NR 601 Chamberlain Older Adults questions with
verified answers
Ans✓✓✓ Difference between Rheumatoid and Osteoarthritis RA OA Autoreactive
Rheumatoid is autoreactive inflammatory pathology can be associated with other
autoimmune disorders such as, systemic lupus erythematosus, and other
inflammatory arthritides in OA articular cartilage is thought to be initially
damaged due to repetitive microtrauma or a single inciting macro-traumatic
event. RA-PIP and DIP for OA-DIP joints RA: symptoms worse in the am and get
better throughout the day symptoms get worse throughout the day due to
overuse of the joints RA: warmth, erythema. OA: enlargement of joints-usually
not warm to touch. RA: twisting of joints. OA: enlargement of joints/crepitus
MIDTERM STUDY GUIDE FOR NR 601-AGING ADULT 49 RA; random timing (flare
ups), fever, malaise, vasculitis, cysts (fluid filled sacs). OA: slow onset and severity
gets worse over time OA: cartilage destruction (it breaks off into pieces and floats
around into the synovial space "joint mice" RA: pannus (granulation tissue from
inflammatory response) in the synovium which leads to contraction, "fusion" of
the bones (ankylosing), pulling and deformities in the PIP joints. bone surface
polishing causes the crepitus, osteophytes (bone spurts grow out of the surface
and are calcium deposits These calcium deposits lead to formation of Bourchard's
nodes PIP and Heberden's nodes DIP RA: elevated RF (IgM) antibody can point to
inflammation, synovial fluid will be high in neutrophils d/t inflammatory response.
• Disease modifying antirheumatic drugs-decreases joint damage 1 st line DMARD
• steroids anti-inflammatory, NSAIDS, pain control • pain control acetaminophen
1st line • NSAIDS, steroid injections into the joint, analgesic injection into the joint
• Surgery • Lifestyle modification, weight loss • PT (physical therapy)-build muscle
bc they atrophy
*Barriers, facilitators, and contraindications to exercise: Ans✓✓✓ Barriers
■ Lack of time
■ Perceived need for equipment
■ Perceived barrier to beginning exercise/physical activity
,■ Disability or functional limitation
■ Unsafe neighborhood or weather conditions
■ No parks or walking trails
■ Depression
■ High body mass index (BMI)
■ Lack of motivation
■ Interpersonal loss or significant life event
■ Ignorance of what to do
Patient Facilitators
■ Social support
■ Positive self-efficacy
■ Motivation to engage in physical activity
■ Good health, no functional limitations
■ Frequent contact with prescriber
■ Regular schedule, planned program
■ Satisfaction with program
■ Insurance incentive
■ Improvement in mobility or health condition
■ Staff
Contraindications
■ Unstable angina
■ Uncompensated heart failure
■ Severe anemia
■ Uncontrolled blood glucose
,■ Unstable aortic aneurysm
■ Uncontrolled hypertension or tachycardia
■ Severe dehydration or heat stroke
■ Low oxygen saturation
*Recommended testing prior to exercise initiation: Ans✓✓✓ None for all adults
who do not have symptoms and have not been diagnosed with chronic disease
such as OA, diabetes, heart disease
• Patients with chronic conditions: need to consult with health care professional
• Men over 45 and women over 55 who are considering a vigorous program need
to screening and routine stress testing
• Sedentary older adults and adults with cardiac disease/or strong risk factors
need screening and stress test before undertaking vigorous exercise program
1 st line tx OA: Ans✓✓✓ • In noninflammatory OA, acetaminophen is the
medication of choice in doses of 2 to 3 g per day
• nonpharmacological therapies, such as walking
• Water therapy has been shown to improve the function of patients with OA
with no evidence of inflammation
• For patients who are not getting relief from acetaminophen and exercise, the
cyclooxygenase type 2 (COX-2) selective agents: celecoxib 50 to 100 mg PO twice
daily
• Selection of a nonselective NSAID should be based on dosing frequency, toxicity
potential, and cost to the patient
• NSAIDS should be avoided in older adults with a calculated creatinine clearance
less than 35 ml/min.
• codeine and oxycodone can be used for patients with severe OA pain or those
who cannot tolerate NSAIDS
, • glucosamine and chondroitin sulfate (1,500 mg/1,200 mg per day) may relieve
the pain of OA
• Capsaicin cream 25% applied twice daily to the affected joint has also been
shown to reduce pain
• Viscosupplementation is another nonpharmacological option for patients with
OA; an intraarticular injection of the highly viscous joint lubrication has been
shown to be effective for 6 months.
• topical diclofenac sodium gel (DSG) 1% for OA of the hand was found to relieve
the local arthritic pain.
• Mediterranean diet was found to have a lower prevalence of OA of the knee.
• physical therapy for muscle strengthening, particularly quadriceps
strengthening for patients with knee OA
• Heat, ice, or ultrasound may be applied locally to decrease pain.
