Nurb test 2: arthritis Flashcards
Most common form of joint disease in North America
Slowly progressive non inflammatory disorder of the diarthrodial joints= movable synovial joint ex: knee and shoulders
Between 20-30 years old, sx don’t start until 50-60s
OSTEOARTHRITIS
What are the most common types of arthritis ?
Osteoarthritis, gout, and rheumatoid arthritis
contribute or accelerate destruction of the cartilage
Trauma, mechanical stress, inflammation, joint instability, neurologic disorder, skeletal deformities, hematologic/endocrine disorders, use of selected drugs=corticosteroids
Secondary disorder
osteoarthritis
: cartilage at the end of the bone begins to deteriorate, less soft and elastic/ leads to fissuring and erosion because it is soft
end up bone rubbing on bone= bone gets really thick and end up with bone spurs= surface is uneven and affects range of motion
Pathophysiology
osteoarthritis
- Joints most commonly affected hands, hips, knees, neck, lower lumbar vertebrae, feet=big toe, fingers
- joints are affected asymmetrically
osteoarthritis
No systemic sx: like fatigue or fever
Joint pain= main sx, mild to severe, can cause disability
Pain worsens with joint use- rest can relieve pain in early stages, late stages can’t help, affects sleeping
Becomes worse as barometric pressure ↓= raining
Over activity can cause mild joint effusion
Crepitation
-early morning stiffness that usually resolves within 30 min
sx osteoarthritis
- grating sensation present in 90 percent in knee
osteoarthiritis Crepitation
- specific to involved joint
Finger- distal joint ____= caused by osteophytes or spurs, caused by repeated trauma that those joints
___same but affect middle joints
osteoarthritis Deformity Hand
Heberdens nodes
Bouchard’s nodes
- often leads to joint misalignment= bowlegged, altered gait
- Advanced hip may cause one leg to be shorter because joint space is lost
Osteoarthritis: Clinical Manifestations Deformity Knee
___ =joint space tells us that cartilage is breaking down, bony sclerosis, bone spurs from osteophyte formation
* not always going to correlate with changes Ex: little change a lot of pain/ a lot of change no pain
In progressed OA: dx
xray
- No cure
- Managing pain and inflammation
- Preventing disability
- Maintaining and improving joint function
OSTEOARTHRITIS: Collaborative Care GOALS:
1.Rest and joint protection, avoid prolonged periods of standing, kneeling, encourage using cane or walker, pt rest with acute episodes, splints and braces
2. Heat= stiffness /cold applications- acute swelling
*Weight reduction- aerobic conditioning, muscle strengthening
Exercise- biking, walking, swimming
Arthroplasty- last resort, joint replacement
Focus on conservation measures
osteoarthritis
use nonpharmacological interventions will do more good
Nutritional Supplement
osteoarthritis
similar to substance that occurs naturally in joints, works by acting like a lubricant and a shock absorber
Hyaluronic Acid: mild to mod pain osteoarthritis
Joint pain and stiffness: type, duration, frequency
Ability to perform ADL’s
Duration and success of tx
Limitation of movement= tenderness, swelling, check both sides of the body
OSTEOARTHRITIS: Nursing Mgt Assessment
Health Promotion
Education of risk factors- *weight loss, stop smoking, safety measures to prevent trauma, exercise programs encouraged
Most time outpatient- collaborative care- doc, nurse, PT
OSTEOARTHRITIS: Nursing Mgt
Pain mgt plan
Physical therapy consult if needed- dev exercise plan
Patient and Family education: assistant devices= how to use, how to protect joint, nutritional guidelines to promote weight loss, exercise programs, edu on safety measures- railing stairs, rugs, shower chair, night light, grab bars
Acute Interventions
osteoarthritis
any time in life, peak 30-50
Chronic, systemic autoimmune disease
Char by: Inflammation of connective tissue in diarthrodial (synovial) joints
Periods of remission and exacerbation
Frequently accompanied by extra-articular manifestations: sx outside of the joint
Rheumatoid Arthritis-
cause is unknown
: autoimmune and genetic factor
Rheumatoid Arthritis: Etiology-
Theories
most commonly accepted, Igg and rheumatoid factor combine and form deposits and activate the inflammatory process
- hypertrophy of the synovial membrane affects surrounding cartledge, tendons, ligaments, cause articular cartilage to erode which leads to deformities
