Rheumatoid arthritis
True or False
RA targets the synovial joints in patients of any age, it is not systemic and is chronic inflammation primarily in males.
False
- RA is systemic -> can affect whole body
- is mainly seen in females
- true: any age, chronic inflammation
* is the only one common in children though!
When giving education to a patient with scleroderma, you tell them they should be using ___ to control skin dryness.
They should also be considerate of their lower extremities by ?
lotion!
warm socks and good shoes
- avoid extreme temp -> affects skin more
Which patient is at highest risk for SLE?
A. Older adult male smoker
B. Young African American woman
C. Child with malnutrition
D. Middle-aged man with osteoarthritis
B. Young african american woman
- SLE can happen at any age but typically 15-44 y/o
3. Which patient is most at risk for scleroderma?
A. Young male athlete
B. Middle-aged woman
C. Child with asthma
D. Elderly man with gout
B. Middle-aged woman
- is genetic (HLA) gene + environmental
- Females , 30-50 y/o
A patient with scleroderma asks about cure. What is the best response?
There is no cure, only treatment to manage symptoms and prevent complications
A nurse is explaining RA to a client, what would they say?
RA is an autoimmune disease that targets the synovial tissue in joints
- do not confuse with osteoarthritis which stems from old age
When do you use cold therapy vs heat therapy?
Which would be more appropriate for joint stiffness in RA patients?
cold -> right after injury
heat -> wait 48-72 hours after injury
heat is more appropriate -> decreases stiffness, promote ROM, increase synovial fluid
A nurse is explaining SLE to their client , what would they say?
SLE is an autoimmune disease where antigen-antibody complexes travel through the body and clot + activate the complement cascade (inflam. + cell damage)
True or False
ANA results are the best diagnostic to diagnose scleroderma
False
The best way to diagnose is taking a good history and assessments
- esophageal study
True or false
Cold and Heat therapy should be put for 1 hour on and 1 hour off?
False
20 min on, 1 hour off
What are the 7 S's of signs and symptoms of RA?
Sunrise stiffness lasting > 1 hour
Swelling in joint
Symmetrical
Synovitis
Soft feeling in joints
Systemic -> can affect CV and RR
Stages (patho)
Why would deep breathing using an incentive spirometer be a part of nursing considerations for SLE patients?
being on bed rest aka immobility puts them at risk for atelectasis
other priorities : schedule activities/cluster care, skin integrity, comfort measures
What s/s can you remember about SLE? there's one main one
Butterfly rash / malar rash
persistent fever > 100
joint pain + fatigue
Raynaud's syndrome -> decreased blood flow
Alopecia, pleurisy, pericarditis
What is scleroderma?
What are the 2 types?
Scleroderma is the chronic hardening of skin from excess collagen
1. localized -> cutaneous (hands, arm, face) mainly in children
2. systemic -> large area of skin + 1 or more organs
A patient presents with joint pain and says they have a rash developing on their cheeks, what disease is most likely the underlying problem?
SLE
For medical management of RA, there'a a couple choices depending on severity, ___ to control inflammation and pain, then ____ to suppress immune response/inflam. response.
In more severe cases what other medications would you use?
NSAID to control inflammation
DMARDs to suppress immune response/inflam. response
- watch for infection! these suppress immune sys.
- corticosteroids suppress immune system
- biologic DMARDs + immunosuppressants most severe / last resort
What would be the nursing interventions for scleroderma?
- monitor ?
monitor I/O
monitor changes in VS
*monitor changes in swallowing!
skin integrity
monitor activity tolerance
What are some SLE triggers for flare ups? name 3
*stress and overheating!!
emotional crisis
*overworked
*exposure to sun
infection, meds, vaccine
sudden withdrawal
The acronym CREST describes s/s of scleroderma, what does it stand for? gosh kill me now
Calcinosis ( Ca in skin)
Raynauds
Esophageal dysfunction (acid reflux)
Sclerodactyly (tight skin on hands)
Telangiectasia (red dots on skin/face)
Which of our disease processes would difficulty swallowing be an expected s/s?
What would be educate this patient on if they state they have cold/pale fingers?
Scleroderma
- keep extremities warm -> prevent raynauds syndrome attacks
Taking into consideration the severity of the medications for RA and the affect that can have on body systems, what are 2 important labs to monitor?
Creatinine -> kidneys expel waste from the body
Hgb -> chronic inflammation causes iron to be trapped -> decreases RBC production in liver
what are the 3 stages of RA?
Starting : synovial inflammation -> cartilage breakdown -> ...
Pannus (complete loss of synovium)
Fibrous ankylosis ( connective tissue forms in joint)
Bony ankylosis (bone fuses)
SLE treatment is dependent on severity!
No major organ involvement treatments? name 2
Major organ involvement treatments? name 3
1. antimalarials, NSAIDs! also low dose steroids
2. corticosteroids, immunosuppressants, monoclonal antibodies!
Despite scleroderma being an autoimmune disease targeting skin, it can have systemic effects on what body system?
Cardiac!
- causes hypertension
- excess Ca+ -> treat with Ca+ channel blocker
An RA patient develops chest pain and shortness of breath, what serious complications should you consider?
Since RA is systemic, the inflammation can affect other body system, in this case a common comorbidity of RA is pericarditis