Chapter 65: Med Surg Flashcards
osteoarthritis
slowly progressive noninflammatory disorder of synovial joints r/t age, genetics, obsesity, frequent kneeling, lack of exercise
Men with OA
men after more often affected than women before age 50, hip OA more common after 55, knee OA more common in men before age 45
women with OA
affected more after age 50 thought to be caused by estrogen reduction at menopause
OA results from
cartliage damage leading to cartilage and bony growth increasing at joint margins causing uneven distribution of stress across joint and reducing motion
s/s of OA
no systemic (unlike RA!), joint pain and may be referred to groin, butt, thigh or knee, early morning stiffness but resolves within 30 min
heberden’s nodes
occur in distal interphalangeal joints as an indication of osteophyte formation and loss of joint space, red, swollen, tender
bouchard’s nodes
affects proximal interphalangeal joints, red, swollen, tender
diagnostics of OA
bone scan, CT, MRI detect early joint changes and x rays confirm disease and stage progression such as joint space narrowing and osteophyte formation, synovial fluid clear yellow and not inflammed (unlike RA!)
tx of OA
managing pain, preventing disability, and maintaining and improving joint fx, rest should not exceed 1 week, heat used more than ice, arthroscopy to repair cartilage or remove bone bits
alternative therapy of OA
glucosamine and chondroitin sulfate helpful in resolving moderate to severe arthritis pain and improving joint mobility
drug therapy for OA
tylenol 1000 mg q6h do not exceed 4 g/day, Zostrix topical cream, no NSAIDs with Coumadin or anticoagulants or Aspirin
hyaluronic acid
viscosupplementation contributes to viscosity and elasticity of synovial joints
spondyloarthropathies
inflammatory disorder that affects the spin, peripheral joints, negative for rheumatoid factor, HLA-B27 gene associated, difficult to distinguish types early in disease
ankylosing spondylitis
chronic inflammatory disorder affecting axial skeleton, highest incidence 25-34 yeras of age, men more likely to develop
s/s of ankylosing spondylitis
low back pain, stiffness, limitation of motion, pain in other areas such as hands, extraarticular inflammation in eyes, lungs, heart, etc
diagnostics for ankylosing spondylitis
pelvic x ray is essential for characteristic changes of sacroiliitis, may see “bamboo spine” which is the result of calcifications that bridge from one vertebra to another
tx of ankylosing spondylitis
maintain maximum mobility while decreasing pain and inflammation, local corticosteroid injections, once pain and stiffness are gone exercising is essential, spinal osteotomy and total joint replacement are most frequent procedures
nursing management of ankylosing spondylitis
ROM should include chest expansion (breathing exercises), no smoking, firm mattress and sleep on back with flat pillow avoiding flexion, swimming, racquet games
psoriatic arthritis
progressive inflammatory disease that can involve primary small joints of hands and feet, can involve asymmetric extremities resembling OA, can involve symmetric extremities resembling RA, can involve sacroiliac joints and spine
diagnostics of psoriatic arthritis
x ray looks similiar to erosion in RA, widened joint spaces, elevated ESR, mild anemia, elevated blood uric acid (gout must be excluded)
tx of psoriatic arthritis
splinting, joint protection, physical therapy, DMARDS such as methotrexate
reactive arthritis
occurs more commonly in young men, urethritis, conjuncitvitis, and mucocutaneous lesions included, etiology unknown but associated with GI infections
tx for reactive arthritis
prognonsis is favorable, pt recovers in 2-16 weeks, Vibramycin 100 mg BID
diagnostic for reactive arthritis
up to 50% of people have a recurring disease, x ray in chronic conditions resemble ankylosing spondylitis
septic arthritis
invasion of joint cavity with microorganisms resulting in hematogenous seeding of joint, can be caused by gonorrhea, large joints frequently involved
s/s of septic arthritis
severe pain, erythema, swelling, fever, chills
diagnostics for septic arthritis
arthrocentesis to do a culture of synovial fluid
tx for septic arthritis
antibiotics promptly to prevent joint destruction, monitor joint inflammation, pain, and fever
lyme disease
spirochetal infection transmitted by the bite of an infected deer tick, not transmitted person to person, occurs most during the summer
s/s of lyme disease
erythema migrans (EM) is a skin lesion that occurs at the site of the tick bite within 2-30 days of exposure, low grade fever, stiff neck, swollen lymph noteds, migratory joint and muscle pain, untreated can migrate to- CNS, heart, and joints
diagnosis of lyme disease
based on clinical manifestations (EM lesion in particular) and a history to endemic area, ELISA test and western blot to confirm
tx of lyme disease
tx with antibiotics such as Doxycycline, no vaccine available
where do you commonly find lyme disease?
