N201 Week 5 Rheumatoid Arthritis (RA)
How long should a patient with RA use ice?
10-15 mins at one time
Does stretching reduce morning stiffness in RA?
NO
rheumatoid arthritis (RA)
SYSTEMIC INFLAMMATORY BILATERAL SYMMETRICAL JOINTS AFFECTED
What test should be done prior to giving Enatarcept (Biologic DMARDs)?
TB test
RA is precipitated by what?
WBCs attacking synovial tissues
NSAIDs should be taken with what and why?
given with food or milk to reduce acidity
Is mild exercise okay for affected joints since immobility increases morning stiffness?
yes
How much should a pt. taking methotrexate increase their fluids?
2L while on this drug (renal excretion)
What lab values do you check to monitor if the medications are working? (2)
ESR CRP
What diagnostic studies for RA? (3)
ESR and CRP (inflammatory marker) WBC (elevated) RBC (decreased)
What do you want to increase in the diet of a patient taking methotrexate?
FOLATE
RA risk factor (6)
Female sex 3:1 30-60 years old Bacterial and viral infection Stress Smoking Environmental
Interprofessional care for RA (drugs)? (3)
NSAIDs Corticosteroids DMARDs
How long can a patient with RA use heat pads?
No more than 20 mins at a time Be alert for burn potential
Methotrexate is a _____genic.
TERATOgenic
Nursing Implementation Acute intervention for RA (3)
Warm showers/bath followed by a short rest period reduce morning stiffness Note active ROM and isometric exercises that put pressure on joints small flat pillow under head and shoulders
A nurse is teaching a client who has a new diagnosis of RA. Which of the following statements should the nurse include in the teaching? a. You can experience morning stiffness when you get out of bed b. You can experience abdominal pain c. You can experience weight gain d. You can experience low blood sugar
a. You can experience morning stiffness when you get out of bed
A nurse working in an outpatient clinic is assessing a client who has RA. The client reports increased joint tenderness and swelling. Which of the following finding should the nurse expect? SATA a. recent flu b. decreased ROM c. hypersalivation d. increased BP e. pain at rest
a. recent flu b. decreased ROM e. pain at rest
A nurse is caring for a patient with RA. Which of the following lab tests are used to diagnose this disease? SATA a. urinalysis b. ESR c. BUN d. Antinuclear antibody (ANA) test e. wbc count
a. urinalysis b. ESR
DMARDs should not be given to patients with what?
active infections
What is rheumatoid arthritis?
chronic, systemic autoimmune disease causing an inflammatory response, damaging cartilage and thickening synovial lining
What to monitor for methotrexate (Nonbiologic DMARDs)? (2)
decreased platelets, RBC, WBC (bone marrow suppression) Liver damage
Methotrexate does or does not increase the risk for infection?
it does increase risk for infection
Clinical manifestations of RA (6)
morning stiffness 1 hour to several hours or longer joint deformities - LATE symptoms Sjorgen's Syndrome (dry mouth, eyes) Ulnar deviation Swan's neck deformity Boutonniere deformity
Methotrexate can cause what adverse effect ? (2)
nausea vomiting
Who can not take methotrexate?
pregnant women and breastfeeding women
How long are steroids (Prednisone) used in RA?
short term until NSAIDs and DMARDs reach therapeutic level
How long does DMARDs Enbrel and Methotrexate/Sulfasalazine take to work?
weeks to work
