CH 64 Arthritis and Connective Tissue Diseases

When the nurse brings medications to a patient with rheumatoid arthritis, the patient refuses the prescribed methotrexate. The patient tells the nurse, "My arthritis isn't that bad yet. The side effects of methotrexate are worse than the arthritis." What is the most appropriate response by the nurse?

"It is important to start methotrexate early to decrease the extent of joint damage" - disease-modifying anti rheumatic drug (DMARDS) are prescribed early to prevent the joint degeneration that occurs as soon as the first year with RA

A patient has recently been diagnosed with rheumatoid arthritis (RA) The patient, who has two school-age children, tells the nurse that home life is very stressful. Which initial response should the nurse make?

"Tell me more about the situations that are causing you stress"

Which information should the nurse include when teaching a patient with newly diagnosed systemic exertion intolerance disease (SEID) about self-management?

A gradual increase in daily exercise may help decrease fatigue - a graduated exercise program is recommended to avoid fatigue while encouraging ongoing activity

How should the nurse suggest that a patient recently diagnosed with rheumatoid arthritis (RA) plan to start each day?

A warm bath followed by. a short rest - taking a warm shower or bath is recommended to relieve joint stiffness, which is worse in the morning

A patient has scleroderma manifested by CREST (calcinosis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia) syndrome. Which action should the nurse include in the plan of care?

Keep environment warm and draft free

What finding should indicate to the nurse that colchicine has been effective for a patient with an acute attack of gout?

Reduced joint pain - colchicine reduces joint pain in 24 to 48 hours by decreasing inflammation

A patient hospitalized with polymyositis has joint pain; erythematous facial rash; eyelid edema; and a weak, hoarse voice. What safety priority should the nurse identify for this patient?

Risk for aspiration - The patient's vocal weakness and hoarseness indicate weakness of the pharyngeal muscles and a high risk for aspiration.

During assessment of the patient with fibromyalgia, the nurse should expect the patient to report which of the following? (Select all that apply.) Sleep disturbances Multiple tender points Cardiac palpitations and dizziness Multijoint inflammation and swelling Widespread bilateral, burning musculoskeletal pain

Sleep Disturbances Multiple tender points Widespread bilateral, burning musculoskeletal pain

A 25-yr-old female patient with systemic lupus erythematosus (SLE) has a facial rash and alopecia. She tells the nurse, "I never leave my house because I hate the way I look." Which patient problem should the nurse plan to address?

Social isolation

A patient with rheumatoid arthritis (RA) tells the clinic nurse about having chronically dry eyes. Which action should the nurse take?

Suggest the patient use over-the-counter (OTC) artificial tears - patient's dry eyes are consistent with Sjögren's syndrome.

A patient who had arthroscopic surgery of the right knee 7 days ago is admitted with a red, swollen, hot knee. Which assessment finding should the nurse report immediately to the health care provider?

The blood pressure is 86/50 mm Hg - the low blood pressure suggests the patient may be developing septicemia as a complication of septic arthritis

A 29-yr-old woman is taking methotrexate to treat rheumatoid arthritis. Considering this treatment, which information should the nurse report to the health care provider?

The patient is trying to get pregnant before her disease becomes more severe - Methotrexate is teratogenic, and the patient should be taking contraceptives during therapy

The home health nurse is making a follow-up visit to a patient recently diagnosed with rheumatoid arthritis (RA). Which finding indicates to the nurse that additional patient teaching is needed?

The patient sleeps with two pillows under the head - the joints should be maintained in an extended position to avoid contractures, so the patients should use a small, flat pillow for sleeping

Which assessment information should indicate to the nurse that a patient with an exacerbation of rheumatoid arthritis (RA) is experiencing a side effect of prednisone?

The patient's blood glucose is 165 mg/dL

A patient is taking methotrexate to treat rheumatoid arthritis (RA). Which laboratory result is important for the nurse to communicate to the health care provider?

The white blood cell count is 1500 - bone marrow suppression is a possible side effect of methotrexate , and the low WBC puts the patient at HIGH risk for infection

A patient with hypertension and gout has a red, painful right great toe. Which action should the nurse include in the plan of care for this patient?

