Chapter 34: Assessment and Management of Patients with Inflammatory Rheumatic Disorders

A client with rheumatoid arthritis arrives at the clinic for a checkup. Which statement by the client refers to the most overt clinical manifestation of rheumatoid arthritis?

My finger joints are oddly shaped Joint abnormalities are the most obvious manifestations of rheumatoid arthritis. A systemic disease, rheumatoid arthritis attacks all connective tissue. Although muscle weakness may occur from limited use of the joint where the muscle attaches, such weakness isn't the most obvious sign of rheumatoid arthritis; also, it occurs only after joint abnormalities arise. Subcutaneous nodules in the hands, although common in rheumatoid arthritis, are painless. The disease may cause gait disturbances, but these follow joint abnormalities.

The nurse is completing the physical assessment of a client with systemic lupus erythematosus (SLE). Which finding will the nurse recognize is most likely to indicate that the client is experiencing a change to the cardiovascular system because of the condition?

Pericardial friction rub: The cardiac system is also commonly affected in SLE. Auscultating a pericardial friction rub would indicate myocarditis. Peripheral edema, jugular vein distention, and bounding peripheral pulses are not symptoms that indicate SLE is affecting the cardiovascular system.

The nurse is caring for a client who is being treated for fibromyalgia. What intervention will best assist the client to restore normal sleep patterns?

Tricyclic antidepressants Tricyclic antidepressants and sleep hygiene measures are used to improve or restore normal sleep patterns in clients with fibromyalgia. Increasing activity during the day or using range-of-motion exercises will not increase the client's ability to sleep. Narcotics are generally not needed for pain control with this disorder.

The nurse is caring for a client with ankylosing spondylitis. Which educational information will the nurse provide to this client?

Use of analgesics Ankylosing spondylitis (AS) is a chronic inflammatory disease of the spine. Back pain is the characteristic feature. AS affects the cartilaginous joints of the spine and surrounding tissues, making them rigid, decreasing mobility, and leading to kyphosis or a stooped position. Constipation, chronic cough, and peripheral edema are not symptoms associated with AS.

The nurse is preparing a teaching tool about the pathophysiology of systemic lupus erythematosus (SLE). Which immunoregulatory disturbance factors will the nurse include in this tool? Select all that apply.

Genetic, hormonal, immunologic, and environmental: While the exact cause is not known, SLE starts with the body's immune system inaccurately recognizing one or more components of the cell's nucleus as foreign, seeing it as an antigen. The immune system starts to develop antibodies to the nuclear antigen. The antibodies also act to destroy host cells. The immunoregulatory disturbance is thought to be brought about by some combination of four distinct factors: genetic, hormonal, immunologic, and environmental. Psychosocial is not an immunoregulatory disturbance factor that affects SLE.

An older adult with rheumatoid arthritis limits going out with others because of the need to use a cane. Which response will the nurse make to this client?

Look at the cane as maintaining your independence The body image and self-esteem of the older adult with rheumatic disease, combined with underlying depression, may interfere with the use of assistive devices such as canes. The use of adaptive equipment may be viewed by the older adult as evidence of aging rather than as a means of increasing independence. The nurse should focus on the cane as a method to increase independence rather than a sign of approaching old age. Reminding the client of aging are inappropriate responses. Inviting people to visit will not help improve the client's feelings about needing to use a cane for safe ambulation.

The nurse is caring for a client with ankylosing spondylitis (AS). Which medication will the nurse expect to be prescribed for this client?

Nonsteroidal anti-inflammatory drugs (NSAIDs) NSAIDs are the first-line therapy for treating all spondyloarthropathies. Antibiotics and anticoagulants are not used to treat AS. Corticosteroid injections may be used for periodic flares; however, oral and long-term use of steroids is not recommended.

A client with osteoarthritis expresses concerns that the disease will prevent the ability to complete daily chores. Which suggestion should the nurse offer?

