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47 Cards in this Set
- Front
- Back
many clients with musculoskeletal disorders can be treated (out, in) |
outpatient |
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subtle changes in geriatric client that must not be overlooked which would delay treatment |
generalized pain cognitive changes depression fatique |
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arthritis |
general condition characterized by inflammation and degeneration of a joint |
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orthopedic problem
connective tissue structures , especially joints |
Rheumatoid disorders |
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RA is a systemic inflammatory disorder of tissue /joints characterized by 3 |
-chronic -remissions -exacerbations |
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potential for disability with RA is great because 2 |
effects on joints effects on other systems |
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theories of cause RA 3 |
-cause unknown -believed to be autoimmune disease -genetic predisposition |
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characteristics of RA 5 |
-affects women more than men -20-40 years of age onset usually -incidences equal with gender as people get older -crippling disease, affects daily life -periods of exacerbations and remissions |
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general SOS of RA |
-joint pain (come and go ) -swelling (come and go) -warmth -erythema (redness) -fever maybe -fatigue -malaise -anorexia -low tolerance for stress -sensitive to temperature changes |
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why does a client with RA develop Anemia |
effects of RA on the blood-forming organs |
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Sjogren's syndrome |
dry eyes and mucous membranes |
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other systemic changes with RA |
-vasculitis (inflammation of blood vessels) -neuropathy (numb, pain from nerve damage) -scleritis (inflammation of sclera) -pericarditis (inflammation of pericardium) -splenomegaly (enlarged spleen) -Sjogren's syndrome (dry eyes mucous membrane) |
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specific SOS of RA (late SOS ) 5 |
-subcutanous nodules, stiff and movable over bony prominences -muscles weaken and atrophy -smooth , glossy , cold clammy extremities -flexion contractures -proximal finger joints swell and deform |
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swan neck deformity |
hyperextension of the proximal PIP joint with fixed flexion of the distal DIP joint |
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Boutonniere deformity |
persistent flexion of the PIP joint with hyperextension of the DIP joint |
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Ulnar deviation |
fingers deviating laterally toward the ulna |
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subcutaneous nodules from RA |
firm, freely moveable , rubbery or granular nodules caused by deposit |
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synovial cysts from RA |
baker's cysts in popliteal fossa. filled with synovial fluid that may be found in a periarticular areas in elbow, shoulder, or small joints |
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arthritis from RA |
bilateral involvement of the small joints and later the large joints. swollen, red , inflammation, flexion contractures are common |
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systemic rhematoid vasculitis From RA |
immune complex-mediated inflammation in arteries. life threatening if in critical areas. causes lesions. necrosis. |
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compression neuropathy from RA |
mainly causes peripheral nerve entrapment with carpal tunnel syndrome. paresthesias, pain, burning, muscle wasting, weakness common symptoms |
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cardiac disease from RA |
pericardial lesions and effusions common and may or may not be symptomatic. conduction blockages due to rheumatic nodules may cause heart block |
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pleuropulmonary disease from RA |
pleural effusions or pleuritic pain common. pulmonary fibrosis or or lung disease common |
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episcleritis RA |
inflammatory condition of the connective tissue between the sclera and conjuctiva |
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sclera with RA |
inflammatory condition of the sclera that can cause sceral perforation |
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sicca syndrome with RA |
condition of dry eyes and dry mouth that can result from infilteration of the lacrimal and salivary glands with lymphocytes |
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ulnar deviation, boutonniere deformity , swan neck deformity with RA are usually found in |
the PIP joints mostly |
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chronic pain with RA is usually worse at this time of day |
morning after a night's rest |
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in RA joints lose motion over time because |
each exacerbation causes more inflammation which leads to more joint damage, pannus (desctructive granular tissue) fills joint margins leading to anklylosis (joint immobility ) . contraction and joint immobility are common |
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in arthrocentesis the synovial fluid for RA |
cloudy milky dark yellow contains leukocytes and complement proteins |
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X ray for RA show 3 |
-joint changes -narrowed joint spaces -bony erosions |
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with RA C4 complement protein level |
decreased |
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ESR with RA level |
elevated |
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two tests that strongly suppport RA diagnoses |
positive CRP test positive RF findings |
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treatment for RA 5 things for RA |
-no cure -decrease joint damage by decreasing inflammation before ankylosis occurs -relieve discomfort -restoring function of affected structures -preventing or correcting deformities |
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to reduce episodes for RA the nurse would suggest 4 |
-optimal health conditions to reduce inflammation -total body rest and joint rest -balance rest with exercise -do not need to modify diet unless other disease present, it will not help |
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nutrition with RA
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-no nutrition can prevent RA or cure it -eat Omega 3 fatty acid found in fish , mackeral, herring, salmon , flax seed oils, canolla inhibit prostaglandins for inflammation, no fish oil supplements -monitor for weight changes, malnutrition common -discourage quack cures |
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when client have joint and bone disease and start to feel better nurse teaching for drugs should include |
do not stop taking the medication without first consulting with your doctor |
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arthroplasty |
tx for RA for joint deformity -reconstruction of the joint using an artificial joint . restores lost function and relieves pain. |
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synovectomy |
a tx for or relief of joint pain. remove the lining of the joint , surgery |
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TENS unit |
transutaneous electrical nerve stimulation to relieve pain in a particular joint. portable machine that has electrodes that the client attaches to skin , can be used for RA |
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nurse management for RA 6 |
-maintain optimal health -relieving pain techniques -reducing stress -decreasing the inflammatory process -medication regimen -hot and cold technique to relieve pain, tens |
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nurse care in home setting RA |
-teaches to use extra time for ADL -providing nurse assistance for ADL -make sure home environment safe -collaborates with PT for exercise regimen and aids , using aids, aquiring them -teaches about energy consumption to promote restful periods -educate client about disease so they don't spend a fortune on quack cures -help client cope with physical changes and limited mobility |
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when joints are severely inflamed the RA clietn should |
use a splint to reduce but not totally eliminate active motion |
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clients with RA should avoid this position |
flexion |
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to prevent ankylosis , muscle wasting, osteoporosis and debilitating effects of long periods of rest the nurse tells client with RA |
to move affected parts gently |
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The most common form of arthritis , wear and tear |
Degenerative joint disease aka osteoarthritis |