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Presentation (5 mins)

Questions under lesson arthritis #8,9,10

1. A patient with rheumatoid arthritis (RA) presents to the clinic for a routine check-up. The nurse notes that the patient may develop a disease exacerbation because of which assessment findings?

1. Presence of rheumatic nodules

2. Extreme dryness of the eyes and mouth

3. Report of a demanding job with long hours

4. New-onset paresthesia in the extremities

2. The nurse is developing a care plan for a patient with rheumatoid arthritis (RA). Which priority goal would guide the nurse in addressing the patient’s condition?

1. The patient will perform activities of daily living (ADLs) independently

3. Which information should the nurse obtain when assessing an older adult patient who is taking multiple medications for osteoarthritis?

1. Mental status

2. List of medications

3. Changes in arthritis symptoms

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- Connective tissue disease (CTD) is the major focus of rheumatology, the study of rheumatic disease.
- rheumatic disease is any disease or condition involving the musculoskeletal system.
- Arthritis means inflammation of one or more joints.
- osteoarthritis (OA), a noninflammatory, localized disorder. OA is not an autoimmune disease.
- rheumatoid arthritis (RA), a systemic, inflammatory disorder

1. Place the clinical progression of rheumatoid arthritis in order of occurrence in the disease process.
- Rheumatoid arthritis is an autoimmune disease that begins with inflammation and swelling in the synovial membrane due to an increased number of lymphocytes in blood. This leads to articular cartilage destruction and vascular granulation tissue formation. The cartilage is worn away by the damage, and the inflamed pannus destroys bone and bone edges, leading to joint deformities.

2. A patient diagnosed with osteoarthritis (OA) would have which manifestations?
- Joint pain and stiffness
Patients with OA will report joint pain and stiffness, which occur because of a break in the cartilage, or cushion, between joints.
- Nodes at the proximal interphalangeal joints
Patients with OA develop certain deformities, such as Broussard’s nodes, which form at the proximal interphalangeal joints
- Grating sensation with movement
Osteoarthritic joints can cause a grating sensation with movement as a result of cartilage damage.

3. Which manifestations would indicate that a patient is in the late stage of rheumatoid arthritis (RA)?
- Gel phenomenon
The gel phenomenon is morning joint stiffness, which is a late manifestation of disease in patients with RA.
- Peripheral neuropathy
RA, as an autoimmune disease, can lead to peripheral neuropathy, which is a late systemic manifestation of the disease.

4. An image of the hand of a patient with osteoarthritis (OA) is provided. Which label (A, B, C, or D) in the image points to a Bouchard’s node?
- C
Label C points to a Bouchard’s node, which is located at the proximal interphalangeal joint. This deformity is commonly found in patients with OA.

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Presentation (5 mins) and Questions 1, 2, 3, 4

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Presentation (5 mins) and Questions under Lesson Arthritis #5, 6, 7

Question 5 of 10

A patient with osteoarthritis (OA) reports doing a lot of walking and is now experiencing increased knee pain. Which actions should the nurse recommend to this patient?

Use of whirlpool on a daily basis.

Using a warm whirlpool bath for a few minutes every day can help alleviate joint pain.

Alternate application of ice and heat to the knee.

Alternating the use of hot and cold compresses can help manage the pain and decrease the inflammation associated with OA.

Take frequent rest periods with the knee elevated.

The nurse should teach the patient to rest frequently with the knee elevated. This will help decrease inflammation.

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Question 6 of 10

Which teaching should the nurse provide to a patient with rheumatoid arthritis (RA) who has just started taking azathioprine?

Avoid people who are sick

Azathioprine is an immunosuppressant drug that decreases the immune response in autoimmune diseases. The nurse should teach the patient to avoid people who are sick and crowded places because this drug increases the risk of infection.

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Question 7 of 10

A female patient with rheumatoid arthritis (RA) states that she has been treated for years with different medications but is frustrated that she still hasn't achieved relief. Which responses from the nurse are appropriate?

“Maybe you should try yoga or Tai Chi.”

Yoga and Tai Chi are ways to manage pain without medication.

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“You should ask your health care provider about joint replacement.”

Joint replacement can be performed if medications have proven ineffective. It is appropriate to refer the patient to the health care provider for further information about this treatment.

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“You can speak to your health care provider about transcutaneous electrical nerve stimulation (TENS).”

TENS is a form of alternative medicine in which nerve stimulation is used to manage pain, and this suggestion is an appropriate response from the nurse.

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Presentation (5 mins)
Questions under Lesson SLE #7, 8, 9

The nurse’s role in caring for the patient with SLE :

·       Reporting satisfactory pain management

Complying with the treatment regimen

Verbalizing an understanding of activities to avoid and ways to prevent complications

Maintaining independence

Nursing Interventions:

Demonstrating a positive self-image

Documentation of symptoms and patient’s response to therapy

Administration of prescribed medications

Facilitating the collection of laboratory specimens

Monitoring of fluid and electrolyte status

Checking for signs of bleeding/petechiae

Assessment of neurologic status and comfort level

Education regarding self-management of the disease

Patient Education:

Ways to manage pain

Energy conservation techniques

Relaxation therapy techniques

Suggestions to reduce physical and emotional stressors

The importance of avoiding people with infections

The importance of avoiding drying soaps, powders, and household chemicals (The patient should be instructed to use lotions to keep the skin moisturized.)

The importance of using sunscreen with a minimum skin protection factor (SPF) of 15, wearing sunglasses and sun-protective clothing, and staying out of the sun during peak sun hours

Pregnancy counseling information and considerations to keep in mind before trying to conceive

The importance of having routine medical check-ups

Community resources available

QUESTIONS:
7.The nurse has established a goal of verbalizing an understanding of activities to prevent exacerbations with a female patient with systemic lupus erythematosus (SLE). Which statement made by the patient would support this goal?

-“I plan to do meditation daily and take time for myself.”
8.A nurse is caring for a patient diagnosed with systemic lupus erythematosus (SLE) who has been on a long-term regimen of methylprednisolone. Which precautions should the nurse take to prevent complications of the treatment?

-Assess the patient’s mental status
-Monitor the patient’s blood glucose levels
9.A patient with systemic lupus erythematosus (SLE) mentions to the nurse that she is trying to conceive. Which questions should the nurse ask to address potential pregnancy complications?
-“Are you currently taking methotrexate?”
-“Have you had an antiphospholipid antibody test?”
-“Have you and your partner started pregnancy counseling?”

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Presentation (5 mins) and Questions under Lesson SLE #1, 2, 3

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Presentation (5 mins) and Questions under Lesson SLE #4, 5, 6