NURS 2207 Exam 3: Increasingly Complex
Musculoskeletal And Neurological Disorders: Qs & As
Rheumatoid Arthritis Right Ans - •disease-causing inflammation of
connective tissue, primarily in the joints.
•remission and exacerbation
•Unknown Cause
- Affects women 3x more often than men
prognosis for pts with RA w/o adequate treatment Right Ans - - develop
marked functional impairment within 20 years of diagnosis.
- This includes the need of mobility aids, loss of self-care ability, and need for
joint reconstruction.
patho of RA Right Ans - •starting at the more distal joints.
•Antigen triggers formation of abnormal immunoglobulin G (IgG)
•Autoantibodies develop: Rheumatoid factor (RF) antibodies
•deposit on synovial membranes or cartilage in joints
•inflammatory response
- damage cartilage and thicken synovial lining
- Pannus (a condition in which a layer of vascular fibrous tissue extends over
the surface) destroys the cartilage and erodes the bone. This causes loss of
articular surfaces and joint motions.
RA summary Right Ans - - symmetrical
- extra articular involvement
- inflamed synovium
- morning stiffness lasting > than 30 mins
- autoimmune
Clinical Manifestations Joints Right Ans - •Onset typically insidious
•Joint stiffness with inactivity
•small joints of hand, wrist, and feet
- Palpation reveals spongy and boggy tissue
•MCP and PIP joints typically swollen
•Fingers spindle shaped
,- Tenosynovitis frequently affects the extensor and flexor tendons around the
wrists, producing symptoms of carpal tunnel syndrome and making it difficult
for the patient to grasp objects
•Muscle atrophy and tendon destruction cause one joint surface to slip past
the other (subluxation).
•Metatarsal head dislocation and subluxation in the feet may cause pain and
walking disability.
Typical Deformities of Rheumatoid Arthritis Right Ans - A, Ulnar drift
B, Boutonnière deformity
C, Hallux valgus
D, Swan neck deformity
Clinical Manifestations Extraarticular (Systemic) Manifestations of RA
Right Ans - •Fever, Weight loss, Fatigue
•Anemia
•Lymph node enlargement
•Rheumatoid nodules
•Nodular myositis
•Nodular myositis and muscle fiber degeneration can cause pain like that of
vascular insufficiency. In later disease, nodules in the heart and lungs can
cause pleurisy, pleural effusion, pericarditis, pericardial effusion, and
cardiomyopathy.
•Sjögren's syndrome: dry eyes and dry mucous membranes. - Photosensitivity
•Felty syndrome: an enlarged spleen and low white blood cell (WBC). High
risk for infection
•Flexion contractures
- Depression
diagnosis of RA Right Ans - •Based on a point system of the following
criteria:
•Joint involvement
•Serology
•Acute phase reactants
•Duration of symptoms
•Scores of 6 or greater us required for the diagnosis of RA
diagnostic tests for RA Right Ans - •Anti-CCP blood test
•More specific marker for RA
,•Rheumatoid factors
•Antinuclear antibody (ANA) titers
•C-reactive protein levels
•ESR: 0-22: women; 0-29: men
•CBC
•Identify anemia
•Arthrocentesis: synovial fluid examination- slightly cloudy, milky, dark
yellow, straw-colored fluid with many fibrin flecks.
•MMP-3 is increased in the synovial fluid of the patient with RA and it may be
a marker of progressive joint damage
•WBC count of synovial fluid is elevated (up to 25,000/µL).
•X-Rays
RA Treatment Goals Right Ans - •Decrease joint pain and swelling
•Achieve clinical remission
•Decrease joint deformity
•Minimize disability
med for RA: Nonbiologic (synthetic): •Methotrexate Right Ans - •Usually
1st DMARD used for RA
•GI SE; Monitor for bone marrow suppression and hepatotoxicity
•therapeutic effects within 4 to 6 weeks.
