arthritis, autoimmune, musculoskeletal Flashcards
osteoarthritis
- progressive loss of cartilage & bone build up in one or more joints
non-inflammatory, not systemic, not autoimmune
primary: cause unknown - aging, genetics
secondary: joint injury, obesity
osteoarthritis etiology & pathophys
OA cartilage: opaque, yellowish, brown, destruction of tissue, eroded cartilage
normal cartilage: smooth, white, translucent
osteoarthritis pt assessment
- non-systemic manifestations
- joint pain:
- relieved by rest in early stages
- worsens with joint use
- loss function
- joint swelling (minimal)
- skeletal muscle atrophy occurs when don’t use muscles but hard bc worsens pain when use
- can affect the spine - compression of spine - radiating pain, stiffness
- heberdens and bouchards nodes
osteoarthritis tx/goals
goal: maintain joint function, use joint protection measures, encourage self-care, pain management
tx: no cure
- medications to relieve pain and maintain function
- tylenol = drug of choice
- topical analgesics= lidocaine patches, aspercreme, NSAIDs
- corticosteroid injections into joints
- muscle relaxants
nonsurgical tx:
- rest balanced with activity
- positioning
- PT
- thermal modalities
- weight control
- integrative therapies
surgical tx:
- total joint replacement (TJR) - most common
- when sever compromise to clients functional ability, failure of other tx
- arthroscopy - used as diagnostic test or surgical procedure
total hip replacement (THR)
total hip arthroplasty
primary replacement = first surgery
revision of THR = any additional surgeries
- procedure is surgeons preference. can be cemented vs non-cemented
THR pre-op care
- talk to pt about transferring, positioning, ambulation
- lab tests, xray
- NSAIDS 1 week prior
- shower with antiseptic soap
- teach turn cough deep breathe –> turn in bed, cough, deep breaths
- incentive spirometer
- low molecular weight heparin to help prevent DVT
- promedicate before surgery
THR post-op complications
- dislocation
- positioning precautions – abductor pillows, avoid positions of extreme hip flexion (greater than 90 degrees). avoid hyperextension
- neurovascular assessment - color, temp, pulses, cap refill, movement, and sedation
- venous thromboembolism (VTE) – anticoagulant therapy, early mobilization, TED
- infection – give prophylactic antibiotics, wound care
- bleeding and anemia – brains, H&H, blood transfusions
- pain management
Total knee replacement
- when severe pain with compromise to functioning ability
- prophylactic antibiotics
- hardware = surgeon choice
- LMW heparin
- pain management
- PT
- cryotherapy
CPM - continous passive motion
- helps decrease pain
- increase ROM
- improves function ability
- assess circulation, movement, sensation (CMS)
- after a year, it won’t help a lot more
rheumatoid arthritis (RA)
- common connective tissue disease
- chronic, progressive, systemic inflammatory autoimmune disease - mainly affects primary synovial joints
- transformed autoantibodies for and attack healthy tissue which causes inflammation
RA assessment
early - joint stiffness, swelling, pain, fatigue, weakness… early and aggressive tx can lead to remission
late - joints become progressively inflamed and painful
- systemic so look for changes in other organs… fever, anorexia, paresthesia (abnormal sensation, tingling), lung disease, kidney disease
- psychosocial assessment: quality of life, fear of pain, embarrassment, loss of ADLs
Labs/Diagnostic:
- pos. rheumatoid factor
- elevated ANA
- increased serum immunoglobins
- decreased albumin
- x-ray, CT, bone scan
tx RA
- NSAIDS - ibuprofen, Celebrex
- Disease modifying anti-rheumatic drugs - methotrexate (immunosuppressive medication - observe decreased WBC & Platelets or elevated liver enzymes or creatinine & risk for infection)
- biological response modifiers (BRMs) - decrease cytokine activity, new but expensive, risk for infection
- glucocorticoids: prednisone
non-pharmacological:
- adequate rest
- proper adjusting
- ice and heat application
- complementary therapy – good nutrition, vitamins/supplements
- promotion of self-management & mobility
- manage fatigue
- learn activity limits
lupus erythematosus (SLE)
- chronic, progressive, inflammatory connective tissue disorder
- onset child-bearing yrs
- due to genetic and environmental factors
- can cause major body organs to fail
- spontaneous remissions
- autoimmune process
- often some degree of kidney involvement
lupus assessment
- variety of symptoms, no classical presentation
- butterfly rash - over nose and cheeks
- polyarthritis = involves 5 or more joints
- osteonecrosis - death of bone tissue often caused by steroid therapy
- muscle atrophy
- fever
- fatigue
- skin biopsy to confirm diagnosis
- immunologic-based laboratory tests (same as RA)
tx lupus
- topical cortisone drugs
- plaquenil
- tylenol or NSAIDs
- chronic steroid therapy - prednisone
- immunosuppressive agents
- belimumab - decreases B lymphocyte survival - first drug approval in 60 yrs for SLE
