chapter 38

Common Blood Studies for Rheumatic Diseases

- creatinine - erythrocyte count - ESR - hematocrit - WBC - uric acid

assessment

- health history- includes the onset of symptoms and how they evolved - family history- should also include information about the patient's perception of the problem, previous treatments and their effectiveness, the patient's support systems, and the patient's current knowledge base and the source of that information. - a complete health history is followed by a complete physical assessment

other nonpharmacologic pain management

Devices such as braces, splints, and assistive devices for ambulation (e.g., canes, crutches, walkers) ease pain by limiting movement or stress from putting weight on painful joints. Acutely inflamed joints can be rested by applying splints to limit motion.

Nonpharmacologic Pain Management

Heat applications are helpful in relieving pain, stiffness, and muscle spasm. Superficial heat may be applied in the form of warm tub baths or showers and warm moist compresses. Paraffin baths (dips), which offer concentrated heat, are helpful to patients with wrist and small-joint involvement. Maximum benefit is achieved within 20 minutes after application.

pharmacologic therapy for rheumatic diseases

Useful medications include the salicylates, nonsteroidal anti-inflammatory drugs (NSAIDs), and both biologic and nonbiologic disease-modifying antirheumatic drugs (DMARDs)

A nurse is preparing a presentation about human immunodeficiency virus (HIV) for a local community group. What would the nurse include in the presentation about HIV transmission? Select all that apply. a. The amount of HIV contained in body fluids on exposure is associated with the risk for infection. b. Sharing of infected equipment used to inject drugs increases the risk for infection. c. HIV can be found in seminal fluid, vaginal secretions, and breast milk. d. HIV transmission from mother-to child occurs primarily during pregnancy while the fetus is in utero. e. The risk of acquiring HIV through the transfusion of blood products is almost nonexistent.

a, b, c, e

A nurse is developing a teaching plan for a community presentation on smoking cessation. Based on current research regarding the effects of cigarette smoking on the immune system, which alterations in immune function can be attributed to smoking and should be included in the teaching presentation? Select all that apply. a. Increased white blood cell count b. Decreased T-cell function c. Decreased IgE antibody production d. Decreased natural killer cells e. Increased risk of infection

a,b,d,e

A patient with a recent diagnosis of HIV infection has expressed to the nurse that he is motivated to learn as much about his disease as possible. The patient has heard and read about the role of the different T cells, but is unclear of their roles in the immune response. Which of the following roles of T cells should the nurse identify? Select all that apply. a. Secreting cytokines b. Producing antibodies c. Stimulating the immune system d. Activating other T cells e. Directly attacking antigens

a,c,d,e

A patient develops gastrointestinal bleeding from a gastric ulcer and requires blood transfusions. The patient states to the nurse, "I am not going to have a transfusion because I don't want to get AIDS." What is the best response by the nurse? a. "I understand your concern. The blood is screened very carefully for different viruses as well as HIV." b. "I understand what you mean, you can never be sure if the blood is tainted." c. "If you don't have the blood transfusions, you may not make it through this episode of bleeding." d. "No one has gotten HIV from blood in a long time. You have to have the transfusion."

a. "I understand your concern. The blood is screened very carefully for different viruses as well as HIV."

A nurse has given a child's scheduled vaccination for rubella. This vaccination will cause the child to develop which of the following? a. Active acquired immunity b. Natural immunity c. Cellular immunity d. Mild hypersensitivity

a. Active acquired immunity

Which of the following is the most severe form of hypersensitivity reaction? a. Anaphylaxis b. Delayed-type c. Immune complex d. Cytotoxic

a. Anaphylaxis

An older client doesn't understand why advancing age increases susceptibility to illness. What will be included in the nurse's explanation? Select all that apply. a. The body's number of T-cell lymphocytes decreases with age. b. The body's number of B-cell lymphocytes decreases with age. c. The amount of antibody produced in response to most foreign antigens decreases with age. d. The body's lymphoid tissue decreases with age.

a. The body's number of T-cell lymphocytes decreases with age. c. The amount of antibody produced in response to most foreign antigens decreases with age.

monoarticular

affecting a single joint

polyarticular

affecting multiple joints

A 38-year-old client has been diagnosed with rheumatoid arthritis, an autoimmune disease. During the health history assessment. the nurse learns that the client works as an aide at a facility that cares for children infected with AIDS, does moderate cardiovascular exercises every other day, takes no medication, has no allergies, and eats mainly a vegetarian diet with fish and chicken one to two times each week. Which factor is the most important consideration in determining the status of the client's immune system? a. Diet b. Gender c. Age d. Environment

b. Gender

What are the primary participants in the immune system? a. Lymphoblasts and gamma globulins b. T- and B- cell lymphocytes c. Macrophages and memory cells d. Stem cells and monocytes

b. T- and B- cell lymphocytes

Lymphoid tissues, which perform a function within the immune response, are found throughout the body. While the thymus gland, tonsils and adenoids, spleen, and lymph nodes are lymphoid tissues, where else in the body can lymphoid tissues be found? Select all that apply. a. brain b. intestines c. lungs d. kidneys e. stomach

b. intestines c. lungs

Client is presenting an anaphylactic response to unknowingly ingesting nuts at a family celebration. What action is of primary importance upon admission? a. induce vomiting to rid body of allergen b. maintain airway c. encourage fluids to dilute allergen d. None of the options is correct.

