective measures -Comfort -GI management -Mobility -Keep the covers off of the affected area -Can have rapid vasoconstriction (necrosis and auto-amputation- fingers fall off)

what lab results are associated with RA?

-Elevation of ANA titer (seen with lupus and systemic sclerosis) -increase in ESR and CRP because of inflammation -CBC- looking for anemia, increased WBC, thrombocytosis (increased platelets)

what are the OA post-op assessments regarding anemia?

-H&H is ordered every morning -may be transfusing blood -cell savers (use hemovacs as a drain, drainage is processed and infused back into patient just like blood)

what are the clinical manifestations of OA?

-Joint pain and stiffness -Crepitus -Heberden's nodes -Bouchard's nodes -Nodes are painful and red -Joint effusions: excessive joint fluid -Atrophy of skeletal muscle: leads to decreased mobility

what is the nutrition therapy for gout?

-Limit proteins -Avoid trigger foods -Plenty of fluids to prevent kidney stones (dilutes urine and prevents sediment formation) -Low purine diet: avoid organ meat, shellfish, oily fish with bones- sardines -avoid aspirin because it activates the effects of Indocin -avoid diuretics because it decreases the normal excretion of uric acid

what is osteoarthritis (OA)?

-Most common arthritis type -Progressive loss of cartilage can result in a floating joint (crepitus) -As we age or injure our joints, the synovial fluid decreases, bone spurs (osteophytes) can develop -Leads to joint pain (loss of function characterized by progressive deterioration), stiffness, redness, and decreased mobility •OA is usually unilateral and in a single joint

what is the typical onset for OA vs RA?

-RA: 35-45 yo -OA: older than 60 yo

what is the common drug therapy for OA vs RA?

-RA: NSAIDs (short-term use), methotrexate, leflunomide (arava), corticosteroids, biological response modifiers, and other immunosuppressive agents -OA: NSAIDs (short-term use), acetaminophen, and other analgesics

what is the risk factors/causes for OA vs RA?

-RA: autoimmune (genetics), emotional stress (triggers exacerbation), and environmental factors -OA: aging, genetic factors, obesity, trauma, and occupation

what is the disease pattern for OA vs RA?

-RA: bilateral, symmetric, multiple joints, affects upper extremities first, distal interphalangeal joints of hands spared, systemic -OA: unilateral, single joint; affects weight-bearing joints, hands, and spine; metacarpophalangeal joints spared; non-systemic

what are the lab findings for OA vs RA?

-RA: elevated rheumatoid factor, antinuclear antibody, and ESR -OA: normal or slightly elevated ESR

what is the disease process for OA vs RA?

-RA: inflammatory -OA: likely degenerative with secondary inflammation

what is the psychosocial impact for OA?

-Severe pain may cause depression/anxiety -Changes their lifestyle (can no longer participate in activities as much), sex decreases -Decrease in energy -Affects what they can do at work -Affects body image

what are the laboratory assessments for systemic lupus erythematosus?

-Skin biopsy (confirms diagnosis): scrape cells from the rash -Immunologic-based laboratory tests -CBC (often shows pancytopenia: low cells of all types because blood cells and bone marrow are being attacked) -Body system function

what are the key features of Systemic Lupus Erythematosus?

-Skin involvement (Butterfly rash***- dry, scaly, and raised) -Polyarthritis -Osteonecrosis: long-term steroid use (glucocorticoids) can cause this -Muscle atrophy -Fever and fatigue -Renal involvement/ lupus nephritis -Pleural effusions -Pericarditis -Raynaud's phenomenon -Neurologic manifestation -Serositis: inflammation of serous membrane, such as pleura, pericardium (cardinal finding in systemic lupus)

what is the lupus drug therapy?

-Topical cortisone drugs -Plaquenil (Hydrooxychloroquine) -Tylenol or NSAIDs -Chronic steroid therapy -Immunosuppressive agents -First drug approved in 60 years for SLE: Belimumab (Benlysta)

what are the surgical interventions for OA?

-Total joint arthroplasty (TJA)/Total joint replacement -Arthroscopy -Osteotomy

what is the drug therapy for OA?

-Tylenol is good for bone pain (check liver functions) -Lidoderm patches: applied each day and needs to be applied to clean, intact skin; contraindicated in patients on class 1 antidysrhythmics (lidocaine, procainamide) -If Tylenol does not work, move to NSAIDs (be sure to check kidney function) -If NSAIDs do not work, we do cortisone injections into the joint (4 times per year) -Muscle relaxants (flexeril); caution in older adults because it can cause acute confusion

what are the systemic complications of RA?

