NURS Clinical Science Exam 2 Prep - Rheumatoid arthritis

What is rheumatoid arthritis?

chornic, progressive, systemic inflammatory, autoimmune process

What does rheumatoid arthritis affect?

synovial joints

What are characteristics of RA?

remissions and exacerbations

What is the result of rheumatoid arthritis?

disfigurmet and inflammation of multiple joints

What are autoantibodies?

rheumatoid factors; activate inflammatory response in joints

What is etiology and genetic risk of RA?

combination of environmental and genetic factors

What is linked to RA exacerbations?

physical and emotional stresses

How many people are affected by RA?

1.5 million people

Who is most at risk of getting RA?

euro-american people; women 2-3 times more liekkly to have RA than men

What is history assessment of RA?

acute and severe, or slow and progressive

What are physical assessment/signs and symptoms?

joint and systemic symptoms, generalized weakness and fatigue, morning stiffness, advanced disease symptoms

When is RA most intense?

mornings; progresses as the day goes on

What is commonly seen in RA?

joint stiffness and pain, swollen joints-tender-warm

Where does inflammation occur in RA?

synovium-synovial membrane thickens and envelope’s the cartilage

What are systemic manifestations of RA?

fever, weakness, fatigue, weight loss, think skin, scleritis, corneal ulcers, vasculitis and nodules under the skin

What is associated with RA?

pulmonary disease and pericarditis

What are lab assessments for RA?

RF, anti-CCP, ANA, ESR, hsCRP

What are diagnositc assessments for RA?

x-rays, CT scan, arthrocentesis

What is initially prescribed for RA?

NSAIDs

What med. is given for severe inflammation?

corticosteroids

What is treatment for RA?

relieve symptoms-reduce pain, maintain joint function, minimize systemic involvement/disability, delay progression of disease, nondrug measures, reduce inflammation

What are nondrug measures for RA?

PT; massage, warm beaths, heat to affected areas, exercise, surgery-joint replacements

What are classes of antiarthritic drugs?

NSAIDs, DMARDs, glucocorticoids

What are glucocortiocids?

used for flare ups not long term

What are major nonbiological DMARDs?

methotrexate, sulfasalazine

What is the most rapid-acting DMARD?

methotrexate

What is the therapeutic effect of methotrexate?

3-6 weeks

What are adverse effects of methotrexate?

hepatic fibrosis, bone marrow suppression, GI ulceration, pneumonitis

What is nurse education for methotrexate?

need to be drinking 2-3 L of water each day

What is sulfasalazine?

used to treat inflammatory bowel disease (IBD); now used for RA as well

What are the actions of sulfasalazine?

anti-inflammatory and immunomodulatory

How does sulfasalazine affect RA?

slow progression of joint deterioration

What are side effects of sulfasalzine?

GI; may be intolerable

What are major nonbiologic DMARDs?

lefulnomide, hydroxychloroquine, minocycline, penicillamine, azathiprine, cyclosporine, prosorba column

What is hydroxychlorquine (plaquenil)?

used with methotrexate; causes photophobia, prototype drug

What is the MOA of plaquenil?

relieves severe inflammation of arthritis and lupus

What is the primary use of disease-modifying antirhuyematic drugs?

for RA and lupus erythematosus

What patients are prescirbed disease-modifying antirheumatic drugs?

those have not responded well to other anti-inflammatory drugs

What are adverse effects of DMARDs?

anorexia, GI disturbances, loss of hair, possible ocular effects, headaches, mood and mental changes

What labs should be performed when on DMARDs?

CBC and liver function test

How often should labs be taken when on DMARDs?

at least 3 months inititally, aand every 203 months thereafter

What labs/exams should be taken when on hydroxychloroquine?

comprehensive ohpthalmology exam, including visual field testing and ocular coherence tomography

How often should labs/exams should taken when on hydroxychloroquine?

tested at baseline, at 5 years, and then annually

What should be performed on patients on tocilizuman, tofacitinib, and sarilumab?

lipid panel test

How often should a lipid panel be taken?

monitored at baseline, and then every 3 months for at least 6 months

What should be closely monitored when on DMARDs?

liver for renal insufficiency; AST and ALT

Why is etanercept used?

moderate to severe RA

What are adverse effects of etanercept?

serious infections, severe allergic reactions, heart failure, hematologic disorfers, liver injury, CNS demyelinating disorders

What is the therapeutic calss of adalimuma (Humira)?

DMARD, drug for psoriasis, drug for infalmmaotry bowel disease

What is the pahrmacologic class of humira?

TNF antagonist

What is Humira?

first human monoclonal antibody approved by the FDA to treat RA

What is the administration of humira?

subq route, every other week

What is nursing education for humira?

practice injecting with a healthcare provider peresent before attempting to use this drug

Where is humira stored?

refrigerator and allow to warm to room temp. before injecting

What is the onset of humor?

4-5 weeks

What is the peak of humira?

5 days

What is the duration of humira?

10-20 days

What are priority collaborative problems for patient with RA?

chronic inflammation and persistent pain, potential for decreased mobility, potential for decreased self-esteem

What is planning nad implementation for RA?

managing chronic inflammation and pain (drug therapy), promoting mobility, enhancing self-esteem

What is care coordination and transition management for RA?

home care management, self-management education, health care resources