Arthritis

Question 1

What is a rheumatic disease?

Answer 1

Any disease or condition involving the musculoskeletal system.

Question 2

What is arthritis?

Answer 2

Inflammation of one or more joints. Categorized as inflammatory or noninflammatory.

Question 3

What is noninflammatory arthritis?

Answer 3

Localized arthritis such as osteoarthritis and is not systemic.

Question 4

What is inflammatory arthritis?

Answer 4

Rheumatoid arthritis and systemic lupus erythematous (SLE) (both autoimmune disorders)

Question 5

What is osteoarthritis?

Answer 5

Progressive deterioration and loss of cartilage in one or more joints.

Question 6

Some causes of primary osteoarthritis?

Answer 6

Aging, genetic changes, obesity, and/or smoking.

Question 7

Which joints are commonly affected by OA?

Answer 7

Weight bearing joints (knees and hips), the vertebral column, and the hands.

Question 8

What is secondary osteoarthritis caused by?

Answer 8

Rheumatoid arthritis and other musculoskeletal conditions.

Question 9

Typical patient with osteoarthritis?

Answer 9

Middle-aged or older woman who reports chronic joint pain and stiffness.

Question 10

What is a drug of choice for OA?

Answer 10

Tylenol (acetaminophen) because OA is not a primary anti-inflammatory disorder.

Question 11

What kinds of exercises are recommended for OA patients?

Answer 11

Minimal weight bearing such as swimming.

Question 12

What position are patients encouraged to keep their legs after hip replacement to avoid hip dislocation?

Answer 12

Abducted, usually with a couple of bed pillows or a wedge pillow between their knees.

Question 13

What should you do if you find the calf of the leg that had hip surgery on feels cool and has weak pulses?

Answer 13

Assess the other leg.

Question 14

Is osteoarthritis a disease that affects joints bilaterally or unilaterally?

Answer 14

Unilaterally.

Question 15

When would you not want to use COX-2 inhibitor (Celecoxib)??

Answer 15

If the patient has hypertension, renal disease, or cardiovascular disease.

Question 16

Why is Lovenox (enoxaparin) used after hip replacement surgery?

Answer 16

To prevent clots from forming.

Question 17

If a patient is no longer limping, will they still nneed to use a cane or sit on seats that are higher than normal?

Answer 17

No. They no longer need an ambulatory/assistive device and may be permitted to sit in chairs of normal height, use regular toilets, and drive a car.

Question 18

If a patient is no longer limping, will they still need to use a cane or sit on seats that are higher than normal?

Answer 18

No. They no longer need an ambulatory/assistive device and may be permitted to sit in chairs of normal height, use regular toilets, and drive a car.

Question 19

What drugs increase the risk for clotting and are discontinued about a week before hip surgery?

Answer 19

NSAIDs, Vitamin C, Vitamin E, and hormone replacement therapy

Question 20

If a patient is on Coumadin after hip replacement surgery, which labs should be monitored?

Answer 20

PT and INR

Question 21

What is the proper way to do a quadriceps-setting exercise for a post-op hip surgery patient?

Answer 21

Straighten the legs and push the back of the knees in to the bed.

Question 22

If a patient had hip surgery, should they cross their legs at any time?

Answer 22

No. It is important to prevent twisting of the body or crossing the legs to prevent hip dislocation.

Question 23

What does a CPM machine do?

Answer 23

Keeps the prosthetic knee in motion and prevents formation of scar tissue, which could decrease knee mobility and increase post-op pain.

Question 24

After knee surgery, a patient’s right lower leg is twice the size of the left. What should you do?

Answer 24

Assess respiratory. A common complication after knee replacement is formation of a thrombus below the surgical site. It can lead to a pulmonary embolus.

Question 25

What is CFNB?

Answer 25

Continual femoral nerve blockade. It is anesthetic that is injected in to the femoral nerve. The patient may receive a continuous infusion of the anesthetic by portable pump. Patients require less opioids and antiemetics when on this treatment.

Question 26

What are some side effects of CFNB?

Answer 26

Metallic taste
Tinnitus (ringing of ears)
Nervousness
Slurred speech
Bradycardia
Decreased respirations.
They must be reported immediately to the anesthesiologist as the anesthetic may be entering the patient's system.  It is imperative to have someone stay with and assess the patient while the anesthesiologist is called and notified of these symptoms.

Question 27

A hip replacement surgery patient is reporting severe pain but has had no relief from vicodin tablets. What should be done?

Answer 27

Assess the surgical site for infection. Although the surgery is performed to relieve joint pain, patients experience pain related to the surgical procedure, and many state that their pain is different and less severe than before surgery.

Question 28

What are some ways to protect joints from further damage?

Answer 28

Use large joints instead of small joints (wear purse on shoulder instead of grasping handles)
Turn doorknobs counterclockwise to avoid twisting arm.
Use two hands instead of one to hold objects.
Bend at knees and keep back straight.
Use assistive devices like velcro closures.