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wvc musc/skel Ch20
wvc musc/skel Ch20 Osteoarthritis, Rheumatoid Arthritis, Gout
| Question | Answer |
|---|---|
| Osteoarthritis | progressive deterioration of bone & cartilage, mostly in weight bearing joints, primary or secondary. As bone & cartilage erode, space between bones shorten & bone spurs form (osteophytes) & pitting, fissures & ulcerations. body can't repair fast enough |
| Osteophytes | bone spurs |
| Nodal Osteoarthritis | involvement of hand |
| Non-nodal Osteoarthritis | without involvement of the hand. |
| Subluxation | partial joint dislocation |
| Risk factors for Osteoarthritis | age, genetic changes, obesity, trauma, smoking, certain diseases (diabetes mellitus, paget’s, sickle cell) |
| Health promotion and maintenance for Osteoarthritis | Keep weight WNL, stop smoking, avoid activities that stress joints, wear good shoes, avoid repetitive stress activities (knitting), prevent trauma. |
| Assessment questions for Osteoarthritis | Swelling, pin, stiffness, occupation, weight history, previous trauma or involvement in sports, loss of ability to complete ADLs |
| Signs and symptoms of Osteoarthritis | crepitus on ROM; bony hypertrophy at joint; Heberden’s nodes & bouchard’s nodes (bony swellings at finger joints), joint effusions (excessive fluid in joint). It may affect only one joint. X-rays |
| Nursing diagnosis related to osteoarthritis | activity intolerance, self care deficit; disturbed body image, impaired walking, ineffective coping, imbalanced nutrition. |
| Medications for osteoarthritis | acetaminophen (liver toxicity), 5% lidocaine patches, NSAID (GI Bleed, renal problems), opiodis (respiratory depression, constipation) cortisone injection, muscle relaxants. |
| Non-phamalogical interventions for osteoarthritis | immobilizing the joint; resting; reducing psychological stress, heat & cold treatments, acupuncture, dietary supplements. |
| Surgical management of osteoarthritis | total joint arthroplasty, osteotomey (bone resection) |
| Preoperative care for total hip | assess the patients level of understanding regarding surgery, explain what post-op care will look like; patients told to have necessary dental procedures done before surgery. X-ray, CT and/or MRI, assess risk factors for DVT. |
| Two hardware components of a total hip | acetabular component and femoral component. |
| Considerations for non-cemented hardware in THA | non-cemented is non weight baring until bone forms around hardware, but is ultimately stronger and seated better (no cement to degrade over time). |
| Considerations for cemented hardware in THA | cement can fracture & deteriorate overtime causing a need for a revision arthroplasty (additional surgery) |
| Surgical related complications in total joint arthroplasty | dislocation; infection; venous thromboembolism; hypotension, bleeding, infection |
| Interventions for dislocation in post surgery TJA | position correctly; keep hip slightly abducted, for hip prevent flexion beyond 90’; assess for pain, rotation & extremity shortening. |
| Signs and symptoms of hip dislocation | assess for pain, rotation & extremity shortening. |
| Interventions for infection in post surgery TJA | use sterile technique; wash hands; culture drainage fluid; monitor temp.; report excessive inflammation to Dr. |
| Interventions for venous thromboembolism in post surgery TJA | TED hose; SCD; leg exercises, encourage fluid intake; observe for thrombosis (redness, swelling, pain); changes in mental status; anti-coagulants; do not massage legs. Early ambulation. |
| Interventions for hypotension, bleeding in post surgery TJA | VS q4hrs; observe for bleeding; report low BP. |
| Anticoagulant Medications | warfarin (Coumadin) PT/ aPTT/ INR |
| Discharge teaching for THA | don’t sit/stand for long periods; don’t cross legs beyond midline; don’t bend >90’; use assistive devices; report increased hip pain; take pain meds as ordered; inspect incision for infection; clean & dry idaily; continue PT exercises as instructed. |
| TKA | total knee arthroplasty |
| Preoperative teaching for total knee arthroplasty (TKA) | assess the patients level of understanding regarding surgery, explain what post-op care will look like; patients told to have necessary dental procedures done before surgery. X-ray, CT and/or MRI, assess risk factors for DVT. Explain CPM |
| Continuous passive motion machine (CPM) | applied after surgery & set to doctors specifications. reduces scar tissue & speeds healing. Ensure well padded; check cycle & ROM to order qshift; assess patients response; ensure joint is being moved properly. |
| Interventions for osteoarthritis | collaborative care with PT & OT; recreational exercise & therapeutic exercise; assistive devices for ADL’s. |
| Rheumatoid arthritis (RA) | chronic; progressive; systemic inflammatory autoimmune disease process effects synovial joints. Antibodies (rheumatoid factors RF) attack healthy cells; fluid accumulates in joint, a granular panus forms, this eventually eats away at cartilage & bone. |
| Systemic | effects many body systems, for example in RA not only the joints are effected, but renal disease, pericarditis, fibrotic lung disease all account for the systemic nature of RA. |
| Early manifestations of Rheumatoid arthritis (RA) | inflammation in the joints; low grade fever; fatigue; weakness; anorexia; paresthesias. |
| Late manifestations of Rheumatoid arthritis (RA) | joint deformities; moderate to severe pain; osteoporosis; severe fatigue; anemia; weight loss; sub q nodules; peripheral neuropathy; vasculitis; pericarditis; fibrotic lung; sjogrens syndrome; renal disease. |
| Onset of Rheumatoid arthritis (RA) | typically in the beginning the symptoms are migratory, also the symptoms are bilateral and symmetrical |
| Spinal column involvement in Rheumatoid arthritis (RA) | subluxation of C1 &C2 can occur this can be life threatening. Assess for spinal pain associated with RA. |
| Baker’s Cysts | enlarged popliteal bursae behind the knee, pain, tissue compression, and tendon rupture are possible. |
| Periungual lesions | small brownish spots commonly around the nail bed. |
| Associated syndromes seen with Rheumatoid arthritis (RA) | Sjogren’s syndrome (drying out of mucus membranes); Felty’s syndrome (enlargement of liver & spleen); Caplan’s syndrome (rheumatoid nodules in lungs) |
| Post operative care for Total Knee arthroplasty | Continuous passive motion (CPM); Increases flexibility; Increases mobility; Decreases recovery time; Increases ROM and function; Decreases pain |
| Sjogren’s syndrome | (drying out of mucus membranes); |
| Felty’s syndrome | (enlargement of liver & spleen); |
| Caplan’s syndrome | (rheumatoid nodules in lungs) |
| Laboratory assessment in Rheumatoid arthritis (RA) | test for ^ RF (Rheumatoid factor); ^ ANA ; ESR >20; Albumin decreased; ^ globulin; x rays are also used to see changes in the joint. |
| Synovectomy | removal of inflamed synovial tissue (a surgical intervention in RA) |
| Nonphamalogical interventions associated with Rheumatoid arthritis (RA) | rest; proper positioning; heat; wax drips; plasma exchange; gene therapy in some cases, energy conservation, setting priorities, obtaining help. |
| Primary gout | an inborn error of purine metabolism; uric acid exceeds the kidney’s ability to excrete uric acid. |
| Secondary Gout | hyperuricemia caused by another disease or factor. |
| Acute gout | painful joint inflammation; serum uric acid levels are elevated; kidney tests are done to assess kidney function (BUN & creatinine) |
| Tophi | deposits of uric acid, irregular shaped & hard on platpation; seen more commonly in chronic gout. |
| Gout interventions | gout is well controlled with medications for pain during gouty attacks and no changes in body image or lifestyle as long as patient adheres to medications. |
| Gout medications | colchicines ( colsalide) (Interferes with the functions of WBCs in initiating and perpetuating the inflammatory response to monosodium urate crystals…N&V, diarrhea, drug toxicity) and NSAID (look for changes in renal function) |
| Nutritional therapy for gout | low purine diet (avoid organ meats, shellfish, oily fish, fish with bones) drink plenty of fluid (2000 ml output) to prevent formation of uric acid stones. Aspirin and diuretics may precipitate an attack. |
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wvc
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