Osteoarthritis Flashcards
The nurse has completed giving discharge instructions to a client with osteoarthritis who has had a total joint replacement (TJR) of the knee with a metal prosthetic system. The nurse determines that the client understands the instructions if the client makes which statement?
Changes in the shape of the knee are expected.”
“Fever, redness, and increased pain are expected.”
“All caregivers need to be told about the metal implant.”
“Bleeding gums or black stools may occur, but this is normal.”
“All caregivers need to be told about the metal implant.”
Rationale:
A TJR is also known as a total joint arthroplasty (TJA). The client must inform other caregivers of the presence of the metal implant because certain tests and procedures will need to be avoided. After total knee replacement, the client needs to report signs and symptoms of infection and any changes in the shape of the knee. These could indicate developing complications. With a metal implant, the client may be on anticoagulant therapy and needs to report adverse effects of this therapy, including bleeding from a variety of sources, and the client will need antibiotic prophylaxis for invasive procedures.
The nurse is caring for a client with osteoarthritis. The nurse performs an assessment knowing that which clinical manifestations are associated with the disorder? Select all that apply.
Elevated white blood cell count
A decreased sedimentation rate
Joint pain that diminishes after rest
Elevated antinuclear antibody levels
Joint pain that intensifies with activity
Joint pain that diminishes after rest
Joint pain that intensifies with activity
Rationale:
The stiffness and joint pain that occur in osteoarthritis diminish after rest and intensify with activity. No specific laboratory findings are useful in diagnosing osteoarthritis. The client may have a normal or slightly elevated sedimentation rate. Morning stiffness lasting longer than 30 minutes occurs in rheumatoid arthritis. Elevated white blood cell counts, platelet counts, and antinuclear antibody levels occur in rheumatoid arthritis.
Diclofenac is prescribed for a client with osteoarthritis. Which medication, if noted on the client’s record, would alert the nurse to consult with the primary health care provider (PHCP)?
Phenytoin
Primidone
Acetaminophen
Warfarin sodium
Warfarin sodium
Rationale:
Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID). Interactions may occur with the use of anticoagulants, and the nurse would consult with the PHCP about a potential medication interaction if an anticoagulant is prescribed. Phenytoin and primidone are anticonvulsant medications, and acetaminophen is a nonopioid analgesic. These medications are not contraindicated with diclofenac.
A client with osteoarthritis is receiving diclofenac sodium. The nurse would be concerned about the administration of this medication if the client’s history and physical included a diagnosis of which condition?
Graves’ disease
Peptic ulcer disease
Coronary artery disease
Benign prostatic hypertrophy
Peptic ulcer disease
Rationale:
Diclofenac sodium is a nonsteroidal anti-inflammatory drug (NSAID). It is a prostaglandin inhibitor and decreases mucous production in the stomach. The use of NSAIDs in the client with ulcer disease could place the client at risk for perforation and hemorrhage. The diagnoses of Graves’ disease, coronary artery disease, and benign prostatic hypertrophy are not concerns with the use of this medication.
Which clinical manifestation is associated with osteoarthritis?
Fever and malaise
Crepitation in the weight-bearing joints
Increased ESR
Morning stiffness of all joints that tends to last all day
Crepitation in the weight-bearing joints
Rationale: Morning stiffness may appear in OA but usually resolves within 30 mins instead of lasting all day.
Which assessment finding may be associated with osteoarthritis of the knees?
Reddened, swollen, affected joints
Stiffness that is worse in the evening
Swan-neck deformity in affected joints
Crepitus upon movement of knee joints
Crepitus upon movement of knee joints
Which diagnostic tests help to determine the severity of osteoarthritis and plan the course of treatment. Select all that apply.
Serum uric acid
CT scan
MRI
ACPA
ESR blood test
CT scan
MRI
Which patient condition may indicate that celecoxib should be prescribed for treatment of osteoarthritis?
The patient is taking warfarin
The patient has hyperchlorhydria
the patient has severe arthritic symptomatology
The patient does not tolerate traditional NSAIDs
The patient does not tolerate traditional NSAIDs.
Which patient statement indicates an understanding of teaching about osteoarthritis of the knees?
“Osteoarthritis is a normal part of the aging process”
“Cartilage destruction does not begin until after the age 50”
“Osteoarthritis is an inflammatory disease of the joints that may present symptoms of at any age.”
“Osteoarthritis is more common with aging, but it usually remains confined to a few joints and does not cause crippling”
“Osteoarthritis is more common with aging, but it usually remains confined to a few joints and does not cause crippling”
Which diagnostic tests are indicative of osteoarthritis?
Elevated C-reactive protein
Osteoporosis on x-ray exam
Elevated ESR
Narrowed joint space on x-ray examination
WBC count > 20,000/uL in the synovial fluid
Elevated ESR
Narrowed joint space on x-ray examination
Which intervention is beneficial for protecting the joints in a patient who has bilateral osteoarthritis of the knees?
Exercise regularly and maintain a well-balanced diet.
Use a wheelchair to avoid walking as much as possible.
Avoid sitting at a 90-degree angle and avoid full flexion of the knees
Use a cane for ambulation to relieve the pressure on the hips.
Exercise regularly and maintain a well-balanced diet.
