OA Osteoarthritis Flashcards
Osteoarthritis
- DJD (Degenerative Joint Disease)
- Non-inflammatory disorder of mobile joints
- Characterized by breakdown in cartilage
Osteoarthritis is the most common…
form of joint disease in US
Most significant risk factor for osteoarthritis
age
-normal process of aging due to wear and tear on joint
Percentage of affected adults by osteoarthritis
greater than 90% by age 40
What gender is more affected by osteoarthritis after age 50
women are more affected after 50
How many people are symptomatic over 65 years old?
60%
Types of Osteoarthritis
- Primary
2. Secondary
Primary Osteoarthritis
- idiopathic (no known cause)
- localized vs. general
Secondary Osteoarthritis
-identifiable cause or predisposition
- repetitive movement
- physical stress
- obesity
- certain occupations
What gender is more affected by osteoarthritis before 45
men more affected before 45
Male osteoarthritis differences
- more affected before 45
- knee OA is more common before 45
- Hip OA is more common after 55
- Hip, Knee, spine
Female osteoarthritis differences
- affected twice as often as men after 45
- knee OA more common after 45
- joints in fingers and thumb base more common after 55
- Hip, knee, hands
Describe cartilage during osteoarthritis
- damaged
- dull, yellow, and granular
- thins/erodes
What happens to the joint during osteoarthritis?
- deteriorates
- spurs develop at joint margins
- joint anatomy changes
- interferes with function, decreases mobility
- underlying bone is exposed
Prevention of OA
- maintain ideal weight
- control blood sugar
- regular moderate exercise
- maintain proper posture
- maintain body alignment
- rest when discomfort noted
- seek treatment early
Diagnostic Studies for OA
- xray
- MRI
- Bone Scan
- CT
- ESR
- Fluid aspiration
What do xrays show for OA patients?
- joint narrowing
- spurs
Joint fluid aspirate is used to detect…
- presence of bacteria (infection)
- uric acid crystals (gout)
Nursing assessment
- fam hx
- OLDCARTS-P
- pain
- activity level
- mobility
- physical apperance
- dx tests
OLDCARTS-P
- onset
- location
- duration
- character
- aggravating/relieving
- radiation
- timing
- severity
- prior
Nursing diagnoses
- chronic pain
- impaired physical mobility
- sedentary lifestyle
- imbalanced nutrition
- dressing self care deficit
Implementation of nursing process
- decrease pain
- increase mobility
- encourage weight loss
- assistive device
evaluation of nursing process
- routine assessment
- monitor changes
Management of osteoarthritis
- no cure
- interdisciplinary
- control of pain and inflammation
- prevention of disability
- improvement of joint function
Non-invasive management
- rest and joint protection
- heat for stiffness
- ice for acute exacerbation
- weight reduction
- complimentary/homeopathic therapies
- PT
complimentary/homeopathic therapies
- acupuncture
- yoga
- massage
- glucosamine and condroitin
PT for osteoarthritis
increases strength and flexibility
Pharm therapies for mild to moderate pain
Non-opioid analgesics
- NSAIDs
- Topical gels/cream
Typical non-opioid analgesics cream for OA
Capsalcin cream
Pharm therapies for moderate to severe pain
- Salicylates
- NSAIDs
- Corticosteroids
- Opioid Analgesics
Major joints for surgical intervention
hips and knees
Purpose of surgery for OA
- improves function
- corrects deformity
- remove damage
- relieves pain
Types of surgery
- joint arthroplasty
- joint resurfacing
- joint irrigation
- joint fusion
- osteotomy
Cemented Hip Arthroplasty (HA)
bonds bone to bone
-can become loose and require revision
Cementless Hip Arthroplasty (HA)
long-term stability
-for patient with high activity level and life expectancy >25 yrs
Risks of Hip Arthroplasty
- infection
- clots
- joint breakdown
Pre-op nursing care for Total Hip Arthroplasty
- establish data base
- reassurance regarding pain relief
- explain and practice post-op activities
- PT consult
- Fit for support hose
how to establish data base
amount of pain and disability
post-op activities
- turn, cough, and deep breathe
- isometric exercises of quads and glutes
- dorsiflexion and plantar flexion of foot
isometric exercises
no joint movement
PT consult
- use of trapeze
- exercises
Support hose for THA patients
- helps prevention for thrombophlebitis
- wear for 6-8 wks
- use along with anticoagulants
Post-op nursing care for THA
- take measures to prevent infection
- assess dressing, drainage tubes, and VS
- early ambulation
- maintain correct positioning
- watch for signs of dislocation
Measures to prevent infection after THA
- educate client about S/S of infection
- antibiotics after new joint
- prophylactic antibiotics before dental procedure
- strict asepsis during dressing change and when emptying any drains
Assessing the dressing & drainage tubes
- expect 200-500cc drainage in 1st 24 hrs
- expect 120cc by 48 hrs
Early ambulation after THA
- 1st post op day
- with walker and PT for cemented
- partial weight bearing for non-cemented
Correct positioning for post-op THA
- do not cross legs
- no adduction or rotation
- hip flexion not to exceed 90 degree for 4-6 weeks
- turn toward unaffected side/use brace
- help with socks and shoes
- use elevated toilet seat
Signs for dislocation
- groin pain on movement
- deformity or external rotation
Total Knee Arthroplasty (TKA)
replacement of knee joint due to unremitting pain and/or instability of joint
Pre and Post op care for TKA
-similar to THA except do not use abduction pillow or brace
Post-op care for TKA
-(CPM) Continuous passive motion machine
CPM
- range per minute ordered by surgeon
- 8-20 hrs/day
- prevents scar tissue
- positioned incorrectly can cause damage
