Gerontology- Test 2
Terms
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- What is osteoarthritis?
- DJD, degenerative joint disease. progressive deterioration and loss of cartilage and bone
- What is rheumatoid arthritis?
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Inflamatory disease- chronic- inflamatory changes in joints (primarily synovial).
synovitis - Etiology or 5 factors effecting osteoarthritis
- age genetics obesity trauma occupation- post menopausal; lack of exersize
- Etiology or 6 factors effecting rheumatoid arthritis
- 1.autoimmune 2genetic 3female rep.hormones 4virus 5 stress; 6 chemicals: nicotine and caffiene
- what is diagnostic test for osteoarth.?
- x-ray
- what is diagnostic test for rheumatoid arthritis? (6)
- x-ray, RF, ANA, ESR, cbc Arthrocentesis.
- What is RF test for?
- rheumatoid factor- measures presence of unusual antibodies
- what is ANA?
- antinuclear antibody test- measure titer of unusual antibodies that destroy nuclei of cells
- what is ESR?
- confirms inflammation test for rheuma. arthritis
- what can cbc confirm?
- anemia
- what is test that samples synovial fluid and relieves pressure?
- arthrocentesis
- what are clinical manifestations of oseoarthritis? (3)
- pain- worse w/use better w/rest; stiffness joints; joint changes-enlargement due to bony hypertrophy
- what joint changes are associated with osteoarthritis?
- heberdens nodes, crepetis, unilateral pain, no inflamation.
- what are the early manifestations of rheumatoid arthritis?
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fatigue weakness stiffness anorexia persistant low fever
joint inflam- pip and mcp
bilateral, symmetrical progresses in # of joints - late manifestations of rheumatoid arthritis?
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joint deformity
swan neck or ulnar deviation
bouchard nodes - what are bouchard nodes vs herberden nodes?
- both reactive bony overgrowth with oseo and rheumatoid arth. bouchard proximal herberden distal
- pain in spine related to pressure from rheumatoid arthritis?
- rabiculapathies- compression of spine press on nerves
- late manifestations of rheumatoid arth?
- osteoporosis, subcutaneous nodules, periperal neuropathy,pericarditis, vasculitis, sjogrens disease, renal disease pulmonary complications
- what is sjorgrens syndrome?
- glands stop secreteing- dry syndrome
- What is first line drug for osteo arth
- tylenol and nonsalicylates- aspirin, buff. aspirin w/ meals
- what is NSAID? examples.
- non steroidal anti inflamm. drug.; aleve motrin naprosin
- prob with nsaids
-
cause sodium retention
better pain control intervention if hyper tension or kidney disorder; nervous system issues disorient and head aches; gi bleeding - name 2 synthetic joint fluid implants for oseo arth
- hyaluronic and synvisc
- name 2 muscle relaxants for osteo arth
- flexeril and robaxin
- topical prep for osteo arth
- capsaicin
- what is last resort drug relief for oseot arth?
- steroid injections
- non pharmalogical relief for osteo arth?
- rest; thermal modality- moist heat if not diabetic, cold only for inflam.; positioning
- what does TENS tx do?
- diverts attention from pain
- diet should be?
- night veges; tomatoes, eggplant
- surgery contraindications?
- infection, inflammation or osteoporosis; recoup is 8 weeks
- Hip replacement post operative procedures?
- prevent dislocation- subluxation- keep legs abducted prevent flexion 90 degrees. turn as ordered
- assessment for dislocation?
- increased pain; shortening of extremity rotation of extremity (**in is out)
- prevent deep vein thrombosis and pulmonary embolis
-
a) venodyne boots b) leg exersize c)red,swell, pain
d)neurovascular assess e)anticoagulents - what anticoagulants might be given after surg?
-
hep. injection- sub cut
lovenox- coumadin bld tests
aspirin- 6-12 mo - what is activity progression?
- 1 day bed rest; 2nd day movement and walking
- what will prevent atrophy of muscle
- continuous passive movement and knee imobilizer to extend at bed time
- 7 classifications of drugs used for rheumatoid artheritis
- 1.salicylates 2 nsaid 3. cytotoxic 4. gold salts 5. minocycline 6 corticosteroids 7 remicade.
- name cytotoxic drug and describe and why used
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methotrexate: 1x week
casues pcp; mouth sore;dyspnea; liver inflam;bone marrow suppression - name 2 gold salts
-
myochrisine- injectable
ridaura - which rheumatoid arthritis drug do you have to monitor cbc and urine?
- gold salts
- what are side effects of gold salts?
- takes 3-6 mos to work; protienurea, mouth ulcer, skin rash anemia and pain; diarrhea nv
- what is minocycline?
- rheum arht; immune modifier: anitmicrobial and anti inflammatory lower side effects: not as effective
- corticosteroid side effects
- DM, infection, fluid and electrolyte imbalance, glaucoma
- what is nursing intervention for cytotoxic drug side effect
- magic mouth wash- mylanta and benedryl: avoid citris, spice and caffeine: no vaseline on wound
- what is gout?
- systemic disease; urate crystals deposit in joints and other body tissues; infamation
- describe 2 types of gout:
-
primary- production of uric acid exceeds excretion- genetics-middle age or older
Secondary-excessive uric acid due to renal insufficiency, diuretics, chemo- all ages - what are 4 phases of gout?
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asymptomatic hyperuricemia- serum level increases
acute- painful inflamation in small joints
intercritical- remission
chronic- after repeated episodes, can feelcrystals under skin and in organs - what are manifestations of gout?
-
acute- painful joints
chronic- tophi- papules- destroy cartilage
renal stones - why was it called rich mans disease?
- wealthy kings ate foods like shell fish, game meats organ meats etc..
- How is it diagnosed?
- ESR, serum uric acid up, urine uric acid up, kidney tests, arthrocentesis
- Signs and symptoms of gout
- hot and red
- medications for acute gout:
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colchine- decreases deposit.5 mg evert hour until pain alleviated
NSAID- indomethacine; pain and inflammation - medications for chronic gout:
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allopurinal(zyloprim)- inhibits enzyme 3xweek
probenecid- increases secretion of uric acid 250 bid-500bid
colbenemid- mix of 2 above - what should be avoided if gout present?
- aspirin and diuretics, alcohol, no fasting, low purine stress
- what should be encouraged if gout is present?
- water intake, fruit juices, alkaline ash diet, citris