Autoimmune etiology
- higher occurrence in twins, smoking increases risk for those who already are genetically predisposed
Genetic factor etiology
Harmful but subtle
- fatigue, weight loss, generalized stiffness
Rheumatoid Arthritis: Clinical Manifestations
Prior to onset:
: pain and tenderness that is localized, stiffness after inactivity or in morning, limited range of motion, see sign of inflammation=heat swelling tenderness
rheumatoid arthritis sx
Progresses to specific articular involvement
- equal on both sides, can start in couple of joints
rheumatoid arthritis sx Affects joint symmetrically
- wrist, hands, elbows, shoulders, ankles, knees
Affects smaller joints first
Most common joints affected rheumatoid arthritis
- inflammation and swelling of the tendon, sx similar to carpal tunnel, difficulty grasping objects
. Tenosynovitis
rheumatoid arthritis sx norm
- Atrophy of muscle and wasting away
Ulnar drift, swan shape of fingers, deformity of fingers
Distortion of hand
rheumatoid arthritis norm sx
- hammer toe
Halluz valgus=deviation towards other toes
Rheumatoid nodule
Distortion of feet
rheumatoid arthritis sx norm
RA: Extra articular (*outside joint) Clinical Manifestations
rheumatoid nodules
sjogrens syndrome
felty syndrome
- firm tender, not removed bc high risk in coming back, can break open and cause infection 25% get them can appear lung, heart, and other organs
Rheumatoid Nodules
rheumatoid arthritis extra articular sx
- dry eyes damage to surface, dry mouth increased tooth decay, disorder of the immune system the mucous membranes of eye and mouth affected first
Sjogren’s Syndrome
rheumatoid arthritis extra articular sx
- more common in those that have the nodules, increase risk for infection bc low wbc, char by splenomegaly, pulmonary disease, anemia, thrombocytopenia
- have malaise=generally feeling of discomfort, pale looking, fatigued, recurrent infections, loss of appetite
- can have spleen removed
. Felty Syndrome
rheumatoid arthritis
extra articular sx
rheumatoid arthritis drug therapy
-disease modifying antirheumatic drugs
-antimalarials
-corticosteroids
- nsaids and salicylates
together
dmard+nsaid+ corticosteroid
- take blood out, filter out rf then put back in, once a week for up to 12 weeks
Emotional stress frequently exacerbates sx
Rheumatoid Arthritis: Collaborative Care Apheresis
Relief of morning stiffness- warm shower or bath
Therapeutic heat- joint stiffness/cold- exacerbation
Rest
Joint protection- splints, no pillow under knee bc flexion, avoid flexion
Relaxation techniques- to manage chronic pain
Exercise
Psychological support- limited function
PT/OT Consult
Adls around morning stiffness
Rheumatoid Arthritis: Nursing Intervention
Rheumatoid Arthritis: Assistive Devices-
easy to grip items, long handle,
-infectious
Invasion of joint cavity by microorganism, can travel through blood stream that has infection
Often involved=- knee and hip
Septic Arthritis
Symptoms: pain, redness, swelling, fever, chills
sx septic arthritis
- important for prompt, can cause avascular necrosis
Antibiotics- right after you do culture- broad-spectrum until u get back
-Heat, gentle range of motion, monitor fever, pain, splinting help pain control
tx
septic arthritis
- arthrocentesis, blood culture, culture of synovial fluid
dx septic arthritis
- Sooner tick is removed, less likely to have infection
- Attached for 48 hours, peak season summer, can’t pass person to person
. LYME DISEASE
*skin lesion, small red bump at site of tick bite, 2-3 days after exposure will have redness that expands with rash with bulls eye pattern, red outer ring with area of clearness
-Body ache, fatigue, joint muscle pain, stiffness
-If untreated nervous system becomes affected, can cause meningitis, severe headaches, bell’s palsy,
___- joint pain, swelling, can shift from one joint to another
Heart rhythm irregularities
sx lyme disease
arthritic sx
hx tick bite, rash, bulls eye lesion=EM Elisa=show positive, or inconclusive will do western blot test, cerebral spinal fluid if have neuro signs
dx lyme disease
- reduce exposure , tick check after walking in heavy wood area, wear long sleeves, tick repellent,
Pt edu lyme disease
Increased uric acid production- by kidneys, Under excretion of uric acid
Increased intake of foods high in purine- shellfish, asparagus
GOUT: Etiology & Pathophysiology
Causes:
hereditary, or retention of uric acid
primary gout