maryland to massachusetts, wisconsin and minnesota, california and oregan
gout
increase in uric acid production, underexcretion of uric acid, increased foods in purines, recurrent attacks of acute arthritis
causes of gout
drugs that increase cell death such as chemotherapy, thiazide diuretics, postmenopausal women, immunosuppresant pt, obesity in men, excessive alcohol, prolonged fasting
what foods are high in purine?
shellfish, lentils, asparagus, spinach, beef, chicken, pork
acute s/s of gout
arthritis may occur in one or more joints, but less than 4, joints dusky or cyanotic, tender, inflammation of great toe, subsides in 2-10 days
chronic s/s of gout
multiple joint involvement and visible deposits of sodium urate crystals (tophi), chronic inflammation, cartilage destruction may precede OA, kidney or urinary tract infection
diagnostics of gout
uric values 6+, synovial fluid aspiration to eliminate possibility of other diseases
tx of gout
Colchicine, NSAIDs for pain management, avoid alcohol and purine foods, adequate hydration
Uloric
given for long term gout
nursing management for gout
supportive care of the inflamed joints, avoiding precipitating factors that can cause the disease- excess calories, alcohol, purine foods, starving, aspirin, diuretics, MI
systemic sclerosis
connective tissue disorder, degenerative, occassionally inflammatory changes in skin, blood vessels, internal organs, more common in african americans women, overproduction of collagen
causes of systemic sclerosis
exposure to coal, plastics, and silica dust
CREST
s/s of systemic sclerosis: calcinosis, raynaud’s phenomenon (abnormal blood flow in response to cold or stress), esophageal dysfunction, sclerodactyly (tightening of skin on fingers and toes), telangiectasia (red spots on hands, forearms, palms, face, lips)
raynaud’s phenomenon
most common symptom in limited systemic sclerosis (more common disease), decreased blood flow in response to cold, cyanosis, and then erythema, numbling and tingling
limited cutaneous disease
more popular systemic sclerosis, skin thickening does not extend above elbows or above the knee
diffuse cutaneous disease
less popular systemic sclerosis, skin loses elasticity and becomes taut and shiny producing expressionless faces with tightly pursed lips
diagnostic studies for systemic sclerosis
mild anemia, SCL-70 gene, lab findings generally normal
tx for systemic sclerosis
no long term effects, attempt to prevent or treat secondary complications of involved organs, calcium channel blockers for early tx
nursing management for systemic sclerosis
don’t have finger sticks because of poor circulation and poor healing of fingers, use moist heat to promote flexibilty of hands and feet, lotions must be rubbed in for long time, small frequent meals to reduce dysphagia, oral hygiene
polymyositis and dermatomyositis
diffuse, idiopathic, inflammatory myopathies that produce bilateral weakness, PM is more serious
s/s of polymyositis and dermatomyositis
weight loss, gradually weakness of muscles, discomfort and tenderness of muscles is uncommon, dysphagia and dysphonia (hoarse voice)
s/s of dermatomyositis
violet colored or cyanotic edema around eyelids, violet colored (heliotrope), cyanotic, or erythematous rash with edema around eyelids
diagnostics for polymyositis and dermatomyositis
confirmed by MRI, EMG findings (bizarre high discharges and positive spikes at rest), muscle biopsy reveals necrosis, degeneration
tx for polymyositis and dermatomyositis
high dose corticosteroids, immunosuppresives, massage, passive movement
sjogren’s syndrome
autoimmune that targets moisture producing glands, lymphocytes attack and damage lacrimal and salivary glands
s/s of sjorgren’s sydrome
gritty sensation in eyes, burning and blurred vision, photosensitivity,
tx of sjorgren’s sydrome
instillation of preservative free tears such as cyclosporine (Restasis), increased fluids with meals, dental hygiene, increased humidity at home
fibromyalgia syndrome
chronic pain with multiple tender points, nondegenerative, nonprogressive, noninflammatory
s/s of fibromyalgia
nonrestorative sleep, morning stiffness, IBS, anxiety, widespread burning pain and improves through course of day
diagnostics for fibromyalgia
muscle biopsy may reveal nonspecific moth-eaten appearance of fiber atrophy, pain experienced in 11 of the 18 tender points, widespread pain for 3 months
tx for fibromyalgia
antidepressants and muscle relaxants, long acting opioids not recommended, benzo with ibuprofen to treat anxiety as well as muscle spasms