-Weight loss, fever, extreme fatigue -Exacerbations -Subcutaneous nodules -Respiratory, cardiac complications -Vasculitis: impacts perfusion, may have ischemia and malfunction in the organs -Periungual lesions: small, brownish spots on the nails -Paresthesias -Sjögren's syndrome -Pneumonitis, pulmonary hypotension, pericarditis -Baker's cyst: enlarged bursa behind the knee

An alert client who recently underwent total hip arthroplasty and is on anticoagulants is preparing for discharge from the hospital. Which information is most important for the nurse to provide to the client and caregiver? a. Use an abduction pillow between the legs. b. Keep heels off the bed. c. Avoid using a straight razor. d. Re-orient frequently.

C

what foods would you promote for your patient that has osteoporosis?

-adequate amounts of calcium and vitamin D (lactose intolerance can choose a variety of soy and rice products that are fortified with calcium and vitamin D) -calcium and vitamin D are added to many fruit juices, bread, and cereal products -emphasize fruits and vegetables, low-fat dairy and protein sources, increased fiber, and moderation in alcohol and caffeine

what is the VTE prophylaxis for post-op OA?

-anticoagulant therapy for 10 days to several weeks after surgery -Coumadin- labs need to be done regularly for PT and INR because dose is based on labs; Vitamin K is the antidote (need regularly available) -Lovenox- watch for S&S of bleeding; antidote is protamine sulfate (antidote for heparin too); look at platelet level -DVT presents as swollen lower extremities (if one leg is more swollen than the other, think DVT)

what are BRMs?

-biological response modifiers given for RA -more susceptible to infection (cannot have live vaccines) -Humira

what is Plaquenil (Hydrooxychloroquine)?

-decrease absorption of UV light by the skin -decreases the risk of skin lesions -need a baseline eye exam and every 6 months after if on this med

what are DMARDs?

-disease modifying antirheumatic drugs that decrease the progression of the disease -immunosuppressant -methotrexate- patient needs to be on it for 4-6 weeks -side effects are not mild (decreased WBC, decreased platelets) -watch liver enzyme test (liver enzymes will increase while on this med- avoid alcohol), check serum creatinine levels (could be elevated) -can cause birth defects (discontinue 3 months before a planned pregnancy), recommend strict birth control while on this med, patient can start med right after birth if they are not going to breastfeed

what is the post-op care for an anterior hip approach (preventing dislocation)?

-do not hyperextend the leg behind you -turning the patient- need to have pillows between the legs or abductor pillow (need pillows behind legs and back)

What is a CPM (continuous passive machine)?

-ensure that the machine is well padded -check the cycle and ROM settings at least once every 8 hours -ensure that the joint being moved is properly positioned on the machine -if the patient is confused, place the controls to the machine out of reach -assess the patient's response to the machine -turn off the machine while the patient is having a meal in bed -when the machine is not in use, do not store it on the floor (there should be a designated cart to store it on)

how should you care for a pt on a CPM (continuous passive motion) machine?

-ensure that the machine is well padded -check the cycle and ROM settings at least once every 8 hours -ensure that the joint being moved is properly positioned on the machine -if the pt is confused, place the controls to the machine out of their reach -assess the pt's response to the machine -turn off the machine while the pt is having a meal in bed -when the machine is not in use, do not store it on the floor

what are exercises for pts with RA or OA?

-follow the exercise instructions that have been prescribed specifically for you. there are no universal exercises; your exercises have been specifically tailored to your needs -do your exercises on both good and bad days. consistency is important -respect pain. reduce the number of repetitions when the inflammation is severe and you have more pain -use active rather than active-assist or passive exercise whenever possible -do not substitute your normal activities or household tasks for the prescribed exercises -avoid restrictive exercises when your joints are severely inflamed

what is the post-op care for the older adult with a total hip arthroplasty?

