Chapter 18 Flashcards
Osteoarthritis is:
the progressive deterioration and loss of cartilage and bone in one or more joints
Crepitus:
occurs when the cartilage disintegrates and pieces of bone and cartilage “float” in the diseased joint causing crepitus, a grating sound caused by loosened bone and cartilage
Cause of PRIMARY OA:
aging
genetic factors
Hips, knees & hands most commonly affected
Cause of SECONDARY OA:
Joint injury (excessive use, trauma or RA)
obesity
Typical onset of RA:
35-45 YR
Typical onset of OA:
Older than 60 yrs
Risk factors of RA
Autoimmune (genetic basis)
Emotional stress (triggers exacerbation)
Environmental factors
Risk factors of OA:
Aging
genetic factor (possible)
Obesity
Trauma
Occupation
Disease process for RA & OA
RA: Inflammatory
OA: Degenerative
Disease pattern for RA:
Bilateral, symmetric, multiple joints
Usually affects upper extremities first
Systemic
Disease pattern for OA:
May be unilateral, single joint
Affects weight bearing joints, hands, spine
Nonsystemic
Common drug therapy for RA:
NSAIDS (Short term use)
Methotrexate
Leflunomide (Arava)
Corticosteroids
Immunosuppresive agents
Common drug therapy for OA:
NSAIDS (Short term use)
Acetaminophen
Analgesics
clinical manifestations of OA
Joint pain and stiffness
Crepitus
Herberden’s nodes
Bouchard’s nodes
joint effusions
Atrophy of skeletal muscle
Early: clinical manifestations of RA (joint/systemic)
Joint stiffness/inflammation
Low grade fever
weakness
fatigue
anorexia
paresthesias
swelling
Late clinical manifestations of RA (JOINT/SYSTEMIC)
Joints become progressively inflamed and quite painful
deformities (swan neck or ulnar deviation)
moderate to severe pain and morning stiffness
osteoporosis
severe fatigue
anemia
weight loss
Lab tests for OA (2)
ESR
HsCRP
Lab tests for RA/CTD
Rheumatoid factor
ANA
ESR
Serum complement (C3 &C4)
SPEP
Serum immunoglobulins
RA Nonpharmacologic interventions:
adequate rest
proper positioning
ice and heat application
plasmapheresis (not common)
complementary and alternative therapies
promotion of self-management
management of fatigue
enhance body image
OA Chronic Pain: Nonsurgical management
Drug therapy (Tylenol) drug of choice
Rest
Immobilization
Positioning
Thermal modalities
Weight control
Integrative therapies (glucosamine, chondroitin)
Inflammatory rheumatology
RA
Systemic lupus erythematosus (SLE)
Autoimmune disease
OA is
most common arthritis type
progressive loss of cartilage
joint pain
- loss of function characterized by progressive deterioration
Cartilage disintegrates; bone and cartilage “float” into joint, causing crepitus
Nursing interventions to prevent dislocation:
position correctly
for hip: keep leg slightly abducted
for hip, prevent hip flexion beyond 90 degrees
assess for acute pain, rotation, and extremity shortening
Nursing interventions to prevent infection:
aseptic techniques for wound care and emptying of drains
hand hygiene
culture drainage fluid, if change
monitor temperature
Nursing interventions to prevent venous thromboembolism
have patient wear elastic stockings or SCDs
teach leg exercises
encourage fluid intake
observe for signs of thrombosis (redness, swelling or pain)
observe patient for changes in mental status
administer anticoagulant as prescribed
do not massage legs
do not flex knees for a prolonged period of time
Nursing interventions to prevent hypotension, bleeding, infection
take vital signs q4hr
observe patient for bleeding
report excessively low bp or bleeding