• For hand osteoarthritis, the ACR conditionally recommends using one or more
of the following:
• Topical capsaicin
• Topical NSAIDs
• Oral NSAIDs
• Tramadol The ACR conditionally recommends against using intra-articular
therapies or opioid analgesics for hand OA. For patients 75 years and older, the
ACR conditionally recommends the use of topical, rather th
1. Chronic insomnia Ans✓✓✓ Thorough family hx (inc. sleep problems), A
validated self-administered instrument, such as the Epworth Sleepiness Scale or
Stanford Sleepiness Scale, sleep diary, interrogate sleep partner (if any), If sleep
apnea is suspected, refer for polysomnography, review sleep hygiene tips
(Combined, sleep hygiene instruction and cognitive behavioral therapy are more
effective than either modality alone or usual treatment), music therapy, aerobic
exercise
verified answers
Ans✓✓✓ Difference between Rheumatoid and Osteoarthritis RA OA Autoreactive
Rheumatoid is autoreactive inflammatory pathology can be associated with other
autoimmune disorders such as, systemic lupus erythematosus, and other
inflammatory arthritides in OA articular cartilage is thought to be initially
damaged due to repetitive microtrauma or a single inciting macro-traumatic
event. RA-PIP and DIP for OA-DIP joints RA: symptoms worse in the am and get
better throughout the day symptoms get worse throughout the day due to
overuse of the joints RA: warmth, erythema. OA: enlargement of joints-usually
not warm to touch. RA: twisting of joints. OA: enlargement of joints/crepitus
MIDTERM STUDY GUIDE FOR NR 601-AGING ADULT 49 RA; random timing (flare
ups), fever, malaise, vasculitis, cysts (fluid filled sacs). OA: slow onset and severity
gets worse over time OA: cartilage destruction (it breaks off into pieces and floats
around into the synovial space "joint mice" RA: pannus (granulation tissue from
inflammatory response) in the synovium which leads to contraction, "fusion" of
the bones (ankylosing), pulling and deformities in the PIP joints. bone surface
polishing causes the crepitus, osteophytes (bone spurts grow out of the surface
and are calcium deposits These calcium deposits lead to formation of Bourchard's
nodes PIP and Heberden's nodes DIP RA: elevated RF (IgM) antibody can point to
inflammation, synovial fluid will be high in neutrophils d/t inflammatory response.
• Disease modifying antirheumatic drugs-decreases joint damage 1 st line DMARD
• steroids anti-inflammatory, NSAIDS, pain control • pain control acetaminophen
1st line • NSAIDS, steroid injections into the joint, analgesic injection into the joint
• Surgery • Lifestyle modification, weight loss • PT (physical therapy)-build muscle
bc they atrophy
*Barriers, facilitators, and contraindications to exercise: Ans✓✓✓ Barriers
■ Lack of time
■ Perceived need for equipment
■ Perceived barrier to beginning exercise/physical activity
,■ Disability or functional limitation
■ Unsafe neighborhood or weather conditions
■ No parks or walking trails
■ Depression
■ High body mass index (BMI)
■ Lack of motivation
■ Interpersonal loss or significant life event
■ Ignorance of what to do
Patient Facilitators
■ Social support
■ Positive self-efficacy
■ Motivation to engage in physical activity
■ Good health, no functional limitations
■ Frequent contact with prescriber
■ Regular schedule, planned program
■ Satisfaction with program
■ Insurance incentive
■ Improvement in mobility or health condition
■ Staff
Contraindications
■ Unstable angina
■ Uncompensated heart failure
■ Severe anemia
■ Uncontrolled blood glucose
,■ Unstable aortic aneurysm
■ Uncontrolled hypertension or tachycardia
■ Severe dehydration or heat stroke
■ Low oxygen saturation
*Recommended testing prior to exercise initiation: Ans✓✓✓ None for all adults
who do not have symptoms and have not been diagnosed with chronic disease
such as OA, diabetes, heart disease
• Patients with chronic conditions: need to consult with health care professional
• Men over 45 and women over 55 who are considering a vigorous program need
to screening and routine stress testing
• Sedentary older adults and adults with cardiac disease/or strong risk factors
need screening and stress test before undertaking vigorous exercise program
1 st line tx OA: Ans✓✓✓ • In noninflammatory OA, acetaminophen is the
medication of choice in doses of 2 to 3 g per day
• nonpharmacological therapies, such as walking
• Water therapy has been shown to improve the function of patients with OA
with no evidence of inflammation
• For patients who are not getting relief from acetaminophen and exercise, the
cyclooxygenase type 2 (COX-2) selective agents: celecoxib 50 to 100 mg PO twice
daily
• Selection of a nonselective NSAID should be based on dosing frequency, toxicity
potential, and cost to the patient
• NSAIDS should be avoided in older adults with a calculated creatinine clearance
less than 35 ml/min.
• codeine and oxycodone can be used for patients with severe OA pain or those
who cannot tolerate NSAIDS
, • glucosamine and chondroitin sulfate (1,500 mg/1,200 mg per day) may relieve
the pain of OA
• Capsaicin cream 25% applied twice daily to the affected joint has also been
shown to reduce pain
• Viscosupplementation is another nonpharmacological option for patients with
OA; an intraarticular injection of the highly viscous joint lubrication has been
shown to be effective for 6 months.
• topical diclofenac sodium gel (DSG) 1% for OA of the hand was found to relieve
the local arthritic pain.
• Mediterranean diet was found to have a lower prevalence of OA of the knee.
• physical therapy for muscle strengthening, particularly quadriceps
strengthening for patients with knee OA
• Heat, ice, or ultrasound may be applied locally to decrease pain.
• For hand osteoarthritis, the ACR conditionally recommends using one or more
of the following:
• Topical capsaicin
• Topical NSAIDs
• Oral NSAIDs
• Tramadol The ACR conditionally recommends against using intra-articular
therapies or opioid analgesics for hand OA. For patients 75 years and older, the
ACR conditionally recommends the use of topical, rather th
1. Chronic insomnia Ans✓✓✓ Thorough family hx (inc. sleep problems), A
validated self-administered instrument, such as the Epworth Sleepiness Scale or
Stanford Sleepiness Scale, sleep diary, interrogate sleep partner (if any), If sleep
apnea is suspected, refer for polysomnography, review sleep hygiene tips
(Combined, sleep hygiene instruction and cognitive behavioral therapy are more
effective than either modality alone or usual treatment), music therapy, aerobic
exercise
