Osteoarthritis

Question 1

Goals of managing OA

Answer 1

• -Suppress inflammation • -Control pain • -Maintain or improve joint mobility • -Maintain or improve functional status • -Increase knowledge • -Promote self-management

Question 2

Other ways to manage OA

Answer 2

Ice, massage, heat
Corticosteroids in the joint
Viscosupplementation shots
Glucosamine

Question 3

Med managing OA

Answer 3

No tx to cure OA. Can be managed though.
-NSAIDs ( Tylenol 3g/day max)

• cox1 meds (Voltaren, capsaicin, ibuprofen, Tylenol) has more gi issues
• cox2 meds (Celebrex) minimal gi issues

Question 4

What is the pathophysiology of OA

Answer 4

• Erosion of cartilage (that cushions the end
of bones) • hypertrophy of bone (osteophytes or
bone spurs) • Reactive inflammation of synovium

Question 5

Diagnostics for OA

Answer 5

X ray
DEXA
Blood tests
Arthroscopy

Question 6

Health preventions and techniques for OA

Answer 6

Healthy weight
Regular exercise
Proper fitting shoes and equipment
Low impact exercise 
Assistive devices like electric can openers, elevators, etc. 
Heat/ice compress
Pain awareness
Clutter free environment
Avoid falls
PT
Balanced diet
Rest when pain is intensified

Question 7

How do we screen for OA

Answer 7

• Questionnaires
– Asking about pain
– Limitations in walking
– Difficulty getting up out of a chair, etc.
– Stiffness

Question 8

Nursing diagnoses of OA

Answer 8

Chronic pain r/t loss of cartilage
Impaired mobility r/t cartilage degeneration and pain
Imbalanced nutrition
Impaired self care deficit

Question 9

What is an arthroscopy?

Answer 9

Examining joint with camera inserting needle into joint sight

Question 10

Overall pre op checklist

Answer 10

• Identification of client/ID band • Marking operative site • NPO? • Informed consent(s)- operative, anesthesia • Accurate Ht and Wt charted • H & P/Pre-operative clearance • Pre-op labs and tests-Are they normal? • Voids before procedure • VS, Assessment * document neurovascular
status, allergies noted • Skin prep/pre-medications if ordered • Pre-operative teaching

Question 11

What is osteoarthritis?

Answer 11

Degenerative Joint Disease (DJD)

• -Chronic, non-inflammatory • -Weight-bearing synovial joints and fingers

Question 12

Symptoms of OA

Answer 12

Joint pain
Reduced mobility
Phalangeal deformities
Swelling and redness at joint site
Non-symmetrical joint pain 
Pain decimates upon rest and inactivity 
Pain intensifies upon activity

Question 13

Nursing considerations with NSAIDS

Answer 13

• Take prior to activity
• Tylenol for fever
• possible confusion in elderly
• monitor for gi bleed, nephrotoxicity, elevated liver enzymes
• prolonged clotting
• reduction of effects of ACE inhibitors

Question 14

Nursing considerations for topical agents

Answer 14

• wear gloves when applying
• dont apply over broken skin
• wash hands after applying
• do not wrap bandage tightly after applying

Question 15

Indicators of neurovascular dysfunction?

Answer 15

• Color: Pale, cyanotic, or mottled
• Temperature: cool
• Capillary refill: over 2 seconds
• Weakness, paralysis
• Paresthesia
• Unrelenting pain
• Absence of feeling

Question 16

What are two local and regional anesthesia’s commonly used?

Answer 16

Lidocaine-short acting
Bupivicaine-long acting

Watch for systemic absorption that can cause bradycardia, dysrhythmia, hypotension

Question 17

Risk factors for an arthroscopy

Answer 17

– Age
– Nutrition
– Fluid and electrolyte status
– General health- delayed with upper
respiratory symptoms 
– Cardiac disease 
– Lung disease 
– Blood coagulation disorders 
– Renal disease 
– Diabetes mellitus 
– Liver disease 
– Obesity 
– Current medications

Question 18

General/sedation anesthesia’s?

Answer 18

Barbituates-Commonly used for induction
❖ Thiopental Sodium (Sodium Pentathol)-fast acting depressant of CNS, rapid progression from sedation to LOC. Hypotension common.

Benzodiazepines
❖ Midazolam hydrochloride (Versed),
Diazepam (Valium), Ativan (Lorazepam)- cause amnesia, sedation

Question 19

Reversal agent for heavy sedation?

Answer 19

Flumazenil (romazicon)