Module 2 ch 11 arthritis/fibro/etc Flashcards

Question

ankylosis

Answer 1

fusing of a joint

Answer 2

Therapeutic exercises cannot positively alter the pathological process of RA, but if administered carefully, they can help prevent, retard, or correct the mechanical limitations and deforming forces that occur and, therefore, help maintain function.

Answer 3

Secondary effects of steroidal medications may include osteoporosis and ligamentous laxity, so use exercises that do not cause excessive stress to bones or joints. Respect fatigue and increased pain; do not overstress osteoporotic bone or lax ligaments.

Answer 4

Do not perform stretching techniques across swollen joints. When there is effusion, limited motion is the result of excessive fluid in the joint space. Forcing motion on the distended capsule overstretches it, leading to subsequent hypermobility (or subluxation) when the swelling abates. It may also increase the irritability of the joint and prolong the joint reaction.

Answer 5

Patient education. Because periods of active disease may last several months to more than a year, begin education in the overall treatment plan, safe activity, and joint protection (Box 11.3) as soon as possible.100 It is imperative to involve the patient in the management, so he or she learns how to conserve energy and avoid potential deforming stresses during activities and when exercising. Joint protection and energy conservation. It is important that the patient learns to respect fatigue and, when tired, rests to minimize undue stress to all the body systems. Because inflamed joints are easily damaged and rest is encouraged to protect the joints, teach the patient how to rest the joints in nondeforming positions and to intersperse rest with ROM. Joint mobility. Use gentle grade I and II distraction and oscillation techniques to inhibit pain and minimize fluid stasis. Stretching techniques are not performed when joints are swollen. Exercise. The type and intensity of exercise vary depending on the symptoms. Encourage the patient to do active exercises through as much ROM as possible (not stretching). If active exercises are not tolerated owing to pain and swelling, passive ROM is used. Once symptoms of pain and signs of swelling are controlled with medication, progress exercises as if subacute. Functional training. Modify any activities of daily living (ADL) needed in order to protect the joints. If necessary, use orthoses and assistive devices to provide protection.

Answer 6

Monitor activities and stop when discomfort or fatigue begins to develop. Use frequent but short episodes of exercise (three to five sessions per day) rather than one long session. Alternate activities to avoid fatigue. Decrease level of activities or omit provoking activities if joint pain develops and persists for more than 1 hour after activity. Maintain a functional level of joint ROM and muscular strength and endurance. Balance work and rest to avoid muscular and total body fatigue. Increase rest during flares of the disease. Avoid deforming positions. Avoid prolonged static positioning; change positions during the day every 20 to 30 minutes. Use stronger and larger muscles and joints during activities whenever possible. Use appropriate adaptive equipment.

Answer 7

Treatment approach. The treatment approach is the same as with any subacute and chronic musculoskeletal disorder, except appropriate precautions must be taken because the pathological changes from the disease process make the tissues more susceptible to damage. Joint protection and activity modification. Continue to emphasize the importance of protecting the joints by adapting the environment, and by modifying activity, using orthoses, and assistive devices. Flexibility and strength. To improve function, exercises should be aimed at improving flexibility, muscle strength, and muscle endurance within the tolerance of the joints.35 Cardiopulmonary endurance. Nonimpact or low-impact conditioning exercises—such as aquatic exercise, cycling, aerobic dancing, and walking/running—performed within the tolerance of the individual improve aerobic capacity and physical activity and decrease depression and anxiety.10,105,132,159 Group activities, such as water aerobics, also provide social support in conjunction with the activity. One randomized review suggested that aerobic training also has a positive impact on the cardiovascular status of patients with RA PRECAUTIONS: The joint capsule, ligaments, and tendons may be structurally weakened by the rheumatic process (also as a result of using steroids), so the dosage of stretching and joint mobilization techniques used to counter any contractures or adhesions must be carefully graded. CONTRAINDICATIONS: Vigorous stretching or high-velocity thrust manipulative techniques.