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18 Cards in this Set
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- Back
- 3rd side (hint)
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Ankylosing Spondylitis: Pathophysiology |
- Chronic inflammatory disease that primarily affects the axial skeleton, including the sacroiliac joints, intervertebral spaces, and costovertebral articulations. - Inflammation in joints and adjacent tissues causes the formation of granulation tissue (pannus) and the development of dense fibroud scars that lead to joint fusion. - May affect eyes, lungs, heart, kidneys, and PNS |
Axial skeleton |
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Ankylosing Spondylitis: Signs & Symptoms |
- Lower back pain, Stiffness, and limitation of motion that are WORSE during the NIGHT and in the AM, but DECREASE with mild activity. - Systemic: Fever, fatigue, anorexia, weight loss (rare) - Uveitis (intraocular inflammation) |
Activity |
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Ankylosing Spondylitis: Complications |
- Chest pain and sternal/costal cartilage tenderness - Aortic insufficiency and pulmonary fibrosis (frequent) - Cauda equina syndrome (lower extremity weakness and bladder dysfunction) - Risk for spinary fracture (associated osteoporosis) |
Chest, Back, and lower body |
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Ankylosing Spondylitis: Diagnostic Tests |
- Xrays (limited diagnostic tool) - MRI: early cartilage abnormalities - Elevated ESR and mild anemia - HLA-B27 antigen and clinicals signs of AS = increased likelihood |
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Ankylosing Sondylitis: Interprofessional Care |
- Genetics: HLA-B27 positive rheumatic Dz - be aware of sign of lower back pain and arthritis - Good posture & stretching excercises of the back, neck and chest - Hydrotherapy - Surgery (spinal osteotomy and total joint replacement) - Local moist heat - Regular exercise |
Family & nonpharm |
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Ankylosing Spondylitis: Pharmacological |
- NSAIDs & Salicylates - Disease-modifying antirheumatic drugs (DMARDs): sulfasalazine (Azulfidine) or methotrexate - etanercept (Ebnrel) - Anti-TNF agents: infliximab (Remicade), adalimumab (Humira), golimumab (Simponi) |
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Ankylosing Spondylitis: Nursing Management |
- Discourage excessive physical exertion during active inflammation - Smoking cessation - Ongoing physical therapy - Proper positioning at rest is essential; firm mattress, sleep on back with a flat pillow, avoiding position that encourage flexion deformity - Avoid spinal flexion: leaning over desk, heavy lifting, prolonged walking/standing/sitting; ok with swimming or racquet games - Family counseling |
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Carpal Tunnel Syndrome: Pathophysiology |
- Compression of the median nerve - Caused by: pressure from trauma or edema from inflammation of the tendon (tenosynovitis), CA, RA, or soft tissue masses such as ganglion cysts |
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Carpal Tunnel Syndrome: Signs & Symptoms |
- Weakness, pain and numbness, impaired sensation - Clumsiness of fine hand movements - TINEL'S SIGN: tapping of the median nerve; positive - sensation of tingling over hand - PHALEN'S SIGN: wrists fall freely into Max flexion and maintain position for more than 60 sec; positive - sensation of tingling over hand - Late - atrophy and recurrent pain = dysfunction of the hand |
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Carpal Tunnel Syndrome: Nursing intervention |
- Instruct patient to shake hands often - Use of wrist splints; ok to wear at night - Ergonomics: special keyboard pads/mice, workstation modification After surgery: - assess the neurovascular status of the hand regularly - Wound care and assessments at home - Full recovery may take months |
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Carpal Tunnel Syndrome: interprofessional Management |
- If CTS more than 6 months, surgery is recommended. - Outpatient w/ local anesthesia - Endoscopic carpal tunnel release: through a small puncture incision(s) in the wrist and palm |
Surgery |
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Gout: Pathophysiology |
- Acute arthritis - Elevation of uric acid (hyperuricemia) and the deposit of uric acid crystals in one or more joints d/t Inc. uric acid production, red. excretion by kidneys, inc. intake of foods containing purines (obesity, excessive alcohol consumption, prolonged fasting) |
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Gout: Signs & Symptoms |
- Affected joints appear dusky/cyanotic and tender - Great toe (podagra; most common) - Acute triggers: trauma, surgery, alcohol ingestion, systemic infection; rapid welling and pain peak within several hours, often with low-grade fever - individual attacks usually subside in 2-10 days - Tophi (chronic gout): multiple joint involvement and visible deposits of sodium urate crystals |
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Gout: Diagnostic Tests |
- Serum uric acid levels: > 6mg/dL - 24hr urine uric acid levels - Xrays: shows tophi - Synovial fluid aspiration: gout vs. septic arthritis vs pseudogout (calcium phosphate crystals are formed) - gout = needlike crystals of sodium urate |
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Gout: Drug Therapy |
- colchicine - NSAIDs: do not give ASA (inactivates the effect of uricosurics = urate retention); give Tylenol - pegloticase (Krystexxa): for pts not taking/do not respond to drugs that lower uric acid in blood; metabolizes uric acid into a harmless chemical excreted in the urine - Corticosteroids (acute attacks) In combo with colchicine: - xanthine oxidase inhibitor: allopurinol (Zyloprim) - probenecid (Probalan): drug that inc. excretion of uric acid in the urine (uricosuric) - febuxostat (Uloric): a selective inhibitor of xanthine oxidase; long term for chronic gout pts |
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Gout: Foods to avoid |
Foods high in PURINE - Red/organ meats, seafood, beans, spinach - Seafood: Anchovies, Mackerel, Mussels, Sardines, Scallops, Trout, Crab, Lobster, Oysters, Shrimp, Codfish, Haddock, Herring - Meat: Liver, sweetbreads, brains, bacon, turkey, veal, venison, beef, chicken, duck, ham, pork - Vegetables: Asparagus, fava beans, garbanzo beans, edamame (soy), mushrooms, peas, lentils, spinach, cauliflower |
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Gout: Nursing Interventions |
- Monitor urine output: 2-3 L/day; prevent precipitation of uric acid - Bed rest with affected joints properly immobilized: bed cradle/footboard - Assess the limitation of motion and degree of pain. Document treatment response. - Explanation of drug therapy and periodic determination of serum uric acid levels - Teach about triggers for an attack |
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Guillain-Barre Syndrome: Pathophysiology |
- Acute inflammatory polyneuropathy - an autoimmune process that occurs a few days/weeks after a viral/bacterial infection - Cytomegalovirus (viral) // Campulovacter jejuni gastroenteritis (bacterial) Loss of myelin (segmental demyelination) and edema and inflammation of the affected nerves. As demyelination occurs, the transmission of nerve impulses is stopped/slowed. Muscles innervated by the damaged peripheral nerves undergo denervation and atrophy. In the recovery phase, remyelination occurs slowly and function returns in a proximal-to-distal pattern. |
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