Use a footboard to hold bedding away from the toe - any touch on the area of inflammation may increase pain, bedding should be held away from the toe, due to urate crystals.

A patient who takes multiple medications develops acute gout arthritis. Which medication should the nurse discuss with the health care provider before administering a prescribed dose?

hydrochlorothiazide - diuretic use increases uric acid levels and can precipitate gout attacks

The nurse should determine additional instruction is needed when a patient diagnosed with scleroderma makes which statement?

"I should lie down for an hour after each meal" - due to esophageal scarring, patients should sit up for 2 hours after eating

Which statement by a patient with systemic lupus erythematosus (SLE) indicates the patient understands the nurse's teaching about the condition?

"I will use sunscreen when I am outside" - severe skin reactions can occur in patients in SLE who are exposed to the sun

What suggestion should the nurse make to a group of women with rheumatoid arthritis (RA) about managing activities of daily living?

Avoid activities requiring repetitive use of the same muscles and joints - patients are advised to avoid repetitious movements. Sitting during household chores is recommended to decrease stress on joints.

A patient being seen in the clinic has rheumatoid nodules on the elbows. Which action should the nurse take?

Assess the nodules for skin breakdown or infection

The health care provider has prescribed the following interventions for a patient who is taking azathioprine (Imuran) for systemic lupus erythematosus. Which order should the nurse question?

Administer varicella vaccine - live virus vaccines, such as varicella, are contraindicated in a patient taking immunosuppressive drugs.

A new clinic patient with joint swelling and pain is having diagnostic tests. Which test should the nurse identify as specific to systemic lupus erythematosus?

Anti-Smith antibody (Anti-Sm) - found exclusively only in SLE

Which information should the nurse include when preparing teaching materials for a patient who has an exacerbation of rheumatoid arthritis?

Applying cold packs before exercise may decrease joint pain - cold application is helpful in reducing pain during periods of exacerbation of RA.

The nurse notices a circular lesion with a red border and clear center on the arm of a patient who is in the clinic reporting chills and muscle aches. Which action should the nurse take to follow up on that finding?

Ask the patient about recent outdoor activities - this suggests possible Lyme disease

A patient with gout has a new prescription for losartan (Cozaar). What should the nurse plan to monitor?

Blood pressure - Losartan may be effective for treating older patients with gout and hypertension. Losartan promotes urate excretion and may normalize serum urate. Losartan, an angiotensin II receptor antagonist, should lower blood pressure.

Which finding for a patient who is taking hydroxychloroquine (Plaquenil) to treat rheumatoid arthritis should the nurse identify as a likely adverse effect of the medication?

Blurred vision - Plaquenil can cause retinopathy

Which laboratory result should the nurse monitor to determine if prednisone has been effective for a patient who has an acute exacerbation of rheumatoid arthritis?

C-reactive protein - this is a serum marker for inflammation, and a decrease would indicate the corticosteroid therapy was effective.

Which result for a patient with systemic lupus erythematosus (SLE) should the nurse identify as most important to communicate to the health care provider?

Elevated blood urea nitrogen (BUN) - elevated BUN and serum creatinine indicate possible lupus nephritis and a need for a change in therapy to avoid further renal damage

Which action should the nurse include in the plan of care for a patient with a new diagnosis of rheumatoid arthritis (RA)?

Encourage the patient to take a nap in the afternoon - adequate rest helps decrease the fatigue and pain associated with RA. Patients are taught to avoid stressing joints, use warm baths to relieve stiffness, and use a firm mattress.

Anakinra (Kineret) is prescribed for a patient with rheumatoid arthritis (RA). What information should the nurse include in teaching the patient about this drug?

Giving subcutaneous injections

A patient reporting painful urination and knee pain is diagnosed with reactive arthritis. What long-term therapy should the nurse plan to explain to the patient?

doxycycline (Vibramycin) - reactive arthritis associated with urethritis is usually caused by infection with Chlamydia trachomatis and requires 3 months of treatment with doxycycline.