- related to another disorder, diabetes, hypertension, renal disease, chemo drugs= increase rate of cell death
secondary gout
less than 4 one or more joints , onset is at night
Swelling-* big toe
Pain, Low-grade fever
Joints appear dusky and cyanotic
Attacks subside 2-10 days with or without tx -free of sx between attacks
GOUT: Clinical Manifestations acute
multiple joints
Uric acid deposits called tophi
Chronic inflammation
Cartilage destruction and deformation
Chronic gout sx
- elevated uric acid level
aspirate synovial fluid- see if sodium uraite crystals
GOUT Diagnostics
- limit alcohol, food high in purine
Pt edu gout meds
- inflammatory disease of connective tissue
Autoimmune reactions directed against constituents of cell nucleus, DNA
Antibody response related to B and
T cell hyperactivity
Inflammation will start,
Areas most commonly affected: kidneys, heart, lungs, brain, skin, and joints
Enviro triggers-sun burn, infectious agent
Any organ can be affected
SYSTEMIC LUPUS ERYTHEMATOSUS
dermatologic musculoskeletal cardiopulmonary renal nervous system hematologic Anxiety, depression, increase sensibility to infection
sx systemic lupus erythematosus
– butterfly rash, alopecia= hair loss
Dermatologic sx systemic lupus erythematosus
- arthritis, polyarthalgeia- pain in two or more joints=1st complaint
Musculoskeletal sx
systemic lupus erthematosus
- tachypnea- rapid breathing, pleurisy
Cardiopulmonary sx systemic lupus erythematosus
- leading cause of death, lupus nephritis
Primary goal- slow progression and preserve renal function
Renal sx systemic lupus
erythematosus
- seizures most common, peripheral neuropathy
- anemia, thrombocytopenia
nervous system
hematologic
sx systemic lupus erythematosus
Antinuclear antibody (ANA)- will be present Anti-DNA *Anti-Smith (Sm)- only 20% have, 99 % that do have lupus, exclusive to systemic lupus
SLE Diagnostics
- fever, joint inflammation, fatigue, fluid balance, neuro status, limitation of motion
- Pain management and pace activities
SLE: Nursing Implementation
Monitor
- sun protection, precipitating factors= stress or infection, pregnancy, infertility= renal involvement, increase risk preeclampsia, and preterm birth
Patient Education sle
Chronic pain syndrome causing nonarticular pain and fatigue with multiple tender points,
Mostly women – some men
Affects all ages
Fibromyalgia
-Abnormal sensory processing in CNS causing pain amplification
Pathophysiology fibromyalgia
- can begin as physical trauma or gradual
Widespread pain above and below the waist, both sides of body, fatigue, point tenderness
Fibromyalgia Clinical Manifestations
- At least 3 months of widespread pain left & right sides of the body above and below the waist, Axial pain (central part of the body) Pain (not just tenderness) in 11 of 18 specific tender points
Diagnostics fibromyalgia
- no cure
NSAIDs
Antidepressants- help with stress, fatigue, sleep disturbances
Ssri- depression and fibromyalgia
Muscle relaxants- flexerile= sleep disturbances
Fibromyalgia Syndrome Drug Therapy
Heat/cold
Massage if tolerated
Yoga, relaxation exercises
Stretching to release tension
Stretching exercises- low impact= walking, swimming, biking, balance
Teach limit sugar caffeine, alcohol interfere with med
Vit good to add- combat immune and stress
Nursing Implementation
fibromyalgia
early phase, inflammation beginning, don’t show up on xray
Stage 1- rheumatoid arthritis
moderate, have some destruction with inflammed synovial tissue growing into the joint cavity, thickening of synovium, muscular atrophy’s present, no involvement of panes of synovium
Stage 2- rheumatoid arthritis
- severe, x ray shows cartilage and bone destruction, joint deformity, narrow joint cavity, extensive muscular atrophy, extra articular soft tissue lesions, involves panes and synovium
Stage 3 rheumatoid arthritis
- terminal, less inflammation, deformities sticking out, fibrous, abnormal bony fusion
Stage 4 rheumatoid arthritis
- 4 of these present
Morning stiffness lasts more than an hour
Rheumatoid nodules
Positive rf (rheumatoid factor)- occurs in 80%
Swelling in 3 or 4 joints
Swelling in hand joints
Symmetric joint swelling
Antinuclear antibody titer- ana = substance produced by own body tissue, only in some ra patients
Synovial fluid increased wbc count
Xray-erosion or decalcification
Bone scan- better for early stages
Rheumatoid Arthritis: Diagnostics Criteria for Diagnosis:
