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NU 340 > Ch. 43 > Flashcards

Ch. 43 Flashcards

1
Q

osteoarthritis

A
  • most common arthritis type
  • progressive loss of cartilage
  • joint pain, loss of function characterized by progressive deterioration
  • osteophytes (bone spurs)
  • cartilage disintegrates, bone and cartilage “float” into joint causing crepitus
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2
Q

osteoarthritis primary etiology (causes)

A

aging
genetic factors

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3
Q

osteoarthritis secondary etiology

A
  • joint injury
  • obesity
  • repetitive stress to joints
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4
Q

most common joints affected by osteoarthritis

A

weight-bearing joints mostly
- knees
- hips

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5
Q

osteoarthritis incidence and prevalence

A

33 million in US
- 5th most common cause of disability worldwide
people > 60 years old: higher risk
F>M: higher risk

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6
Q

osteoarthritis health promotion

A

maintain proper nutrition
avoid injuries
stay active
take work breaks: think construction workers who bend their joints all day at work

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7
Q

joint changes in degenerative joint disease

A
  • bone hypertrophy (bone spurs)
  • cartilage particles
  • loss of cartilage

joint thickens, decrease in synovial fluid: think bone on bone

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8
Q

osteoarthritis assessment: history

A
  • joint pain: localized, unilateral
  • may be secondary to another dx
  • age: usually older than 60 years old
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9
Q

osteoarthritis assessment: physical assessment/ s/sx

A

Persistent joint pain and stiffness
Crepitus: grating sound from bone on bone
Joint effusions
Heberden’s nodes (in hand)
Bouchard’s nodes (in hand)
Atrophy of skeletal muscle

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10
Q

osteoarthritis assessment: psychosocial assessment

A

lifestyle changes
- can’t walk as well
- not socializing or going out as much

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11
Q

osteoarthritis assessment: labs

A
  • aspirated joint fluid: analyzed under microscope
  • ESR: generic blood level showing inflammation in the body, may be elevated
  • hsCRP: generic blood level showing inflammation in the body, may be elevated
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12
Q

osteoarthritis assessment: imaging

A

X-ray: arthritic changes in the joints
MRI

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13
Q

hebern’s nodes

A

bony nodules at the distal interphalangeal joints (closer to end of the fingers/nail beds)

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14
Q

bouchard’s nodes

A

bony nodules at the proximal interphalangeal (closer to the hand)

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15
Q

priority problems for patients with osteoarthritis

A
  • persistent pain (once you have arthritic, it does not go away- unless you have a joint replacement)
  • potential for decreased mobility
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16
Q

(arthritis) chronic pain: non-surgical management

A

Drug therapy
- most commonly: Acetaminophen (arthritis 500mg)
- OTC NSAID like ibuprofen
Rest, immobilization
Positioning
Thermal modalities: heating pad or ice
Weight control: getting weight stable, nutrition/diet
Integrative therapies
- Glucosamine, chondroitin (let PCP know! interactions!)

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17
Q

chronic joint pain: surgical management

A

total joint arthroplasty (TJA)/total joint replacement (TJR)
- knees: outpatient
- hip: inpatient

arthroscopy: osteotomy
- less invasive, use scope to clean up cartilage

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18
Q

osteoarthritis care coordination and transition management

A
  • home care management
  • health care resources
  • self-management education
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19
Q

post-op care for TJR

A
  • abductor position (triangle foam pillow) while in bed: prevent dislocation of hip
  • watch for VTE, leg exercises, use of compression devices/socks
  • assess signs of infection: redness, edema, inflammation, drainage
  • monitor Hgb, Hct (normal for slight decrease), watch for need of blood transfusion
  • check limb for: color, pulses, temperature, sensation
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19
Q

post-op complications for TJR

A

Collaborate with patient/family to become safety partners to prevent complications
- Hip dislocation
- VTE** (very common w/ ortho surgeries)
- Infection
- Anemia
- Neurovascular compromise

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20
Q

exercise after THR

A

hip flexion no greater than 90° (want < 90°)
- leg exercises

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21
Q

continuous passive motion machine

A
  • patient comes up from OR with
  • computerized iPad with settings: compare with computer to ensure that they match
  • used after THR
22
Q

osteoarthritis evaluation

A
  • Achieves pain control to a pain intensity level of 2 to 3 on a scale of 0 to 10 or at a level that is acceptable to the patient
  • Does not experience complications associated with total joint arthroplasty (if performed)
  • Moves and functions in own environment independently with or without assistive devices
23
Q

rheumatoid arthritis (RA)

A
  • Common connective tissue disease, destructive to joints
  • Chronic, progressive, systemic inflammatory autoimmune disease
  • affects primarily synovial joints; affects joints throughout the body (not just one, not unilateral)
  • Characterized by remissions and exacerbations
  • Transformed autoantibodies (rheumatoid factors) form, attack healthy tissue causing inflammation
24
Q

RA: causes

A
  • combination of environmental and genetic factors
  • physical and emotional stressors are linked to exacerbations
25
Q

RA pathology

A

bone erosion
decreased synovial fluid
- may be unilateral, single joint
- affects weight-beating joints and hands, spine
- metacarpophalangeal joints spared
- systemic autoimmune inflammatory d/o

26
Q

RA incidence and prevalence

A
  • 1.5 million people
  • more common in Euro-Americans
  • women 2-3x more likely to have RA than men
27
Q

