Nurb test 2: arthritis Flashcards by katie boone

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

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What are the most common types of arthritis ?

Osteoarthritis, gout, and rheumatoid arthritis

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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

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: 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

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Joints most commonly affected hands, hips, knees, neck, lower lumbar vertebrae, feet=big toe, fingers
joints are affected asymmetrically

osteoarthritis

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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

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grating sensation present in 90 percent in knee

osteoarthiritis Crepitation

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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

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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

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___ =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

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No cure
Managing pain and inflammation
Preventing disability
Maintaining and improving joint function

OSTEOARTHRITIS: Collaborative Care GOALS:

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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

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use nonpharmacological interventions will do more good

Nutritional Supplement

osteoarthritis

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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

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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

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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

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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

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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-

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cause is unknown

: autoimmune and genetic factor

Rheumatoid Arthritis: Etiology-

Theories

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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

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higher occurrence in twins, smoking increases risk for those who already are genetically predisposed

Genetic factor etiology

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Harmful but subtle

- fatigue, weight loss, generalized stiffness

Rheumatoid Arthritis: Clinical Manifestations

Prior to onset:

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: 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

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equal on both sides, can start in couple of joints

rheumatoid arthritis sx Affects joint symmetrically

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- 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: