Chapter 18

Question 1

Osteoarthritis is:

Answer 1

the progressive deterioration and loss of cartilage and bone in one or more joints

Question 2

Crepitus:

Answer 2

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

Question 3

Cause of PRIMARY OA:

Answer 3

aging

genetic factors

Hips, knees & hands most commonly affected

Question 4

Cause of SECONDARY OA:

Answer 4

Joint injury (excessive use, trauma or RA)

obesity

Question 5

Typical onset of RA:

Answer 5

35-45 YR

Question 6

Typical onset of OA:

Answer 6

Older than 60 yrs

Question 7

Risk factors of RA

Answer 7

Autoimmune (genetic basis)

Emotional stress (triggers exacerbation)

Environmental factors

Question 8

Risk factors of OA:

Answer 8

Aging

genetic factor (possible)

Obesity

Trauma

Occupation

Question 9

Disease process for RA & OA

Answer 9

RA: Inflammatory

OA: Degenerative

Question 10

Disease pattern for RA:

Answer 10

Bilateral, symmetric, multiple joints

Usually affects upper extremities first

Systemic

Question 11

Disease pattern for OA:

Answer 11

May be unilateral, single joint

Affects weight bearing joints, hands, spine

Nonsystemic

Question 12

Common drug therapy for RA:

Answer 12

NSAIDS (Short term use)

Methotrexate

Leflunomide (Arava)

Corticosteroids

Immunosuppresive agents

Question 13

Common drug therapy for OA:

Answer 13

NSAIDS (Short term use)

Acetaminophen

Analgesics

Question 14

clinical manifestations of OA

Answer 14

Joint pain and stiffness

Crepitus

Herberden’s nodes

Bouchard’s nodes

joint effusions

Atrophy of skeletal muscle

Question 15

Early: clinical manifestations of RA (joint/systemic)

Answer 15

Joint stiffness/inflammation

Low grade fever

weakness

fatigue

anorexia

paresthesias

swelling

Question 16

Late clinical manifestations of RA (JOINT/SYSTEMIC)

Answer 16

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

Question 17

Lab tests for OA (2)

Answer 17

ESR

HsCRP

Question 18

Lab tests for RA/CTD

Answer 18

Rheumatoid factor

ANA

ESR

Serum complement (C3 &C4)

SPEP

Serum immunoglobulins

Question 19

RA Nonpharmacologic interventions:

Answer 19

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

Question 20

OA Chronic Pain: Nonsurgical management

Answer 20

Drug therapy (Tylenol) drug of choice

Rest

Immobilization

Positioning

Thermal modalities

Weight control

Integrative therapies (glucosamine, chondroitin)

Question 21

Inflammatory rheumatology

Answer 21

RA

Systemic lupus erythematosus (SLE)

Autoimmune disease

Question 22

OA is

Answer 22

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

Question 23

Nursing interventions to prevent dislocation:

Answer 23

position correctly

for hip: keep leg slightly abducted

for hip, prevent hip flexion beyond 90 degrees

assess for acute pain, rotation, and extremity shortening

Question 24

Nursing interventions to prevent infection:

Answer 24

aseptic techniques for wound care and emptying of drains

hand hygiene

culture drainage fluid, if change

monitor temperature

Question 25

Nursing interventions to prevent venous thromboembolism

Answer 25

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

Question 26

Nursing interventions to prevent hypotension, bleeding, infection

Answer 26

take vital signs q4hr

observe patient for bleeding

report excessively low bp or bleeding