NCMA219 finals

• Chronic autoimmune inflammatory disease causing inflammation of joints

  Juvenile Rheumatoid Arthritis
• Arthritis in one or more joints associated with at least 2 weeks of quotidian fever, rash, lymphadenophaty, hepatosplenomegaly, and serositis


  Systematic Arthritis
• Cause of Juvenile Rheumatoid Arthritis

  unknown
• Clinical manifestations of JIA

  Joint deformity

  functional disability
• What chronic and acute uveitis can cause if undiagnosed and not aggressively treated?

  Permanent vision loss
• Arthritis in one to four joints for the first 6 months of disease

  Oligoarthritis
• Affects five or more joints in the first 6 months with negative rheumatoid factor.

  Polyarthritis rheumatoid factor negative
• Affects five or more joints in first 6 months but have a positive rheumatoid factor.


  Polyarthritis rheumatoid factor positive
• Two factors hypothesized as cause of JIA


  Immunologic susceptibility

  environmental or external trigger such as virus
• Arthritis with psoriasis 


  Psoriatic arthritis
• Arthritis or associated with at least two of the following: sacroiliac or lumbosacral pain, HLA-B27 antigen, arthritis in a boy older than 6 years, acute anterior uveitis, inflammatory bowel disease, Reiter syndrome, or acute anterior uveitis in a first degree relative.

  Enthesitis-related arthritis
• Fits no other category above or fits more than one category

  Undifferentiated arthritis
• Laboratory tests for JIA


  ESR

  Leukocytosis

  Antinuclear antibodies

  Plain radiographs
• ESR 


  May or may not be elevated
• Present during exarcerbations


  Leukocytosis
• Helps identify children who are ay greater risk for uveitis

  Antinuclear antibodies
• Shows soft-tissue swelling and joint space widening. This test can reveal osteoporosis, narrow join space, erosion, subluxation, and ankylosis

  Plain radiographs
• Therapeutic management for JIA:


  • No cure

  • major goals of therapy is to CONTROL PAIN

  • preserve joint range of motion and function

  • minimize effects of inflammation, such as joint deformity

  • promote normal growth and development

  • outpatient care is mainstay of therapy
• Therapeutic management for JIA


  • medications

  • physical and occupational therapy

  • ophthalmologic slit lamp examination

  • splints, comfort measures

  • dietary management

  • psychosocial support
• First drug used for JIA


  Nonstreoidal Anti-Inflammatory Drugs (NSAIDs)
• NSAIDs approved for use in children


  Naproxen

  Ibuprofen

  Tolmetin

  Indomethacin

  Celecoxib

  Meloxicam

  Aspirin
• Second-line medication used in children who have failed with NSAIDs alone

  Methotrexate
• Methotrexate is started in combination with?


  NSAIDs
• Methotrexate is effective, with acceptable toxicity. It requires monitoring of?


  CBC

  liver functions
• Medication for JIA that works to interrupt and minimize the inflammatory process. Used in children with severe arthritis and may be used with combination with methotrexate

  Biologic Agents
• Nursing Care for JIA 


  • Relieve pain

  • Promote general health

  • Encourage heat and exercise
• Inflammation in the inside of the nose caused by an allergen such as pollen, dust, mold, or flakes of skin from certain animals.

  Allergic rhinitis
• Symptoms of allergic rhinitis


  Sneezing

  itchiness

  blocked or runny nose
• Treatment/Management for allergic rhinitis


  • reduce exposure to allergen

  • non-sedating antihistamines

  • regularly rinsing nasal passages with salt water solution

  • nasal spray w/ corticosteroids
• Type of pruritic eczema that usually begins during infancy and is associated with an allergic contact dermatitis with a hereditary tendency.

  Atopic dermatitis
• three forms of atopic dermatitis


  Infantile eczema Childhood Preadolescent and adolescent
• usually begins at 2 to 6 months of age; generally undergoes spontaneous remission by 3 years of age


  Infantile eczema
• May follow the infantile form; occurs at 2 to 3 years of age; 90% of children have manifestations by age 5 years

  Childhood
• begins at about 12 years of age; may continue into the early adult years or indefinitely


  preadolescent and adolescent
• Clinical manifestations of atopic dermatitis

  distribution of lesions
• generalized, especially cheeks, scalp, trunk, and extensor surfaces of extremities

  infantile form
• flexural areas (antecubital and popliteal fossae, neck), wrists, and feet


  childhood form
• face, sides of neck, hands, feet, face, and antecubital and popliteal fossae (to lesser extent)

  preadolescent and adolescent form
• Appearance of lesions in infantile form

  • Erythema
  • Vesicles
  • Papules
  • Weeping
  • Oozing
  • Crusting
  • Scaling
  • Often symmetric
• distribution of lesions in childhood form

  Flexural areas (antecubital and popliteal fossae, neck)

  wrists

  ankles

  feet