osteoarthritis Flashcards
osteoarthiris patho
- Occurs when the cartilage that cushions the ends of bones in your joints gradually deteriorates. Cartilage is a firm, slippery tissue that enables nearly frictionless joint motion.
- Loss of articular cartilage
- Narrowing of joint space
- Thinning of cartilage
- Affects joints independent of each other
synovitis
The joint becomes inflamed
What we see: Swelling Redness Warmth Pain
crepitus
Grading sound/ crunching sound caused by the loosened bone and cartilage in a synovial joint causing pain and stiffness
- Cartilage deterioded- calcified. Moving in joint space
- Movement of loosened bone and cartilage
risk factors for osteoarthritis
Repetitive use disorder weight/load bearing More common in females due to estrogen Overweight Age Mechanic(Job) Diet
assessment findings for osteoarthritis
- Pain
- Stiffness
- Tender at joint
- Grating sensation
- Swelling: body sending healthy cells to area, vasodilate, joint effusion= fluid build up in joint
- Bone spurs
diagnostic imaging
***XRAY
**Conventional radiography
MRI: for more details
Ultrasound
**Joint fluid analysis
lab results
erthrocyte sedimentation (ESR) c-reactice protein (CRP)
erthrocyte sedimentation (ESR)
Will be higher in osteoarthritis patients, advanced age, or infection. The erythrocyte sedimentation rate is the rate at which red blood cells in anticoagulated whole blood descend in a standardized tube over a period of one hour. It is a common hematology test, and is a non-specific measure of inflammation.
- Indirect measure of inflammation in the body
c-reactice protein (CRP)
Will be elevated in patients with osteoarthritis. C-reactive protein is an annular pentameric protein found in blood plasma, whose circulating concentrations rise in response to inflammation.
- Rises in response to inflammation: direct measure of inflammation in the body
priority problem for osteoarthritis
**Pain
**Inflammation
**Immobility
Stiffness
nonpharmacological interventions
**Rest
**Balanced rest with exercises
Elevation ( only small pillows) slightly bent if not created flexion contractures
Diet
**Loose weight
**Brace (assistive devices)
**Thermal modalities and or ice ( whichever provides more relief)
**Keep extremity in function/ dependent positon
exercise plan
- Start with short walks (aerobic), then make the walks longer distances or a quicker pace. Pay close attention to how the joint feels and what level of pain they are experiencing.
- National guidelines recommend 150 minutes per week (spaced out) of moderate intensity physical activity, plus 2 strength training sessions/ week. Examples include: brisk walking, slow biking, general gardening, and ballroom dancing.
tylenol
- first drug of choice
Dose:
650mg can take up to 4g of tylenol
Therapeutic Effect:
Management of moderate to severe pain
Nursing Considerations
Assess for clinical improvement and relief of pain
Follow up labs to monitor liver function
lidocaine
Dose Transdermal Patch (Lidoderm 5%), tube
Therapeutic Effect
To provide topical anesthesia for mucous membranes or skin;To provide pain relief postherpetic neuralgia
Nursing Considerations
- Use caution in patients with severe hepatic or renal disease because accumulation of lidocaine may occur and lead to toxicity
- Question for hypersensitivity to lidocaine, amide anesthetics.
- Only stays on for 12 hours. On for 12 off for 12
tramadol
** added when tyelnol doesnt work
Dose
50-100 mg orally every 4-6 hours PRN pain
Therapeutic Effect
- Immediate-Release: Management of moderate to moderately severe pain. Extended-Release: Around-the-clock management of moderate to moderately severe pain for extended periods.
- Reduces pain by acting on serotonergic and noradrenergic nociception
Nursing Considerations
- Can cause respiratory depression, dependence, don’t drink alcohol, caution with seizures
- Lightheaded and dizzy
glucosamine with chondroitin
Gluco: decrease inflammation
Chron: strength cartilage
Controversial
Dose
adults doses of 1500 mg by mouth daily
Therapeutic Effect
provide pain relief and improve function for people with knee osteoarthritis
Nursing Considerations
Glucosamine sulfate is well tolerated with occasional gastrointestinal discomfort
asks what his incision will look like and how long he will have to stay in the hospital for. How do you respond?
A vertical line over the knee cap, with only a short stay in the hospital. (Generally you’d leave the same day) 2-3 days very young same day
J.W. then says “Am I going to have to go to one of those convalescent homes, I really don’t want to go there. My sister went to one of those places and never got to go home.” What is the nurse’s best response?
I understand your diagnosis of OA is a difficult change in your lifestyle. Let’s talk about your concerns regarding home-care facilities.
Up to 75% of pt are going home and not going to rehab
rationale for this:
- Cefazolin (Kefzol) 1000mg IV q8h X 3 doses
- Xarelto (rivaroxaban) 10mg daily
- CBC in morning POD1
- Hydromorphone (Dilaudid) 1 – 2mg IVP q4h PRN pain
- PT and OT to evaluate on postoperative day one and start therapy
- Maintain leg in neutral position (Avoid internal/external rotation)
- CPM Machine
- Cryotherapy 30 min on q2h
- Pneumatic Compression Stockings
- Cefazolin: antibiotic would be used to prevent infection after surgery
- Rivaroxaban: anticoagulant would be used to prevent blood clots after surgery
- The CBC would be used to check for WBC CRP and ESR after surgery and bloodloss
- The hydromorphone is used for post surgery pain
- PT and OT would be used to improve and evaluate ADL’s
- Having the leg in a neutral and avoiding rotation will decrease the stress on the knee: prevent flexion contractor and reduce stress on knee
- The CPM machine is used to increase ROM and allow joint movement after surgery
- Cryotherapy(extreme cold) is used to reduce patient pain perception and decrease inflammation process
- Compression stockings are used to prevent blood clots in the deep veins of your legs
The nurse is performing a dressing change to the surgical incision. What are some of the things he/she should document?
- Any fluid/drainage coming out of the knee
- Color and size of incision site
- Any detected odors
- Redness, tenderness, swelling
- Count stables
