NCLEX Secrets about Musculoskeletal Injuries
Situation: Karen, a 32 year old vendor, is admitted to the hospital with diagnosis of Rheumatoid Arthritis.
9. Which type of exercise should the nurse recommend to Cindy?
a) jogging
b) swimming
c) bicycling
d) skating
10. Before discharge, the nurse tells Karen that she should pace her activities. An example of pacing activities would be:
a) doing all her household chores in the morning and resting in the afternoon
b) taking a nap before going shopping
c) hiring a helper to do the housework
11. Which type of medication is most commonly used to treat rheumatoid arthritis?
a) glucocorticoids
b) non-steroidal ant-inflammatory drugs (NSAIDs)
c) antimalarial drugs
d) gold salts
12. Which assessment findings should the nurse expect for Karen?
a) an asymmetrical pattern of affected joints
b) a positive rheumatoid factor titer
c) the presence of Herberden's nodes
d) a positive antinuclear antibody titer
13. The nurse discussed to Karen the nature of RA. Which of the following statements by indicate a correct understanding of disease process?
a) the nodules under my skin behind my forehead is part of RA
b) I have to be careful because my bones have become brittle
c) I have been working very hard lifting heavy things while selling in the market
d) my disease is a normal aspect of my aging
NCLEX Secrets about Musculoskeletal Injuries:
ANSWERS AND RATIONALE
9) B
- swimming is an ideal exercise for patient with arthritis because it allows ROM exercise for most of the joints of the body with less danger of injury.
10) B
- pacing activities means alternating and balancing rest periods and activity in order to prevent excessive fatigue and over exertion.
Rheumatoid arthritis is a chronic autoimmune disease characterized by inflammation and destruction of connective tissue within the joints that leads to eventual depletion of joint cartilage that weakens and cause dislocation of joint. This disease is characterized by periods of remissions and exacerbations. This disorder occurs three times more frequent in women until age 65 when both sexes have the same incidence. The most common joints affected are those of the hands, wrist, feet, ankles, elbows and knees. May also affect the heart, lungs and spleen late in the disease process.
11) B
- NSAID's are the first drugs of choice of RA. Its main action is to inhibit the inflammatory action of the mediators of inflammation; arachidonic acid and prostaglandins, etc to stop the disease process. It also provide pain relief. However it does not correct existing damage or bone deformity. below are the drugs used to treat RA.
SALICYLATES:
- ASA-Aspirin
Anti-inflammatory and
analgesic
SIDE-EFFECTS
- take every 4-6 hours to maintain anti-inflammatory effect
- gastric irritation - take with food or milk
- toxicity - tinnitus, increase bleeding tendencies - instruct to report dark tarry stool
- hypersensitivity - rash
indomethacin (indocin)
ibuprofen (motrin)
tolmetin Na (tolectin)
naproxen (naprosyn)
fenoprofen (nalfon)
sulindac (clinoril)
diflunisal (dolobid)
piroxicam (feldene)
diclofenac Na (voltaren)
SIDE-EFFECTS
- GIT irritation - take with food and milk, take with antacids
- headache and dizziness - discontinue and notify physician
- drowsiness - avoid driving
- do not use with salicylates or other anti-inflammatory agents
- do not crush enteric coated tablets
Prednisone
Suppresses inflammatory
reaction by the body
SIDE-EFFECTS
- fluid retention - monitor weight
- increased susceptibility to infection - avoid exposure to persons with infection
- GIT irritation - take with food or antacid. Take in the morning if to be taken once a day
- decreased healing potential
- osteoporosis
- hirsutism
- adrenal crisis if abruptly withdrawn
- DM - do not stop, increase, decrease without doctor's order
Hydroxychloroquine (plaquenil)
Chloroquine (aralen)
anti-inflammatory effect
Quinacrine (atabrine)
SIDE-EFFECTS
- effect expected after 6-12 months
- retinal edema that can lead to blindness - have an eye exam every 6 months
- yellow discoloration of the skin - may be stopped periodically to prevent deepening of skin discoloration
Gold Sodium
Thimalate (myochrysine)
Gold thioglucose (solganol)
Gold (oral)
Aurafin (ridaural)
SIDE-EFFECTS
- effect after 3-6 months
- renal damage and hepatic damage - urinalysis and CBC before each injection
- dermatitis, ulcerations in mouth - report dermatitis and metallic taste and lesions in mouth to physician
- Signs and Symptoms: Begins as fatigue, musculoskeletal pain, low grade fever, lack of appetite and weight loss.
Criteria for diagnosis of RA: The first four signs must be present for at least six weeks. Four of these signs and symptoms must be present at the same time to establish a diagnosis.
- stiffness after prolonged period of inactivity. Morning stiffness lasting at least one hour
- swelling of three or more joints
- swelling of the wrist, proximal interphalangeal (PIP) or metacarpophalangeal (MCP) joints
- symmetric joint swelling, same joint on each side of the body excluding the phalangeal joints
- positive rheumatoid factor
- rheumatoid nodules - painless and firm nodules found in subcutaneous tissue that develop during periods of exacerbation and most often in the wrist, carpal, knee, elbow and finger joints
- X-ray - decalcified areas of bone near joint margins
- formation of pannus - fibrous scar tissue at the cartilage that eventually invades and erodes bones
- hand deformities
- ulnar drift
- boutonniere deformity
- swan neck deformity
histological changes of synovium - presence of chronic inflammatory infiltrate
13) A
- the bones in rheumatoid arthritis do not become brittle as it is the joints that are affected not the bone. Brittle bone is characterized of osteoporosis. Overuse of joint is associated with osteoarthritis which is a wear and tear disease. Rheumatoid arthritis is not a part of normal aging as it is a disease process and occurs often in young women. Nodules which are firm and nontender may develop in the subcutaneous tissues of patients with RA.
Go to the next page ---> NCLEX Secrets about Musculoskeletal Injuries (14-20)
Or Go back to NCLEX Secrets about Musculoskeletal Injuries (1-8) to start the test from the beginning.
Posts
0 comments:
Post a Comment