RA assessment: history

A

Acute and severe, or slow and progressive

28
Q

RA assessment: physical assessment/ s/sx

A

Joint and systemic symptoms
Generalized weakness and fatigue: malaise
Morning stiffness
Advanced disease symptoms

29
Q

RA assessment: psychosocial assessment

A

body changes
mobility changes
- go out less/ less social

30
Q

RA assessment: labs

A

Rheumatoid Factor
Anti-CCP
ANA: can be elevated due to inflammation in the body
ESR: can be elevated due to inflammation in the body
hsCRP: can be elevated due to inflammation in the body
Serum complement (C3 & C4)
Serum protein electrophoresis
Serum immunoglobulins
Thrombocytosis can occur with late RA

31
Q

RA assessment: diagnostic tests

A

X-rays
CT scan
Arthrocentesis (fluid analysis in the lab)
Bone Scan

32
Q

RA joint involvement progression (s/sx early vs late)

A

Early—joint stiffness, swelling, pain, fatigue, generalized weakness, low-grade fever (99°)
Late—joints become progressively inflamed and quite painful, SQ nodules; OT involvement, assistive devices

33
Q

priority problems for patients with RA

A
  • Chronic inflammation and persistent pain
  • Potential for decreased mobility
  • Potential for decreased self-esteem
34
Q

RA plan/interventions

A

Managing chronic inflammation and pain
- Drug therapy
Promoting mobility
Enhancing self-esteem

35
Q

RA systemic complications

A

Weight loss, fever, extreme fatigue
- Exacerbations
Subcutaneous nodules
Respiratory, cardiac complications
Vasculitis: inflammation of the blood vessels- pulmonary and cardiac problems
Periungual lesions
Paresthesias: numbness and tingling to extremities

36
Q

RA- associated syndromes

A

Sjögren’s syndrome
Felty’s syndrome
Caplan’s syndrome

37
Q

Sjögren’s syndrome: triad of sx

A

triad of sx
- dry eyes, dry mouth, vaginal dryness

38
Q

Felty’s syndrome

A

associated with RA
triad of disorders/diagnoses
RA, splenomegaly: enlarged spleen, elevated WBC

39
Q

Caplan’s syndrome

A

a combination of rheumatoid arthritis and pneumoconiosis that manifests as intrapulmonary nodules, which appear well-defined and homogenous on chest x-ray.
It is defined as lung nodules in dust-exposed personnel, either with a history of rheumatoid arthritis or develops RA after 5-10 year

40
Q

RA nonpharmacologic interventions

A

Adequate rest
Proper positioning
Ice and heat application
Plasmapheresis (not common): machine takes plasma out of body and removes rheumatoid antibodies and then puts plasma back into body
Complementary and alternative therapies
Promotion of self-management
Management of fatigue
Enhance body image

41
Q

RA drug therapy

A

DMARDs (disease modifying antirheumatic drugs)
- methotrexate: decrease inflammation, immunosuppressive agent: decrease immune system/low platelet/low WBC- stay out of public places, stay away from sick people; teratogenic agent: pregnancy test before using, need to be on strict birth control
- hydroxychloroquine: decrease inflammation, immunosuppressive agent: decrease immune system/low platelet/low WBC- stay out of public places, stay away from sick people; retinal vessel damage- regular eye exams needed, look behind retina for damage

NSAIDs

BRMs (biological response modifiers)
- affects immune system: look for s/sx of infection, call PCP if develop a sx of infection (ie cough)

Other:
- Glucocorticoids (taper off, don’t stop suddenly)
- Immunosuppressive agents (prednisone- hyperglycemia sugar levels)
- E788 awaiting approval

42
Q

gout

A

aka gouty arthritis
- urate crystals deposit in joints and other body tissues, causing inflammation
- primary or secondary
- M > F higher risk
- men > 50 years at higher risk

43
Q

primary gout

A

related to underexcretion or overproduction of uric acid, often associated with a mix of dietary excesses or alcohol overuse and metabolic syndrome

44
Q

secondary gout

A

hyperuricemia: high levels of uric acid
- causative diet: steak, wine, red meats
- use of diuretics: thiazide

45
Q

gout assessment: phase 1

A

asymptomatic hyperuricemia
high levels of uric acid levels in the blood

46
Q

gout assessment: phase 2

A

acute gouty arthritis
- painful attack
- affects 1 joint; usually the great toe but can affect any joint
- severe pain, swollen, red (no sheet on feet so painful)

47
Q

gout assessment: phase 3

A

tophaceous arthritis (aka tophi)

48
Q

gout interventions

A

Maintain serum uric acid level less than 6 mg/dL
Drug Therapy
- Colchicine
Nutrition therapy
- Limit proteins
- Avoid trigger foods: seafood, red meat, alcohol
- Plenty of fluids
- pH increased with alkaline foods
- Low purine diet

49
Q

tophi

A

stage 3 gout
- most common in great toe
- can affect hand
- swollen nodule-type things

50
Q

hip flexion after THR

A
  • don’t want hip flexion > 90°: causes dislocation
  • use abductor pillow
  • can do leg exercises
  • stand up with leg extended out and support with hands on either side to push off
  • slide on shoes/ have someone that can help with putting them on
  • no crossing legs: hip dislocation
51
Q

gout drug therapy: acute attack

A
  • NSAIDs
  • colchicine

*pain treatment, but no uric acid treatment

52
Q

gout drug therapy: chronic attack

A
  • allopurinol
  • finoxbasat

*decrease uric acid levels

NU 340 (26 decks)

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