NURS 4700 NURSING CONCEPTS AND
INTERVENTIONS FOR THE CARE OF OLDER
ADULTS II FINAL EXAM STUDY GUIDE
MARQUETTE UNIVERSITY
,Monoclonal antibodies: action, types, sx
✔✔-Action: inhibits T cell proliferation
-Example: Basiliximab, Muromonab-CD3
-Sx: flu like sx for first few days
What are long-term effects of transplantation?
✔✔-HTN, renal insufficiency
-Hyperlipidemia, diabetes, osteoporosis
-Malignancy: skin cancer, post-transplant lymphoproliferative disease,
other tumors
What is osteoarthritis?
✔✔-A non-systemic, non-autoimmune, slow progressive condition that
gets worse overtime with gradual loss of cartilage
-Cartilage becomes: dull, yellow, granular; soft and elastic; less able to
resist wear with heavy use
-Predisposed: age, obesity, genetics, overuse of joints, lack of exercise,
repetitive activities, trauma, women after menopause
What are the symptoms of osteoarthritis?
✔✔1. Early changes show articular cartilage degeneration; later shows
bone thickening, heberden's and Bouchard's nodes
2. Pain: mild to disabling and worsens with joint use
-Early: rest relieves pain
-Late: pain with rest and sleep is disturbed
3. Stiffness: occurs with rest and early morning
4. Deformities: bow-legged, knocked-knees, can cause 1 leg to be shorter
,Assessing osteoarthritis
✔✔1. Joint pain, stiffness with COLDERR
2. Affect on daily life: to determine tx options
3. Prior treatment
4. Examining joint: tender, swelling, ROM, crackles, compare with
unaffected side
Osteoarthritis: drug therapy
✔✔1. Mild to moderate joint pain
-Acetaminophen
-Topical agent: capsaicin cream
-Topical salycylates: aspercreme
-Hyaluronic acid
2. Moderate to severe pain
-NSAID: risk for GI ulcers, bleeds
-Corticosteroid injections at night
Osteoarthritis: nurse management
✔✔1. Nonpharm pain management: rest/exercise, heat/cold, CAM,
nutritional supplements (*glucosamine*, chondroitin)
2. Patient teaching: weight loss
3. PT
4. Meds for pain and inflammation
5. Home and work environments modified to max safety
, What is rheumatoid arthritis?
✔✔-Chronic, systemic, autoimmune disease that causes inflammation in
the synovial joints and is symmetrical
-Periods of remission and exacerbation
Symptoms of rheumatoid arthritis
✔✔1. Nonspecific sx (early): fatigue, weight loss, anorexia, general
stiffness
2. Joint pain: increase with motion, varies in intensity, may not be
proportional to degree of inflammation
3. Stiffness after periods of inactivity: morning stiffness 60 mins to several
hours
4. Inflammation and fibrosis leads to deformity and disability
Extraarticular symptoms of RA
✔✔1. Rheumatoid nodules: SQ, firm nontender masses seen on bony
areas and can lead to skin breakdown
2. Sjogren's syndrome: lymphocytes attack body causing dry eyes and
decreased salivation
Rheumatoid arthritis nursing assessment
✔✔-Subjective: health history (vaccines, virus/illness), meds, treatments
-Objective: general (systemic responses), musculoskeletal (deformities)
RA: drug therapy (I)
✔✔1. DMARDs for mild to moderate disease
-Methotrexate (rheumatrex): CBC and chem panel monitoring; early tx,
constant labs (liver and kidney), low risk toxicity