DMARDS med for RA: Nonbiologic (synthetic): •Sulfasalazine (Azulfidine)
Right Ans - •Risk for neutropenia and thrombocytopenia
•Requires frequent CBC
DMARDS med for RA: Nonbiologic (synthetic): •Hydroxychloroquine
(Plaqenil) Right Ans - •Antimalarial agent
•6 months of therapy before effects
•Baseline eye exam with yearly follow up
SE: retinitis and vision loss
DMARDS: Biologic action Right Ans - •Work by interrupting the
inflammatory cascade.
DMARDS Biologic meds Right Ans - •Etanerecpt (Enbrel): SQ
•Infliximab (Remicade)- in combo with methotrexate: IV
•Adalimumab (Humira): SQ
, •Abatacept (Orencia) & Rituximab (Rituxan): Given IV
- No live vaccines during and 3 months after treatment.
- Administer tuberculin test and chest x-ray before starting therapy.
- monitor for s/s of infection and discontinue
Medications to treat RA Right Ans - •NSAIDs/Salicylates
•Opioid analgesics
•Corticosteroids: Low dose oral, Intraarticular corticosteroids
•Antidepressents: Paroxetine (Paxil), Sertraline (Zoloft)
Immunosuppressive Therapy for RA Right Ans - •Cyclosporine
•Sandimmune
•Azathioprine- brings out skin cancer: after 5 years
- Imuran
Gold Salts-Gold Compounds for RA Right Ans - •For patients not
responding to DMARDs
•Gold sodium thiomalate (GST):
•Contains almost 50 percent gold in a water-based solution
•Given IM injection every one to four weeks.
•Auranofin
•gold triethylphosphine compound
•taken orally each day
toxic reactions of gold salts gold compounds Right Ans - •Bone marrow
suppression, proteinuria, and nephrosis
nutritional therapy for RA Right Ans - •Balanced nutrition important
•Loss of appetite or inability to shop for and prepare food → weight loss
•Corticosteroid therapy → weight gain
Surgical Therapy for RA Right Ans - •Relieve severe pain
•Improve function
•Synovectomy
•Total joint replacement (arthroplasty)
Musculoskeletal And Neurological Disorders: Qs & As
Rheumatoid Arthritis Right Ans - •disease-causing inflammation of
connective tissue, primarily in the joints.
•remission and exacerbation
•Unknown Cause
- Affects women 3x more often than men
prognosis for pts with RA w/o adequate treatment Right Ans - - develop
marked functional impairment within 20 years of diagnosis.
- This includes the need of mobility aids, loss of self-care ability, and need for
joint reconstruction.
patho of RA Right Ans - •starting at the more distal joints.
•Antigen triggers formation of abnormal immunoglobulin G (IgG)
•Autoantibodies develop: Rheumatoid factor (RF) antibodies
•deposit on synovial membranes or cartilage in joints
•inflammatory response
- damage cartilage and thicken synovial lining
- Pannus (a condition in which a layer of vascular fibrous tissue extends over
the surface) destroys the cartilage and erodes the bone. This causes loss of
articular surfaces and joint motions.
RA summary Right Ans - - symmetrical
- extra articular involvement
- inflamed synovium
- morning stiffness lasting > than 30 mins
- autoimmune
Clinical Manifestations Joints Right Ans - •Onset typically insidious
•Joint stiffness with inactivity
•small joints of hand, wrist, and feet
- Palpation reveals spongy and boggy tissue
•MCP and PIP joints typically swollen
•Fingers spindle shaped
,- Tenosynovitis frequently affects the extensor and flexor tendons around the
wrists, producing symptoms of carpal tunnel syndrome and making it difficult
for the patient to grasp objects
•Muscle atrophy and tendon destruction cause one joint surface to slip past
the other (subluxation).
•Metatarsal head dislocation and subluxation in the feet may cause pain and
walking disability.