-for pts who had a posterior surgical approach, use an abduction pillow or splint to prevent adduction after surgery if the patient is very restless or has an altered mental state. for patients with an anterior surgical approach, no abduction pillow is needed -keep the pt's heels off of the bed to prevent pressure injuries -do not rely on fever as a sign of infection, older patients often have infection without fever. be alert to decreasing mental status and/or elevated WBC as indicators of infection -when assisting the pt out of bed, move them slowly to prevent orthostatic hypotension. allow the pt to sit on the side of the bed for a brief period of time before standing; have them stand for a brief period before beginning ambulation -encourage the pt to cough and deep breathe and to use the IS every 2 hours to prevent atelectasis and pneumonia -as soon as permitted, get the pt out of bed to a recliner chair to prevent complications of immobility -anticipate the needs for pain medication, especially if your pt cannot verbalize the need for pain control. for pts on a multimodal pain protocol, assess the need to medicate for breakthrough pain -expect a temporary change in mental state immediately after surgery as a result of the anesthetic and unfamiliar sensory stimuli. reorient the pt frequently.

why are NSAIDs given for RA?

-given to decrease inflammation and for analgesic effect -watch for bleeding (GI bleeds if used chronically) -use Pepcid with NSAIDs

what is CREST syndrome?

-limited form of scleroderma -C: Calcinosis (calcium deposits) -R: Raynaud's phenomenon -E: Esophageal dysmotility (difficulty swallowing) -S: Sclerodactyly (scleroderma of digits) -T: Telangiectasia (spider-like hemangioma)

who is at risk for OA?

-older than 60 years -athletes/runners -obese patients -smokers -farmers, mechanics, & nurses -women

what is the difference between primary and secondary gout?

-primary: inborn errors of peering metabolism -secondary: hyperuricemia (high levels of uric acid) caused by another disease

what is the post-op care for a posterior hip approach (preventing dislocation)?

-pt not to bend knee more than 90 degrees or do not cross the knees -pillows between the legs to keep them abducted (look under the straps for skin breakdown)

what are the non-pharmacological interventions for OA?

-rest -immobilization -positioning: joint needs to be in functioning position (use a SMALL pillow behind the neck) -weight control: help patients get BMI below 30 -thermal modalities -Glucosamine is used to decrease inflammation -Chondroitin plays a role in strengthening cartilage

what is a TJA/ total joint replacement?

-the most common surgical procedure for patients with OA (surgical creation of new joint) -need PT, OT, dietician -CHD showering and wipes used before surgery

how can you tell your patient to protect their joints?

-use large joints instead of small ones (place your purse on your shoulder instead of grasping the purse with your hand) -do not turn a doorknob clockwise. turn it counterclockwise to avoid twisting your arm and promoting ulnar deviation -use 2 hands instead of 1 to hold objects -sit in a chair that has a high, straight back -when getting out of bed, do not push off with your fingers; use the entire palm of both hands -do not bend at your waist, instead bend your knees while keeping your back straight -use long-handled devices such as a hairbrush with an extended handle -use assistive/adaptive devices such as Velcro closures and built-up utensil handles to protect your joints -do not use pillows in bed expect a small one under your head -avoid twisting or wringing your hands

what are the risk factors for cholecystitis?

-women -aging -American Indian, Mexican American, and Caucasian -obesity -rapid weight loss or prolonged fasting -increased serum cholesterol -women on hormone replacement therapy -cholesterol-lowering drugs -family history of gallstones -prolonged TPN -Crohn's disease -gastric bypass surgery -sickle cell disease -glucose intolerance/ DM -pregnancy -genetic factors

what is the normal range for creatinine?

0.5-1.4 mg/dL

what is the normal range for INR?

0.8-1.8 sec

which health teaching by the nurse is important for clients diagnosed with systemic lupus erythematosus? select all that apply. a. take frequent rest periods to prevent fatigue b. avoid green leafy vegetables to prevent bleeding c. avoid sun exposure to prevent disease flare-up d. report fever to your health care provider immediately e. use a mild soap for bathing to prevent skin irritation

A, C, D, E

The nurse assesses a client diagnosed with Sjögren's syndrome. The nurse anticipates that the client will also have which common condition? a. Dry eyes b. Abdominal bloating after eating c. Excessive production of saliva in the mouth d. Intermittent episodes of diarrhea

A

a nursing assistant is assigned to care for a client who has a cemented total knee arthroplasty. which statement by the NA indicates a need for further teaching and supervision by the nurse? a. i'll keep an abduction pillow in place at all times b. i'll tell the client not to place a pillow under the surgical knee c. i'll apply ice packs to decrease swelling in the knee as ordered d. i'll check to make sure the client's leg is not rotated

A

what is the normal range for PTT?

60-70 sec

what is the normal range for BUN?

7-20 mg/dL

Before administering low-molecular-weight heparin (LMWH) to an older adult client after total knee arthroplasty, the nurse notes that the client's platelet count is 50,000/mm3 (50 x 109/L). What action is most important for the nurse to take? a. Notify the health care provider of the platelet count. b. Administer the prescribed LMWH on schedule. c. Assess the activated partial thromboplastin time (aPTT). d. Assess the international normalized ratio (INR).

