Musculoskeletal

Question 1

Pathophysiology of osteoarthritis

Answer 1

A chronic condition characterised by deterioration of joint tissue

Cartilage gradually thins due to enzymatic degredation, and the collagen fibres within cartilage are destroyed. This causes cartilage to thin and eventually disappear, exposing bones and causing them to causing bones to rub against each other with friction during movement. Joints respond by increasing the production of synovial fluid which leads to joint swelling, stiffness and pain. Bone thickens and causes development of spurs and reduced ROM.

Occurs typically in main joints eg. knees, shoulders, hips etc.

Is often bilateral but can be unilateral

Question 2

Pathophysiology of rheumatoid arthritis

Answer 2

A systemic autoimmune disease causing inflammation of connective tissue. Inflammatory response attacks the synovial membrane in the joint, causing inflammation and damage. Causess deposits of fibrin which turn into granulation tissue known a panes, leads to scar formation and immobilises the joint.

Can occur in its of areas eg. hands

Always bilateral

Characterised by flareups and a more significant impairment of mobility

Question 3

S+S and clinical manifestations of osteoarthritis

Answer 3

Insidious onset

Joint pain that worsens with activity
decreased ROM
joint stiffness
bone spurs
crepitus during movement
morning stiffness <30 mins
Bony spurs which enlarge joints

Question 4

S+S and clinical manifestations of rheumatoid arthritis

Answer 4

Joint swelling and stiffness
warmth
tenderness
pain
fatigue
fever
weight losss
rheumatoid nodules
Prolonged morning stiffness

Question 5

Impact of arthritis

Question 6

Acute pain vs chronic pain

Answer 6

Acute pain:
<3 months
sudden onset, directly related to injury or event
often localised
typically related to trauma, tissue damage or inflammation
anticipate it will resolve
Managed with analgesia

Chronic pain
>3 months
gradual onset, associated with an underlying condition
localised or diffuse
anticipate that it likely might not resolve
neurological pain
Difficult to manage with analgesia
non pharmacological and psychosocial treatment required too

Question 7

Arthritis diagnosis

Answer 7

Hx
Physical examination
Xray of joints

Question 8

Role of the nurse in supporting people with musculoskeletal disorders

Question 9

List 6 non pharmacological nursing interventions and their rationale

Answer 9

Patient education surrounding self management - eg. diet and exercise
- moderate recreational exercise decreases progression of manifestation
Patient education, support and resources on living with the condition
Medication administration as an inpatient
Physiotherapy and referral for specialists

Question 10

Medications used in management of OA and RA

Answer 10

Osteoarthritis:
Simple analgesia
NSAIDS
Intra-articular corticosteroid injections

For rheumatoid arthritis and inflammatory forms:
NSAIDS
corticosteroids
Disease modifying anti rheumatic drugs

Question 11

Goal of care when nursing patients with arthritis

Answer 11

Treatment aims to manage symptoms and quality of life

Question 12

NSAIDS

Question 13

Corticosteroids

Answer 13

Relieves the symptoms of RA and appears to slow process of joint destruction

Question 14

Disease modifying anti rheumatic drugs (DMARDS)

Answer 14

Modifies the immune and inflammatory responses
Leflunomide - reversibly inhibits an enzyme involved in the autoimmune process
Etanercept - inhibits the binding of tumour necrosis factor to receptor sites

Question 15

Risk factors for developing osteoarthritis

Answer 15

Increasing age
Genetic predisposition
trauma or mechanical stress to joints
high BMI

Women - more susceptible due to hormones

Question 16

Methotrexate

Question 17

Risk factors for developing rheumatoid arthritis

Question 18

Pharmacologic management of OA

Question 19

Non pharmacologic management of OA

Question 20

RA