b. maintain airway

Patients with systemic lupus erythematosus (SLE) are likely to manifest a _________-shaped rash across the bridge of the nose and cheeks.

butterfly

A client is undergoing testing to determine the overall function of her immune system. Which test will best identify the functioning of the client's cellular immune system? a. Total serum globulin assessment b. Immunoglobulin testing c. Delayed hypersensitivity skin test d. Specific antibody response

c. Delayed hypersensitivity skin test

A nurse has been administering seasonal influenza vaccinations to the residents of a long-term care facility. One resident has refused the vaccinations, stating that he believes the vaccination to be a cause of influenza infection rather than a protection against it. The nurse's response to this resident should encompass which of the following facts about vaccination? a. Vaccination against influenza means that future exposure does not require an immune response. b. Vaccination confers life-long immunity against influenza. c. Vaccination prompts the body to produce antibodies against influenza. d. A vaccine is directly cytotoxic to the influenza virus.

c. Vaccination prompts the body to produce antibodies against influenza.

A client with rheumatoid arthritis informs the nurse that since he has been in remission and not having any symptoms, he doesn't need to take his medication any longer. What is the best response by the nurse? a. "If you don't take your medication, you will become very ill." b. "Be sure to let the physician know after you stop your medications." c. "As long as you are not having symptoms, you can take a medication vacation." d. "It is important that you continue to take your medication to avoid an acute exacerbation."

d. "It is important that you continue to take your medication to avoid an acute exacerbation."

During a mumps outbreak at a local school, a patient, who is a school teacher, is exposed. She has previously been immunized for mumps. What type of immunity does she possess? a. Humoral immunity b. Natural immunity c. Phagocytic immunity d. Acquired immunity

d. Acquired immunity

The nurse is caring for an older client admitted to the health-care facility with a new onset of confusion and a low-grade fever. Which age-related changes might contribute to decreased functioning of the immune system? a. Increased ciliary action b. Thickening of the skin c. Increased gastric secretions d. Decreased kidney function

d. Decreased kidney function

A neonate exhibited some preliminary signs of infection, but the infant's condition resolved spontaneously prior to discharge home from the hospital. This infant's recovery was most likely due to what type of immunity? a. Active acquired immunity b. Specific immunity c. Cytokine immunity d. Nonspecific immunity

d. Nonspecific immunity

The nurse is completing a focused assessment addressing a client's immune function. What should the nurse prioritize in the physical assessment? a. Percussion of the client's abdomen b. Palpation of the client's liver c. Auscultation of the client's apical heart rate d. Palpation of the client's lymph nodes

d. Palpation of the client's lymph nodes

Why would it be important for the nurse to question the client about sexual practices, history of substance abuse, and his lifestyle during the interview process? a. To determine if the client needs a referral to counseling services b. To find out if the client will be compliant with therapeutic treatments c. To determine what type of personality the client has d. To determine if the client has practices that put him at risk for acquired immunodeficiency syndrome (AIDS)

d. To determine if the client has practices that put him at risk for acquired immunodeficiency syndrome (AIDS)

A client has recently been diagnosed with rheumatoid arthritis, and is also receiving further testing for disorders of the immune system. The client works as an aide at a facility caring for children infected with AIDS. Which factors will hold significant implications during the client's assessment? Select all that apply. a. diet b. age c. Her home environment d. history of immunizations and allergies e. work environment f. use of other drugs

d. history of immunizations and allergies e. work environment f. use of other drugs

1. Three distinct characteristics of the pathophysiology of rheumatic diseases are inflammation, autoimmunity, and ______________.

degeneration

The most definitive indicator of rheumatoid arthritis is the rheumatoid factor which is present in 100% of all diagnosed patients. (true/false)

false

human leukocyte antigen (HLA) genes

has been linked to the immune response and the development of multiple rheumatologic diseases

disease-modifying antirheumatic drugs (DMARDs)

have the ability to suppress the autoimmune response; alter disease progression; and stop or decrease further tissue damage on the joints, cartilage, and organs. DMARDs have been found to halt the progression of bone loss and destruction and can induce remission

Three distinct characteristics of pathophysiology

inflammation, autoimmunity, and degeneration.

_______________, a noninflammatory degenerative disorder of the joints, which is the most common form of joint disease, is routinely referred to as degenerative joint disease.

osteoarthritis

The major goal when caring for a patient with rheumatic disease is ____________.

pain control

what is the most common symptom in rheumatic diseases?

pain; Other common symptoms include joint swelling, limited movement, stiffness, weakness, and fatigue.

In degenerative rheumatic diseases, inflammation also occurs, but as a __________ process

secondary

The autoimmune reaction that causes rheumatoid arthritis originates in the ______________ tissue.

synovial

Gout is the most common form of inflammatory arthritis.

true- it is the most common form

Risk factors for osteoarthritis and its progression include older age, female gender, and obesity.

true- these are risk factors

Alkylating agents and purine analogues are the first line of pharmacologic therapy for people with systemic lupus erythematous because of their effect on overall immune function. (true/false)

true- these are the first line of pharmacologic therapy for SLE

A hallmark of rheumatologic diseases is autoimmunity, where the body mistakenly recognizes its own tissue as a foreign pathogen (antigen). (true/false)

true- this is a hallmark

in general, women are ___ __ _____ times more ____________ affected by rheumatologic diseases than men

two to nine; commonly

A hallmark of rheumatologic diseases is autoimmunity, what is it?

where the body mistakenly recognizes its own tissue as a foreign antigen.