A

The home health nurse conducts a community presentation on Lyme disease for the residents of an assisted-living facility. Which statement from the audience indicates to the home health nurse that further instruction is needed? a. "I will gently remove the tick with tissue and then burn it to prevent the spread of the disease." b. "It is best to walk in the center of an outside trail." c. "I should wait 4 to 6 weeks after being bitten by a tick to be tested for Lyme disease." d. "I'll wear light-colored clothes with long sleeves, long pants, closed shoes, and a hat when I am walking in the woods."

A

During a health history assessment, a patient with rheumatoid arthritis, chronic hypertension, and diagnosis of a recent cerebrovascular accident states that she takes 2 fish oil capsules (5 g) daily as a supplement for her RA. What additional question(s) should the nurse ask? (Select all that apply.) A."Are you taking anticoagulant medications?" B."Have you found the fish oil to help your RA?" C."What other supplements do you currently take?" D."How long have you been taking fish oil capsules?" E."Have you notified your physician about taking fish oil capsules?"

A, B, C, D, E

which assessment findings will the nurse expect for the client with late-stage rheumatoid arthritis? select all that apply. a. bony nodes in finger joints b. subcutaneous nodules c. severe weight loss d. joint deformity e. thrombocytosis

A, B, C, D, E

the primary health care provider prescribed acetaminophen for a client with osteoarthritis. which health teaching will the nurse provide for the client regarding this drug? select all that apply. a. don't take more than 3000-4000 mg of this drug each day b. stop taking this drug if unusual bleeding occurs and call your primary health care provider c. tell your primary health care provider if you notice any yellowing of the skin or eyes d. expect fluid accumulation in your legs and feet that usually gets worse during the day e. check OTC drugs to see if they contain acetaminophen

A, C, E

a client had a left anterior total hip arthroplasty 2 days ago. which precautions will the nurse teach the client to prevent surgical complications? select all that apply. a. avoid extending your left hip behind you when you sit b. do not flex your hips more than 90 degrees when toileting c. you may cross your legs to be more comfortable in a chair d. avoid twisting your body when moving or performing ADLs e. stand on your right leg and pivot into the chair when getting out of bed

A, D, E

Which instructions for joint protection does the nurse recommend for a client with a connective tissue disease? Select all that apply. a. Use long-handled devices such as a reacher. b. When getting out of bed, use fingers to push off. c. Sit in a low back chair. d. Bend at the waist while keeping the back straight. e. Use adaptive devices such as Velcro closures. f. Turn a doorknob clockwise.

A, E

Assessment findings reveal that an older adult client with severe osteoarthritis of the left hip can no longer perform activities of daily living (ADLs) and has had several falls in the home over the past month. To which community resource does the nurse refer the client? a. Local senior citizen center b. Citizens for Better Care c. Home health care agency d. Meals on Wheels

C

In teaching a client with acute secondary gout, which instruction about preventing recurrence is most important for the nurse to include? a. "Limit your intake of fruits and vegetables." b. "Weight Watchers has healthy meal plans." c. "Limit fluid intake to 1500 mL/day." d. "Discuss with your health care provider about having your estrogen and progesterone levels checked to see where you are in menopause."

B

An hour later, the patient is crying because of severe joint pain in her hands. What are your priority actions at this time?

Assess the patient's level of pain. Check for pain medication orders and administer prn meds as ordered. Reassess her pain level after administering pain medication.

A 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 they are used for what purpose? a. Inspect skin for lesions or changes b. Promote comfort from Raynaud's phenomenon c. Prevent foot drop and contractures d. Decrease chilling of the extremities

B

A client has symptoms of rheumatoid arthritis (RA). Which laboratory finding indicates to the nurse that the client may have RA? a. Total serum complement, 75 units/mL b. Positive total antinuclear antibody (ANA) c. Erythrocyte sedimentation rate (ESR), 20 mm/hr d. Beta-globulin level, 1.0 g/dL (10 g/L)

B

Before administering prednisone IV push to a middle-aged adult with rheumatoid arthritis (RA), the nurse notes that the client's random blood glucose level is 139 mg/dl (7.7 mmol/L). Which action is most important for the nurse to take? a. Instruct the client to drink diet soda to prevent elevation of blood sugar. b. Administer the prescribed prednisone on schedule. c. Notify the health care provider of the random blood glucose result. d. Review the client's antinuclear antibody (ANA) level.

