Bloodwork for Rheumatic Diseases
Which two blood studies test for inflammation?
CRP (C-Reactive Protein) and ESR (Erythrocyte sedimentation rate)
What education should you provide for someone who will start taking methotrexate for their RA?
Monitor CBC, liver enzymes, creatinine at 6 weeks after initiation, advise client to use contraceptives measures due to teratogenicity, monitor bone marrow suppression, high risk of infections.
Medication can be given PO, IM, SQ
Which interventions could be used to address fatigue in a client with a rheumatic disorder?
Sleep hygiene- for example, effective bedtimes routines
Energy conservation techniques- for example use of assistive devices, relaxation, time management strategies in daily activities, alternate rest and activity
Exercise- for example stretching exercises, aerobic, muscle conditioning; PT/OT
A nutritious diet can help counteract fatigue
Chart 34-3, p. 1076
What are three clinical manifestations of SLE? (Not butterfly rash)
Skin- erythematosus papules; discoid rash, fingertip lesions, oral ulcers, alopecia
Joint pain
Cardiac- pericardial friction rub, myocarditis, hypertension, cardiac arrythmia
Nephritis
CNS- psychosis, seizures, strokes, neuropathies
T/F: Prostaglandins produce vasodilation, increased permeability, pain, and inflammation.
True; they are a primary mediator
True/False: Rheumatoid factor is a test used to specifically diagnose rheumatoid arthritis
False- Positive RF may suggest RA, SLE, Sjogren's syndrome or mixed connective tissue disease.
True/False: DMARDs may be taken concurrently with NSAIDs.
True
Remember: DMARDS are slow acting
Which non-pharmacologic method can be used to relieve pain, stiffness and muscle spasms?
Heat applications- examples are warm tub baths/shower, warm moist compresses, paraffin baths
Maximum benefit achieved within 20minutes after application
Which disorder has the clinical manifestations of kerotoconjunctivitis, xerostomia, and vaginal dryness?
Sjogren's Syndrome
Transfusion reaction, myasthenia gravis, and Goodpasture syndrome fall under which Type of Hypersensitivity?
Type II Cytotoxic reaction (involves binding IgG and IgM); mistaken identity
What does a positive antinuclear antibody (ANA) indicate?
Positive test may ne associated with SLE, RA, scleroderma, Raynaud's disease, Sjogren's syndrome
Remember: Anti-DNA test would be used to confirm a positive ANA for SLE
What education will you provide for a client starting a regimen of meloxicam?
Meloxicam (NSAIDs) should be administered with food.
Monitor for GI bleed, peptic ulcers, cardiovascular event, renal (nephrotoxic) , CNS (watch for confusion in older adults)
Examples of NSAIDs: diclofenac, ketoprofen, ibuprofen, naproxen, meloxicam, etc.
What are some sleep hygiene practices?
Establish a set time to sleep and wake-up; quiet environment; comfortable room temperature; avoid alcohol and caffeine; relaxation exercises; get out of bed to read, etc.
What does CREST stand for in scleroderma?
C- calcinosis, R- Raynaud's, E- esophageal hardening, S- sclerodactyly, T- telangiectasia
Which medications should be stopped 48-96 hours prior allergy testing?
Corticosteroids, antihistamines, OTC allergy medications
Remember: It can suppress the reaction
True/False: Increased levels of immunoglobulins are found in clients with autoimmune disorders.
True
Which DMARD should not be used for clients with sulfa allergies?
Sulfasalazine
What are examples of topical analgesics that could be used to address joint pain?
Capsaicin, methylsalycylate, topical diclofenac sodium gel
Which gout medication is used to address an acute attack?
Colchicine- lowers deposits of uric acid and reduces inflammation; relieves pain
What are three of the most common causes of anaphylaxis?
Food- peanuts, tree nuts, fish, milk, eggs, soy
Medications- antibiotics (penicillin, sulfa), allopurinol. aspirin, NSAIDs
Animal Serums
Insect stings- bees, wasps, hornets, ants
Latex
Chart 33-2, p. 1046
Which two blood values can be seen decreased in clients with chronic inflammation?
Erythrocyte count and Hematocrit
Remember: Anemia of chronic disease, examples RA, SLE
Which DMARD can cause visual changes and requires ophthalmologic examinations every 6-12months?
Hydroxychloroquine (antimalarial) used for RA and SLE
What are some adverse effects from corticosteroid use?
Cataracts, GI irritation, hyperglycemia, hypertension, fractures, avascular necrosis, psychosis
Which tricyclic antidepressant can be used as sleep hygiene measure to improve and restore normal sleep?
Amitriptyline
Remember: addresses depression, pain, sleep
What are contraindications for first generation antihistamines?
Third trimester pregnancy; lactation
Glaucoma, asthma, BPH, hypertension,
Caution with older patients
p.1051