LEARNING GUIDE cmj
Autoimmune, Inflammatory, Metabolic & Infectious Disorders
Answers to “matching” in Discussion Board
Part I
1.
Autoimmune/inflammatory
Indicate whether each of the following statements are true or false: (p.
1248)
Women are affected with RA 3 times more often than men
Manifestations of RA usually occur initially in a single joint on one
side of the body.
Remissions of RA are most likely to occur during the first year
Disease progression of RA usually speeds up after the first 6
years.
2.
Explain how the clinical manifestations of osteoarthritis defer from those
of RA. (p. 1249)
3.
What are rheumatoid factors and how do they contribute to the clinical
manifestations of RA? (p. 1249)
4.
What is pannus and how does it develop?
5.
Describe the following deformities associated with RA:
a. Swan neck deformity
b. Boutonniere deformity
c. Hallux valgus
6.
What common extra-articular manifestations are common in clients with
high levels of circulating rheumatoid factor? (p. 1250)
RNSG 2432  399
What are rheumatoid nodules and what problems do they cause?
7.
What is the goal of treatment for RA?
8.
Complete the following grid for each of the medication types indicated: (p.
1254-1255 & 1263)
Medication
Side Effects
Nursing Implications
ASA
NSAIDS
Corticosteroids
Disease modifying
Drugs
_________________
Gold salts
(Cuprimine)
Hydroxychloroquine
(Plaquenil)_________
Sulfasalazine
(Azulfidine)_________
Penicillamine_______
Immunosuppressive
drugs ie Methotrexate
400  RNSG 2432
______________
____________________________
9.
Describe the following “experimental” therapies for RA and SLE:
a. Plasmapheresis (p. 241 & 1255…why does this work?)
10.
State 5 recommendations that you would give to a client with RA for
preventing pain and deformities? (p. 1255)
11.
Indicate whether each of the following statements is true or false: (p.
1260)
SLE is less common in women of child bearing age.
Women with SLE have reduced levels of androgens
The number of SLE exacerbations tend to decrease over time.
The leading cause of death in clients with SLE is pneumonia.
Early manifestations of SLE mimic those of RA.
_____ A “butterfly rash” is common is patient’s with SLE (p.1261)
12.
What “causes” (pathophysiology) SLE?
13.
Describe what you would expect to find for each of the following
diagnostic tests for a client with SLE:
a. Anti-DNA antibody testing
b. ESR
c. Serum complement levels
d. CBC
e. Urinalysis
14.
What hematologic problems are associated with SLE? Why do they occur?
(1260-1261)
15.
Which clients with SLE would require corticosteroid therapy in high doses?
(Discoid or systemic form of lupus) (Notes & 1263)
16.
Clients with SLE often have impaired skin integrity. What should the
nurse teach the client as to how to minimize these effects of the disease?
(p. 1263-1264)
RNSG 2432  401
17.
Case study: a client with systemic sclerosis (scleroderma) presents with a
BP of188/104. she also complains of esophagitis and shortness of breath.
She has a history of Raynauld’s phenomenon. Her laboratory tests return
with an elevated serum BUN and creatinine.
a. What complication(s) may be occurring with this client?
b. What nursing interventions should be implemented as soon as
possible?
c. What are the medications that will most likely be prescribed for this
client? Why/when are these medications needed? (p. 1276-1277)
d. What is CREST syndrome? (Notes, p. 1275)
18.
Compare and contrast the following the diseases
Disease
Ankylosing
Spondylitis
Lyme disease
402  RNSG 2432
Etiology/Initiating
Event
Manifestations
Priority
Treatment/Mgt
Part II
Metabolic
1.
Match each of the following risk factors with one of the disorders on the
left. The disorder may be used more than once: (p. 1233, 1230, 1224.
1237)
Common Pacific Islanders
a. Paget’s Disease
Women in Northern China
b. Gout
Nephrotic syndrome
c. Osteoporosis
Asst. with long term steroid therapy d. Osteomalacia
Peak onset in men aged 40 – 50
Post-menopausal women
20-30% with family history (genetic ?)
Smoking
2.
The bones of clients with Paget’s Disease are larger than normal but break
more easily. Explain how and why this occurs. (p. 1230)
3.
What is the difference between primary and secondary gout? (p. 1233)
4.
Match the following manifestations with the appropriate disorder:
Dowager’s hump
a. Paget’s Disease
Waddeling gait
b. Osteoporosis
Red, hot, tender joints
c. Osteomalacia
Loss of height
d. Gout
Elevated WBC and sed rate
Enlarged skull
Flushing of skin over the bone
Ulceration over the joint
Fever, chills, malaise
5.
Why do clients with chronic gout often develop kidney disease? (p. 1233)
RNSG 2432  403
6.
Complete the following table:
Medication
What Disorder(s) is Side Effects
it used for
(major)
Allopurinol
p. 1235-1236
Nursing
Implications
Probenecid
(Benemid)
Sulfinapyrazon
(Anturane)
p. 1235-1236
Colchicine
p. 1235-1236
Biphosphates
(Fosamax)
p. 1231, 1232
Calcitonin
(Miacalcin)
p. 1226
Raloxifene
p. 1226
7.
Clients with gout are sometimes instructed to eat a low purine diet. Name
several foods that the client should avoid.
What else should the client with gout avoid?
Why is a high fluid intake very important for the client with gout? Is
this needed when the client is taking medications as treatmnt for
gout?
Why should aspirin NOT be given to client receiving probenecid?
(1236)
What stressors might trigger an “attack of gout” (p. 1233)?
8.
How is a definitive diagnosis of gout determined? ( what lab results, such
as uric acid level, etc) (p. 1234)
9.
What lab values are typically altered in Paget’s disease? (p. 1231)
404  RNSG 2432
10.
What recommendations would you make to a client with Paget’s disease to
help reduce pain, promote comfort, and increase physical mobility?
What medications are helpful in treating Paget’s disease? (ref table above
& p. 1231-1232)
Part III
1.
Infectious Disorders of the Bone and Joint
Explain how an infection of soft tissue can lead to an infection of the bone
(describe the pathophysiology.) p. 1267-1268)
2.
Complete the chart for management of osteomyelitis (acute/chronic)
Osteomyelitis Identify
Treatment
Length of
Teaching
Pathogen
/management
treatment
needs/p.
(usual)
indicated (include
1271
medications/surgery)
Osteomyelitis
3.
Describe the difference between septic arthritis and osteomyelitis?
4.
Which of these statements are true or false about septic arthritis and/or
osteomyelitis?
a.
b.
c.
d.
e.
f.
5.
Osteomyelitis is usually caused by a bacteria such as
Staphylococcus aureus
Septic arthritis typically has a viral causative agent
With septic arthritis multiple joints are effected at the same
time
Onset of septic arthritis is typically very abrupt and a medical
emergency
Sequestra is devitalized (dead) bone that has separated from
the periosteum due to osteomyelitis
Bone and joint immobilization is required to avoid pathological
fractures with osteomyelitis
What are three (3) priority nursing diagnosis for the patient with acute
osteomyelitis? (p. 1270-1271)
RNSG 2432  405
406  RNSG 2432