B

what do ESR and CRP indicate?

identifies synovial inflammation

The nurse is caring for an older, alert adult client diagnosed with osteoarthritis. Which client statement indicates to the nurse that the client is using effective coping strategies? a. "I do not know how long my wife will be able to take care of me at home." b. "The bus is coming to pick me up from the senior center three times a week so I can play cards." c. "I am helping with the dishes and laundry, but I hurt so badly when I am doing it." d. "I do not know how much longer my neighbor can continue to help clean my house."

B

Which element is a risk factor for osteoarthritis (OA)? a. Thin build b. Obesity c. Nonsmoker d. Male

B

Which factor indicates to the nurse the only similarity between discoid lupus erythematosus (DLE) and systemic lupus erythematosus (SLE)? a. Feeling tired and having a temperature that runs about 100° F (37.8° C) during the day b. Disfiguring and embarrassing rash c. Peripheral neuropathies and cranial nerve palsies d. High risk for renal inflammation

B

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?

A 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. "Any side effects of this drug will be mild." d. "I will avoid any live vaccines."

C

The nurse is caring for a middle-aged client diagnosed with rheumatoid arthritis. Which client statement requires further assessment for unproductive coping strategies? a. "I'm letting my husband do most of the cooking, but I help plan the menus." b. "Since I started taking etanercept (Enbrel), I can walk up and down the stairs of my home easier." c. "My husband is getting used to having sex only once a month." d. "I worry about what's going to happen to me if my husband cannot take care of me, but he says he'll hire someone if he must."

C

Which population group is most likely to be diagnosed with fibromyalgia syndrome? A.Men between 30 and 50 years of age B.Men between 50 and 70 years of age C.Women between 30 and 50 years of age D.Women between 50 and 70 years of age

C

Which statement indicates to the nurse that a client with fibromyalgia syndrome is using a complementary therapy to help relieve symptoms? a. "My Thera-Band really helps me loosen up my arms." b. "The brace on my lower leg is helping me walk better." c. "Focusing on the slow stretching movements and my breathing in tai chi helps me relax." d. "Water aerobic exercises have helped me sleep better."

C

the nurse is preparing to give medications to a group of clients. which drug is not appropriate to treat the disease with which it is matched? a. rheumatoid arthritis- leflunomide b. osteoarthritis- acetaminophen c. acute gout- allopurinol d. systemic lupus erythematosus- prednisone

C

Two hours later, laboratory values are drawn to investigate the patient's symptoms. The results are: Sodium 136 mEq/L HCT 41.6% Potassium 4.6 mEq/L HGB 12.8 g/dL Calcium 8.9 mg/dL ESR 28 mm/hr Are any of these results of concern?

CBC and electrolytes (sodium, potassium, calcium, HCT, and HGB) are within normal limits. The patient's ESR is high-normal, which is common in patients with osteoarthritis.

The nurse is assessing a patient who has undergone total knee arthroplasty for which continuous femoral nerve blockade was utilized. The nurse notes that the patient is anxious. Vital signs include BP 92/58, HR 62, RR 12, and SpO2 89%. What is the priority nursing intervention? A.Take vital signs every 10 minutes. B.Notify physician of the vital signs. C.Anticipate administering IV fluids. D.Notify the Rapid Response Team.

D

The nurse is developing a teaching plan for a client diagnosed with osteoarthritis (OA). The nurse includes which instruction in the teaching plan? a. Begin a running program. b. Take up knitting to slow down joint degeneration. c. Eat at least 2 cups (17 ounces) of yogurt per day. d. Wear supportive shoes.

D

The nurse is reviewing the medication history for a client diagnosed with rheumatoid arthritis (RA) 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. Glaucoma b. Hypertension c. Hypothyroidism d. Sulfa allergy

D

The nurse is teaching a client about the difference between rheumatoid arthritis (RA) and osteoarthritis (OA). Which statement by the client indicates a need for further teaching? a. "RA is inflammatory. OA is degenerative." b. "The risk factors or causes of RA are probably autoimmune, whereas OA may be caused by age, obesity, trauma, or occupation." c. "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." d. "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."

D

The nurse is caring for a postoperative client with total joint arthroplasty. What actions does 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, E

what are the nursing implications for Humira?

teach patient to report site reaction, which may indicate local allergic response

how do you treat Lyme's disease?

