ch.30 immune function- juvenile idiopathic arthritis
A child is diagnosed with juvenile idiopathic arthritis and is receiving several different medications listed in the medication administration record. Which agent would the nurse identify as being used to prevent disease progression?A)AspirinB)PrednisoneC)IbuprofenD)Methotrexate
D. methotrexateDisease-modifying antirheumatic drugs (DMARDs), such as methotrexate, are necessary to prevent disease progression. Other agents, such as aspirin and ibuprofen, are helpful with pain relief. Prednisone helps for relief of inflammation.
The nurse is caring for a child with juvenile idiopathic arthritis (JIA). There is involvement of five or more small joints and it is affecting the body symmetrically. This tells the nurse which of the following?a) The child has polyarticular JIAb) The child has pauciarticular JIAc) The child is at risk for anaphylaxisd) The child has systemic JIA
The child has polyarticular JIAExplanation:Polyarticular JIA is defined by the involvement of five or more joints, frequently the small joints, and affects the body symmetrically. Pauciarticular JIAs is defined by the involvement of four or fewer joints. Systemic JIA presents with fever and rash in addition to join involvement at the time of diagnosis. The child with JIA is not at greater risk for anaphylaxis.
Which of the following treatments are common to both systemic lupus erythematosus and juvenile idiopathic arthritis? Select all that apply.a) Nonsteroidal antiinflammatoriesb) Corticosteroidsc) Antipyreticsd) Antirheumaticse) Antimalarial
• Corticosteroids• Nonsteroidal antiinflammatoriesExplanation:Antimalarials are specific to SLE; antirheumatics are specific to JIA. Antipyretics are not typically used for either disorder
The parents of a child with juvenile idiopathic arthritis bring the child to the emergency department because the child is very drowsy and breathing heavily. The child also has been vomiting and complaining of ringing in her ears. The nurse suspects that the child is experiencing a toxic reaction to one of her medications. Which medication would the nurse suspect?a) Etanerceptb) Aspirinc) Corticosteroidd) Methotrexate
AspirinExplanation:The child is exhibiting signs and symptoms of aspirin toxicity. Corticosteroids would lead to signs and symptoms of Cushing syndrome as well as masking the signs of infection. Methotrexate would lead to changes in the white blood cell count, placing the child at risk for infection. Etanercept, like methotrexate, places the child at risk for infection. (less)
The nurse is caring for a 6-year-old with juvenile idiopathic arthritis. The mother states that she has trouble getting her daughter out of bed in the morning and believes the girl's behavior is due to a desire to avoid going to school. What is the best advice by the nurse?a. Refer the girl to a psychologist for evaluation of school phobia related to chronic illness.b. Administer a warm bath every morning before school.c. Give the child her prescribed NSAIDs 30 minutes before getting out of bed.d. Allow her to stay in bed some mornings if she wants.
B. Heat or warmth helps ease the stiffness resulting after a period of inactivity in a child with juvenile arthritis.
The nurse is assessing a child with pauciarticular-type juvenile idiopathic arthritis. What would the nurse expect to assess?A)FeverB)RashC)Eye inflammationD)Splenomegaly
C. Eye inflammationWith pauciarticular juvenile idiopathic arthritis, eye inflammation may be noted. Fever, rash, and enlarged spleen would be noted with systemic juvenile idiopathic arthritis.
Which exercise would the nurse suggest as most helpful to maintain mobility in a child with juvenile idiopathic arthritis?A)Jogging every other dayB)Using a treadmillC)SwimmingD)Playing basketball
C. SwimmingSwimming is a particularly useful exercise to maintain joint mobility without placing pressure on the joints. Jogging, using a treadmill, and playing basketball would place pressure on the joints of the lower extremities.
The young girl has been diagnosed with JIA and has been prescribed methotrexate. Which of the following statements by the child's parent indicates that adequate learning has occurred?a) "She may start feeling better by next week."b) "She can take methotrexate with yogurt or chocolate milk."c) "Swimming sounds like a good exercise for her."d) "We'll need to bring her back in for some lab tests after she starts methotrexate."e) "A warm bath before bed might help her sleep better."
D. "We'll need to bring her back in for some lab tests after she starts methotrexate."C."Swimming sounds like a good exercise for her."E. "A warm bath before bed might help her sleep better."Explanation:- The child diagnosed with juvenile idiopathic arthritis should not take the oral form of methotrexate with dairy products.- The approximate time to benefit from methotrexate is typically 3 to 6 weeks.- The child will need blood tests to determine renal and liver function during treatment.- Children with juvenile idiopathic arthritis usually find swimming to be a useful exercise for them because it helps maintain joint mobility without placing pressure on the joints.- Sleep may be promoted by a warm bath at bedtime.
