osteoarthris/rhuematoid arthritis

Question 1

osteoarthritis

Answer 1

overuse of joint –> eroded cartilage + bone –> osteophytes –> degenerative change in joints

progressive deterioration of articular cartilage
bone on bone
joint space narrow; dec joint mobility
localized, non systemic
asymmetric

Question 2

osteoarthritis risk factors

Answer 2

age > 60
female
obesity (weight bearing joints)
occupation
sports
genetics
repetitive injury to joint/stress

Question 3

osteoarthritis s/s

Answer 3

joint pain + stiffness
functional impairment
crepitus
enlargement of joint/hypertrophy
pain with joint palpation/ROM
heberden’s node + bouchard’s node
spinal DJD - pain, down nerve peripherally due to compression of spinal nerve roots
limp w/ ambulation
joint effusion
muscle atrophy
inflammation local due to synovitis

Question 4

osteophytes

Answer 4

bone spurs
PIP joint - Bouchard’s Nodes
DIP joint - Heberden’s Nodes
can be bilateral; tender + inflamed

Question 5

osteoarthritis diagnostics

Answer 5

labs - norm
x ray - rule out fracture, spinal degen
MRI - show soft tissue of back, inter-vertebral disks, SC + spinal nerves
CT scan - shows injury/pathology to bone
EMG - measures electrical impulses prod by nerves + muscles
arthrogram - injection of contrast dye to enhance visualization of joint, bone chips, ligaments or loose bodies

Question 6

osteoarthritis nursing mgmt

Answer 6

assessment: pain, musculoskeletal, neuro, psycho-social
pt edu: neutral position, med mgmt, balance act/rest, exercise (aerobic + strength), heat/ice, promote independence, diet = ideal BW, fall risks, body mechanics, assistive device, alt therapy

Question 7

osteoarthritis meds

Answer 7

acetaminophen/tylenol - NO LONGER REC
max dose: 3000mg/24 hrs, long term chronic use, liver toxic, OD

duloxetine - SSRI
used when contraind. to NSAIDs

NSAIDs
topical (Diclofenac patch) - local pain
oral (Celocoxib, Ibuprofen, Naproxen)

opioids (hydrocodone/lortab, oxycodone +/- aceta/)

capsaicin ointment

lidoderm patch - topical, remove after 12 hrs

intra-articular injections (glucocorticoid for inflammation)

Question 8

NSAIDs

Answer 8

topical (Diclofenac patch) - local pain
oral (Celocoxib, Ibuprofen, Naproxen)
baseline + monitor liver enzymes, renal and CBC
SE: PUD, GI bleed, elev. liver enzymes, renal toxic
Cox 2 inhibitor less GI but inc CV risk (MI, stroke, death)
take w/ water + food
combo w/ tylenol
may need GI prophylaxis - H2 blocker (famotidine) or PPI (omeprazole)

Question 9

opioids

Answer 9

tx of mod to severe pain/short term use
avoid if poss
mon for adverse effects (elders)
alt. tramadol - non opioids
DONT DRIVE

Question 10

capsaicin

Answer 10

from hot peppers/avoid eye touching
wear gloves
initial burn will subside
application of heat over capsaicin = skin burn

Question 11

athroplasty

Answer 11

total hip or total knee replacement (TKR, THR)
advanced disease
goal: dec pain, inc mobility, inc QoL
contraind: infection within 4 weeks, adv osteoporosis
risks: bleeding, VTE, post op infection, persistent pain

Question 12

rheumatic athritis

Answer 12

autoimmune disease
systemic, chronic, inflam, progressive
WBC’s attack synovial tissue –> thick + inflamed –> inflammation to cartilage, tendon, ligaments around joint –> joint deformity + bone erosion –> dec ROM + function

bilateral/asymmetrical –> affects multiple joints at once
periods of remission + exacerbation
can affect any connective tissue but joints are primary
(BV - vasculitis, lung, pericardium, eyes - iritis, scleritis)

Question 13

RA stages

Answer 13

Synovitis – inflammation of synovium
Development of pannus – fibrous connective tissue and the joint space starts to disappear
ankylosis - bone fusion, severe lim mobility

healthy –> synovitis –> pannus –> fibrous ankylosis –> bony ankylosis

Question 14

RA risk factors

Answer 14

age: 20-60
females
genetic predisposition
older age
prior infection, particularly Epstein-Barr virus (EBV)
stress

Question 15

RA s/s

Answer 15

pain @ rest + with movement
morning stiffness > 30 mins
fatigue
joint swell/pain/erythema/warmth
joint immobility/lim movement/lack of function
joint deformity: ulnar deviation, swan neck hands
SQ nodules
muscle weakness/atrophy
lymph node enlargement
low grade temp

Question 16

RA s/s

Answer 16

anti CCP - positive
RF - inc titer = RA
ANA - pos titer
ESR - elevated in inflammation + infection
CRP - can be used to dx, mon disease act
CBC - wbc, anemia
xrays

Question 17

RA nursing mgmt

Answer 17

assessment: health hx, physical exam + functional assessment (gait, posture, gross deformities, abnorm movements)

Question 18

RA meds

Answer 18

NSAIDs
usually start, provide analgesia + anti inflam
can cause PUD, GI bleed, inc CVD complications (MI, stroke, death)

steroids
exacerbations
bridges DMARDs
not for long term
mon blood sugar, weight BP

Question 19

DMARDs

Answer 19

disease modifying anti-rheumatic drugs
conventional/synthetic = (Methotrexate, Hydroxychloroquine, Sulfasalazine, Leflunomide)
biologic = (Infliximb, Etanercept, Adalinumab)
- slow progression
- suppress immune sys. reaction –> dec pain + inflam
- may take weeks, function + QoL improved

Question 20

RA + OA differences

Answer 20

RA is warm, OA is cool
Timing: RA worse in am, OA worse with use and as the day progresses
Location: DIP is spared in RA
RA is systemic; OA is localized

OA: degenerative, morning stiffness less than 30, herberden’s node, asymmetrical, cartilage loss

RA: inflamed synovium, autoimmune, morning stiffness longer than 30, symmetrical, extra-articular involvement

Question 21

RA + OA similarities

Answer 21

pain, stiffness, weakness, depression

Question 22

nursing diagnoses

Answer 22

Acute on chronic pain
Fatigue
Impaired physical mobility
Self-care deficits
Disturbed body image
Ineffective coping
Complications secondary to effects of medications

Question 23

goals of care

Answer 23

pain + fatigue relief
Inc mobility
Maintenance of self-care
Improved body image
Effective coping
Absence of complications
Improved QOL

Question 24

nursing interventions

Answer 24

Pain = comfort measures, anti inflam analgesics
Fatigue = energy conserving techniques, activity/rest schedule
Impaired physical mobility = PT/OT needs, independence
self care = assistive devices, community agencies
body image = identify elements of control, encourage verbalization of feelings
ineffective coping = areas affected, dev plan for manage symptoms + enlist support
complications 2ndary to meds = labs + assessments, pt edu, admin meds in modified dose