Rheumatoid Arthritis and Multiple Sclerosis

Terms in this set (25)

risk for infection r/t medications
- assess skin, mouth, lungs, urine
- monitor labs for changes in CBC including WBCs
- use hand hygiene
- protect from nosocomial and community acuired infections - give flu vaccine
- provide anti-inflammatory diet; avoid sugar and processed foods

acute and chronic pain r/t inflammation
- pain assessment: rate pain/location/type, impact on ability to rest and complete normal activities; obtain acute and chronic pain hx (joint pain causes decreased mobility and fatigue)
- administer meds as ordered promote absorption and prevent/minimize SE (e.g., give NSAIDs and steroids in the middle of meals every time to prevent gastric ulcer)

readiness for enhanced nutrition r/t inflammatory effect of select nutrients
- assess dietary intake (24 hr recall)
- assess family hx of autoimmune disease/food sensitivities
- assess dietary awareness of anti-inflammatory foods and decreased intake of sugar/processed foods
- refer to RD

fatigue r/t pain
- assess fatigue and ability to perform ADLs
- assess sleep, rest, and pain management
- assess intake: quality and timing of meals/snacks/hydration
- alternate periods of activity and rest
- provide low stress, restful environment

impaired physical mobility r/t pain
- assess pt's perception of own physical activity and observe performance
- consult w/ PT and encourage activity
- incorporate assistive devices if ordered
- educate on safety/fall prevention

self care deficits r/t fatigue and loss of motion
- assess for contractures, fatigue, and loss of mobility
- ID pt's goals and priorities: protecting joints, conserving energy, simplifying ADLs, minimizing sun exposure
- consult w/ PT and OT to develop a plan promoting independence

knowledge deficit: medications r/t lack of exposure/recall
- assess pt's knowledge: medications, timing, dose, method of administration, and awareness and prevention of SE
- consult w/ pharmacist
- educate about meds
- have pt "teach back" info

disturbed body image r/t physical and psychological changes
- encourage pt to verbalize concerns/fears about change in body image

ineffective coping r/t inability to cope w/ lifestyle or role changes
- consult w/ social worker/chaplain
- have pt and family ID coping skills and support systems
GLUCOCORTICOIDS

prednisone

slows disease progression; decreases inflammation and pain

used in lower doses to treat chronic, mild, non-organ-threatening disease; used in higher doses (IV) to treat active, organ-threatening lupus

nursing actions:
- monitor for SE of steroids and toxicity: cataracts, GI irritation, hyperglycemia, HTN, fractures, avascular necrosis, hirsutism, psychosis
- caution not to stop suddenly
- give w/ food

DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMARD)

diverse group of meds including drug that modify immune and inflammatory responses

can decrease disease activity, but do not slow bone erosion or facilitate healing

require close monitoring due to toxicity

DMARD: ANTIMALARIALS

hydroxychloroquine

limits cell's ability to process antigens, decreasing antibodies

does not lower blood counts or increase susceptibility to infections

side effects: GI upset, rashes, tachycardia, HA, black spots in visual fields, hearing loss

nursing actions:
- monitor vision q 6 mos
- administer w/ NSAIDs


DMARD: IMMUNOSUPPRESSANT

alkylating agents
- e.g., cyclophosphamide - developed to treat lung cancer but may improve kidney and lung fx
- cytotoxic and "steroid sparing," interfering w/ replication of susceptible cells
- side effects: bladder problems, hair loss, sterility, pancytopenia, infection, alteration of liver and renal fx, rashes, drowsiness, confusion

antimetabolite cytotoxic meds
- e.g., methotrexate - treats skin lesions, arthritis, and pleuritis
- impede enzyme actions needed for DNA synthesis
- side effects: similar to cyclophosphamide; bone marrow suppression, N/V, stomatitis, fatigue, interstitial pneumonitis, hepatic or renal toxicity

anti-rejection meds: T&B cell suppressors
- e.g., azathioprine - blocks inflammation pathways in SLE
- helps lower steroid dosage, improve liver and kidney disease
- side effects: dizziness, N/V/D, infections, pancreatitis, liver and renal dysfunction

nursing actions:
- assess for bone marrow suppression, GI ulcerations, skin rashes, alopecia, bladder toxicity, increased infections
- monitor CBC, liver enzymes, Cr q 2-4 wks
- advise pt of contraceptive measures bc of teratogenicity

IMMUNOMODULATORS: TNF BLOCKING AGENTS

adalimumab

biological response modifier that binds to TNF, a cytokine involved in inflammation and immune response

nursing actions:
- monitor for increased risk for infection and withhold if fever occurs
- do not give w/ hx of TB
- educate about subq injection; refrigerate
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