joint disorders Flashcards
what are some causes/risk factors for rheumatoid arthritis
- chronic inflamatory disorder
- autoimmune with unknown etiology
- risk factors: smoking, egenetics, viral or bacterial illness
whats happening with rheumatoid arthritis
- immne system attacks synovial lining of joints
- begins in disal joints (fingers and toes)
- inflammation thickens synovium destroying joint (pannus formation)
- tendons and ligaments weaken and stretch
- lose joint mobility and use of joints
how will the client present with rheumatoid arthritis
- tender, warm, swollen and erythemic joints (bilateral and symmetric)
- joint stiffness worse in mornings and after inactivity
- fatigue, fever, and loss of appetite
what labs and diagnostic tests are used for rheumatoid arthritis
- arthocentesis (check that synovial fluid)
- CT
- CBC, ESR and CRP (inflammatory markers), rheumatoid factor
what meds can help with rheumatoid arthritis
- avoid opioids
- DMARDs (disease modifying antirheumatic drugs): nonbiologic (methotrexate - nasty, need annual blood tests) and biologic (adalimumbab)
- NSAIDs: ibuprofen and naproxyn (not for long term, just flare ups)
- Cox-2: celecoxib
- corticosteroids: prednisone (for flare ups)
what are some complications of rheumatoid arthritis
- CVD
- medication toxicity (methotrexate is shitty)
- damage to skin, eyes, lungs, heart, blood vessels, kidneys, nerve tissue, salivary glands, and bone marrow
- deformity of hands and feet
whats included in treatment of rheumatoid arthritis
- educate
- aggressive teratment early
- goals: decrease joint pain and swelling, prevent joint damage, and minimize disability
- exercise (discuss complications of immobility on joints)
- nonpharm methods (relaxation, heat and cold)
- yoga (improve mood and quality of life, gentle stretching)
- complimentary alternative medicine (CAM): fish oils and plant oils
- weight management
what are some causes of osteoarthritis
- noninflammatory joint destruction
- end result of autoimmune disorder but not an autoimmune disorder
- obesity
- laborious occupations and sports
- genetic predisposition
whats happening with osteoarthritis
- breakdown of articular cartilage
- progressive damage to underlying bone
- narrowing of joint space
- pain and damage
- progressive joint degeneration
how will the clinet with osteoarthritis present
- pain, stiffness, and functional impairment
- joint pain aggravated by movement/exercise
- relieved by rest
- morning stiffness
- decreased ROM in affected joint
- crepitus (rice crispies) over kneee or grating sensation
what labs and diagnostic tests are used for osteoarthritis
- xray or MRI (shows articular cartilage is gone)
- blood test to rule out RA
whta meds can help with osteoarthritis
- NSAIDs (ibuprofen, naproxen)
- cox-2 (celecoxib)
- intra-articular corticosteroids
- acetaminophen
- diclofenac
- glucosamine and chrondroitin
what are some complications of osteoarthritis
- depression and anxiety
- difficulty with ADLs
- need for arthoplasty
how can nurses help with osteoarthritis
- educate
- exercise and lower extremity strength training
- weight loss
- OT/PT
- splints/braces or walking aids
- CMA therapies
- heat/cold
what are some causes of gout
- high levels of uric acid in blood (fructose-rich beverages, alcohol consumption - beer)
- age, BMI
- HTN meds: beta blockers, aces and arbs
- thiazide diuretics
whats happening with gout
- hyperuricemia
- macrophages in joint space phagocytize urate
- macrophages become crystalized (crystals are sharp and needle like)
- deposits in peripheral areas (great toe, hand and ear)
how will the client present with gout
- arthritis
- sudden and severe attacks of pain
- pain, swelling and tenderness (great toe, knee or ankle)
- limited ROM
what are some labs and diagnostic tests for gout
- joint fluid analysis
- xray/dual energy CT scan
what are some meds that can help with acute gout attacks
- cochicine
- NSAIDs
- corisosteroids
what are some management meds for gout
- xanthines (allopurinol)
- uricosurics (probenecid)
what are some complications of gout
- tophi (deformity in joint from crystals hardening)
- kidney stones
how can nurses help with gout
- educate
- eat food low in purines and avoid high purine diet
- coffee, vitamin C, and cherries can reduce uric acid
- lifestyle changes
- weight loss
- decrease alcohol intake
- avoid certain meds
- med compliance
- avoid trauma/stress
what are some causes of fibromyalgia
- unknown
- triggers: genetics, anxiety, depression, physical/emotional trauma, infection
whats happening with fibromyalgia
amplified pain d/t CNS abnormally amplifying pain signals
how will the client present with fibromyalgia
- bilater widespread pain (dull ache x3mo)
- fatigue (restless leg/sleep apnea)
- cognitive difficulties (fibro fog)
- other conditions usually coexist
what are some labs and diagnostic tests for fibromyalgia
none but may rule out other conditions
what are some meds that can help with fibromyalgia
- NO opioids
- NSAIDs/acetaminophen
- TCAs
- muscle relaxants
- SNRIs/SSRIs
- anticonvulsants
how can nurses help with fibromyalgia
- educate
- CAM/exercise therapy
- CBT
- sleep hygiene
- support groups
- stress reduction
- provide education on pharm/nonpharm methods