Typical Deformities of Rheumatoid Arthritis Right Ans - A, Ulnar drift
B, Boutonnière deformity
C, Hallux valgus
D, Swan neck deformity
Clinical Manifestations Extraarticular (Systemic) Manifestations of RA
Right Ans - •Fever, Weight loss, Fatigue
•Anemia
•Lymph node enlargement
•Rheumatoid nodules
•Nodular myositis
•Nodular myositis and muscle fiber degeneration can cause pain like that of
vascular insufficiency. In later disease, nodules in the heart and lungs can
cause pleurisy, pleural effusion, pericarditis, pericardial effusion, and
cardiomyopathy.
•Sjögren's syndrome: dry eyes and dry mucous membranes. - Photosensitivity
•Felty syndrome: an enlarged spleen and low white blood cell (WBC). High
risk for infection
•Flexion contractures
- Depression
diagnosis of RA Right Ans - •Based on a point system of the following
criteria:
•Joint involvement
•Serology
•Acute phase reactants
•Duration of symptoms
•Scores of 6 or greater us required for the diagnosis of RA
diagnostic tests for RA Right Ans - •Anti-CCP blood test
•More specific marker for RA
,•Rheumatoid factors
•Antinuclear antibody (ANA) titers
•C-reactive protein levels
•ESR: 0-22: women; 0-29: men
•CBC
•Identify anemia
•Arthrocentesis: synovial fluid examination- slightly cloudy, milky, dark
yellow, straw-colored fluid with many fibrin flecks.
•MMP-3 is increased in the synovial fluid of the patient with RA and it may be
a marker of progressive joint damage
•WBC count of synovial fluid is elevated (up to 25,000/µL).
•X-Rays
RA Treatment Goals Right Ans - •Decrease joint pain and swelling
•Achieve clinical remission
•Decrease joint deformity
•Minimize disability
med for RA: Nonbiologic (synthetic): •Methotrexate Right Ans - •Usually
1st DMARD used for RA
•GI SE; Monitor for bone marrow suppression and hepatotoxicity
•therapeutic effects within 4 to 6 weeks.
DMARDS med for RA: Nonbiologic (synthetic): •Sulfasalazine (Azulfidine)
Right Ans - •Risk for neutropenia and thrombocytopenia
•Requires frequent CBC
DMARDS med for RA: Nonbiologic (synthetic): •Hydroxychloroquine
(Plaqenil) Right Ans - •Antimalarial agent
•6 months of therapy before effects
•Baseline eye exam with yearly follow up
SE: retinitis and vision loss
DMARDS: Biologic action Right Ans - •Work by interrupting the
inflammatory cascade.
DMARDS Biologic meds Right Ans - •Etanerecpt (Enbrel): SQ
•Infliximab (Remicade)- in combo with methotrexate: IV
•Adalimumab (Humira): SQ
, •Abatacept (Orencia) & Rituximab (Rituxan): Given IV
- No live vaccines during and 3 months after treatment.
- Administer tuberculin test and chest x-ray before starting therapy.
- monitor for s/s of infection and discontinue
Medications to treat RA Right Ans - •NSAIDs/Salicylates
•Opioid analgesics
•Corticosteroids: Low dose oral, Intraarticular corticosteroids
•Antidepressents: Paroxetine (Paxil), Sertraline (Zoloft)
Immunosuppressive Therapy for RA Right Ans - •Cyclosporine
•Sandimmune
•Azathioprine- brings out skin cancer: after 5 years
- Imuran
Gold Salts-Gold Compounds for RA Right Ans - •For patients not
responding to DMARDs
•Gold sodium thiomalate (GST):
•Contains almost 50 percent gold in a water-based solution
•Given IM injection every one to four weeks.
•Auranofin
•gold triethylphosphine compound
•taken orally each day
toxic reactions of gold salts gold compounds Right Ans - •Bone marrow
suppression, proteinuria, and nephrosis
nutritional therapy for RA Right Ans - •Balanced nutrition important
•Loss of appetite or inability to shop for and prepare food → weight loss
•Corticosteroid therapy → weight gain
Surgical Therapy for RA Right Ans - •Relieve severe pain
•Improve function
•Synovectomy
•Total joint replacement (arthroplasty)