Treat with doxycycline (14-21 day course)

what are polyclonal antibodies?

antibodies derived from other animals (horses, rabbits, rats) that bind to and eliminate most T-lymphocytes, thus stopping a transplant rejection episode

what is the gender affected for OA vs RA?

both female

how does an older adult present with infection?

confused or with no S&S

what are the OA post-op assessments regarding neurovascular status?

do circulation checks every 2-4 hours unless they report something abnormal, then it is every hour (check affected and unaffected limb for comparison)

What is Sjogren's syndrome?

dry eyes, dry mouth, and dry vagina associated with RA

what is gel phenomenon?

early morning stiffness associated with RA

what is the critical rescue for continuous femoral nerve blockade?

if the patient has a continuous femoral nerve blockade, perform and document neurovascular assessment every 2-4 hours, or according to hospital protocol. be sure that patients can perform dorsiflexion and plantar flexion motions of the affected foot without pain in the lower leg. in addition, monitor these patients for S&S that indicate absorption of the local anesthetic into the patient's system, including metallic taste, tinnitus, nervousness, slurred speech, bradycardia, hypotension, decreased respirations, and seizures. document and report these new-onset S&S to the surgeon and anesthesiologist/CRNA immediately and carefully continue to monitor the patient for any changes.

what are the early S&S of RA?

joint stiffness, swelling, pain, fatigue, and generalized weakness

what is the action alert for methotrexate?

patients taking methotrexate are at risk for infection caused by impaired or decreased drug-induced immunity. teach them to avoid crowds and people who are ill. remind patients to avoid alcoholic beverages while taking methotrexate to prevent liver toxicity. teach them to observe and report other side and toxic effects, which include mouth sores and acute dyspnea from pneumonitis. although not commonly occurring, lymph node tumor (lymphoma) and pneumonitis (lung inflammation) have been associated in those who have RA and are taking methotrexate. folic acid, one of the B vitamins, is often given to those who are taking methotrexate to help decrease some of the drug's side effects.

what are monoclonal antibodies?

specifically target the activation sites of T-lymphocytes, increasing their elimination from circulation

what is an absolute neutrophil count?

the percentage and actual number of mature circulating neutrophils are used to measure a patient's risk for infection: the higher the numbers, the greater the resistance to infection

what is the drug alert for Tylenol?

the standard ceiling dose of acetaminophen is 4000 mg each day. however, patients may be at risk for liver damage if they take more than 3000 mg daily, have alcoholism, or have liver disease. older adults are particularly at risk because of normal changes of aging such as slowed excretion of drug metabolites. remind patients to read the labels of OTC or prescription drugs that could contain acetaminophen before taking them. teach them that their liver enzyme levels may be monitored while taking this drug

While completing your admission assessment, you observe the patient's hands, which appear as shown. 1. How would you document this finding? 2. What do you suspect the patient may be suffering from?

•1. Nodes should be described as reddened, swollen on ends of all fingers. •2. The patient has Heberden's nodes, which is a finding of osteoarthritis. A complete work-up will need to be completed by the provider.

what are tophi?

•Chronic gout- see uric acid deposits under the skin •With treatment, they dissolve and disappear

what is the drug therapy for gout?

•Chronic gout: use allopurinol (blocks uric acid production); second drug of choice is indomethicin •Make sure patients take meds after meals and drink a large glass of water to prevent GI distress

what psychosocial assessments need to be done for RA?

•Depression, inhibits patients from getting to jobs because the disease is disabling •Let these patients be as independent as possible*** ask what they would like help with***

what is the difference between Heberden's nodes and Bouchard's nodes?

•Heberden's nodes: distal •Bouchard's nodes: at the proximal interphalangeal joint

what diagnostic testing is used for gout?

•Need ongoing lab testing for liver and kidney •CBC because meds can cause bone marrow suppression

what are the different stages of Lyme's disease?

•Stage 1 looks like the flu •Stage 2: 2-12 weeks after bite, can develop heart issues (dysrhythmias), dizziness, neurologic issues (meningitis, facial paralysis, and peripheral neuritis) •Stage 3: months to years after the bite, only presenting sign may be arthritis

what diagnostic tests are used for RA?

•X-ray: visualizing joints •CT: looking for spinal involvement •Arthrocentesis: taking fluid from the joint, looking at synovial fluid and analyzing it for inflammatory cells and increased WBC; patient needs ice to the site for 24 hours after this

what diagnostic assessments are used for OA?

•X-rays: looking for structural changes •MRI and CT determine if there is vertebral involvement