Pace yourself and rest frequently, especially after activities A client with osteoarthritis must adapt to this chronic and disabling disease, which causes deterioration of the joint cartilage. The most common symptom of the disease is deep, aching joint pain, particularly in the morning and after exercise and weight-bearing activities. Because rest usually relieves the pain, the nurse should instruct the client to rest frequently, especially after activities, and to pace oneself during daily activities. Telling the client to do chores in the morning is incorrect because the pain and stiffness of osteoarthritis are most pronounced in the morning. Telling the client to do all chores after performing morning exercises or in the evening is incorrect because the client should pace oneself and take frequent rests rather than doing all chores at once.

The nurse is caring for a client with palindromic rheumatism. The nurse knows that this type of rheumatism can lead to which diagnosis?

Rheumatoid arthritis Palindromic rheumatism is an uncommon variety of recurring and acute arthritis and periarthritis that in some may progress to rheumatoid arthritis (RA) but is characterized by symptom-free periods of days to months. Because of this, the nurse should plan care that would be similar to the client with RA. The symptoms of palindromic rheumatism are not similar to those of scleroderma, fibromyalgia, or systemic lupus erythematosus.

The nurse is teaching a newly diagnosed client about systemic lupus erythematosus(SLE). What statement by the client indicates the teaching was successful?

The belief is that it is an autoimmune disorder with an unknown trigger Systemic lupus erythematosus is believed to be an autoimmune disorder but the triggering mechanism is not known. The disorder is more common in women than in men, most with the disorder in the 3rd or 4th decade of life. The disease is considered the "great imitator" because the clinical signs resemble many other conditions. SLE is a diffuse connective tissue disease that affects multiple body systems.

The nurse is completing a health history with a client diagnosed with systemic lupus erythematosus (SLE). Which information will the nurse identify as environmental triggers for the condition? Select all that apply.

stress, sunlight, stress on the body from surgery, and cigarette smoking It is hypothesized that exogenous or environmental triggers are implicated in the onset of SLE. These triggers include stress, sunlight, stress on the body from surgery, and cigarette smoking. A vegetarian diet is not identified as a trigger for SLE.

A nurse is assessing a client with possible osteoarthritis. What is the most significant risk factor for primary osteoarthritis?

Age is the most significant risk factor for developing primary osteoarthritis. Development of primary osteoarthritis is influenced by genetic, metabolic, mechanical, and chemical factors. Secondary osteoarthritis usually has identifiable precipitating events such as trauma.

The nurse is discussing the new medication that a client will be taking for treatment of rheumatoid arthritis. Which disease-modifying antirheumatic drug (DMARD) will the nurse educate the client about?

Methotrexate Methotrexate is a DMARD that reduces the amount of joint damage and slows the damage to other tissues as well. Celecoxib is a nonsteroidal anti-inflammatory drug (NSAID). Methylprednisolone is a steroid to reduce pain and inflammation and slow joint destruction. Mercaptopurine azathioprine is a cytotoxic drug.

The nurse knows that a patient who presents with the symptom of "blanching of fingers on exposure to cold" would be assessed for what rheumatic disease?

Raynaud's phenomenon Blanching of fingers on exposure to cold is associated with Raynaud's phenomenon.

Which assessment suggests to the nurse that a client with systemic lupus erythematous is having renal involvement?

Hypertension is suggestive of renal damage in the client with systemic lupus erythematous.

The nurse is working with a client with systemic lupus erythematosus (SLE). What are the immune abnormalities characterized by SLE? Select all that apply.

The immune abnormalities that characterize SLE occur in five phases: susceptibility, abnormal innate and adaptive immune responses, autoantibodies immune complexes, inflammation, and damage.

A client asks the nurse how to identify rheumatoid nodules with rheumatoid arthritis. What characteristic will the nurse include?

located over bony prominence Rheumatoid nodules usually are nontender, movable, and evident over bony prominences, such as the elbow or the base of the spine. The nodules are not reddened.