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NSG 470 > Osteoarthritis and Rheumatoid Arthritis EXAM 3 > Flashcards

Osteoarthritis and Rheumatoid Arthritis EXAM 3 Flashcards

1
Q

Osteoarthritis (OA) Patho

A

-Overuse of the joint, causing degeneration of the cartilage , narrowing the joint space, causing bone on bone abrasion forming osteophytes
-Loss of the synovium, which is responsible for production of synovial fluid
-Joint space narrowing, causing the bone on bone
-Bone on bone can cause bone to break off and float around in the joint space (Painful)
-Polishing of the bone, can occur

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2
Q

Osteoarthritis, joint space

A

-Formation of osteophytes (Bone spurs)
-Bits of bone that stick out, super painful
-Not symmetrical

-Affects the PIP and DIP joints

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3
Q

Bouchard’s nodes

A

PIP

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4
Q

Heberden’s nodes

A

DIP

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5
Q

Osteoarthritis risk factors

A

-60+ age (bone wears down over time)
-Obesity (extra weight extra wear)
-Genetics
-Repetitive injury to joint
-Strenuous jobs (like nursing)
-Occurs mainly in weight bearing joints, hips and knees, but can occur in the hands and feet and spine
-Women are more prone than men but it can affect both

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6
Q

Osteoartritis, S+S

A

-Joint pain and stiffness
-May not be systemic, only affects the joints
-Crepitus
-Enlargement of the joint/ hypertrophy
-Pain with joint palpation
-Heberden’s nodes/ bouchard’s nodes
-Inflammation, only to the joints from tissue dmg: Not inflammatory like RA

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7
Q

Osteoartritis, S+S: Joint pain and stiffness

A

-Morning stiffness but it goes away with use fast, however at the end of the day they experience more pain and stiffness because they’ve been using their joints
-Pain improves with rest

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8
Q

Osteoartritis, S+S: Only affecting the joints

A

-Won’t experience Fever or anemia

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9
Q

Osteoartritis, S+S: Enlargement of the joint

A

Can have bone spurs which are tender when touched

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10
Q

Osteoarthritis Labs

A

-Essentially normal in OA

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11
Q

OA: Xray

A

-Used to rule out fracture and spinal degeneration
-Doesn’t show cartilage degeneration, only the bone
-Usually all you need for a diagnosis

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12
Q

OA: MRI

A

Shows soft tissue of back, intervertebral disks, spine, and spinal nerves
-Can see the cartilage
-Can see sclerosis of the bone and ostreophytes
-Early diagnosis

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13
Q

OA: Ct scan

A

Shows injury and patho to bone
-Can see osteophytes and all that
-Early diagnosis

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14
Q

OA EKG

A

-Measures electrical impulses produced by nerves and muscles
-Used to rule out other causes

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15
Q

OA Arthogram

A

-Injection of contrast dye to enhance visualization of the joint, bone chips, torn ligaments and loose bodies

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16
Q

OA nursing mgmt: Assessment

A

-Pain
-Musculoskeletal system
-Neuro
-Psychosocial impact

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17
Q

OA nursing mgmt: Pain Assessment

A

-Sharp pain or burning
-Morning pain or stiffness, but improves quickly

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18
Q

OA nursing mgmt: Musculoskeletal Assessment

A

-ROM of the joint can be impaired
-Crepitus
-Joints should be cool and hard/ boney, not warm
-Spinal alignment is off, can put pressure to one side (Lean away from the affected side)
-Pain on activity

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19
Q

OA nursing mgmt: Neuro Assessment

A

-Movement and sensation

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20
Q

OA nursing mgmt: Psych-social Assessment

A

-Depression is super common
-Decreased self esteem from joint deformities
-Fatigue and malaise

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21
Q

OA nursing mgmt: Education

A

-Positioning
-Med mgmt
-Activity/rest
-Heat/ ice application
-Exercise
-Alt therapies
-Promote independence
-Promote ideal body weight
-Assistive devices

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22
Q

OA nursing mgmt: Education, Positioning

A

Sitting or laying, upright (30 degrees) and a pillow under the knees to take the weight off

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23
Q

OA nursing mgmt: Education, Activity/Rest

A

-Schedule with rest periods
-Need to schedule to limit fatigue and pain
-More intense activities in the morning and more chilling later on

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24
Q

OA nursing mgmt: Education Exercise

A

-Super helpful
-Slow progression in exercise, slowly feels better
-Dont do high impact activity
-Low impact is good (swimming)
-Strength training is good too

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25
Q

Med mgmt of OA

A

-Acetaminophen/tylenol
-NSAID’s
-Opioids
-Capsaicin ointment
-Lidoderm patch
-Intraarticular injections
-Pt/ot

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26
Q

Med mgmt of OA, Acetaminophen/tylenol

A

-Analgesic/ pain relief
-Max dose is 3000mg in 24 hours when used for long term chronic mgmt
-Risk for liver tox
-Be aware of tylenol in combo with opiates (Hydrocodone/lorotab), count to that 3000mg
-Be sure to look at all pain med

Not recommended anymore, Not evidence based

27
Q

Med mgmt of OA : NSAID’s

A

-Non steroidal anti inflammatory
-Celecoxib, Ibuprofen, Naproxen
- Need baseline liver and renal, CBC required/ Monitor routinely
-Side effects: GI bleed, elevated LE, Renal tox, (Report bloody stool to provider)
-May be used in combo with tylenol
-Topical NSAIDs may be used in local area to relieve pain, non systemic

28
Q

Med mgmt of OA : Opioids

A

-Hydrocodone/Lortab
-Treatment of moderate to severe pain/ short term use
-Monitor for adverse effects, especially old people

29
Q

Med mgmt of OA : Capsaicin ointment

A

-From hot peppers, avoid contact with eyes
-Wear gloves when applying, remove gloves and wash hands after
_Initial burning when applied, will subside over time
-Application of heat over capsaicin could cause skin burn, dont put a hot pack on after

30
Q

Med mgmt of OA : Lidoderm patch

A

-Topical application
-Apply to clean/dry skin
-Remove after 12 hours, need to wait 12hrs to apply a new dose

31
Q

Med mgmt of OA : Intra-articular injections

A

-Glucocorticoids may be used to treat localized inflammation
-Oral isnt used in this injected into joint
-Only temp relief

32
Q

What method are glucocorticoids given for OA

A

Injected into the joint, its only local swelling due to trauma to the site so a systemic route, like oral wouldnt be effective

33
Q

Med mgmt of OA : PT/OT

A

_Exercise for muscle strengthening
-Transcutaneous electrical nerve stim

34
Q

Rheumatic arthritis (RA)

A

-Chronic INFLAMMATORY, progressive disease
-Auto immune disease
-Bilateral/symmetrical, affecting multiple joints at once, usually upper joints first
-Commonly manifest the clinical features of arthritis
-Marked by periods of remission and exasperation
-Chronic and progressive

35
Q

Clinical features of arthritis

A

-Inflammation of joint and pain

36
Q

RA patho

A

-Autoimmune, WBC attack the synovial tissue
-Inflammation extends to cartilage, tendons, and ligaments around joints
-Joint deformity and erosion
-Decreased ROM and function in the affected joint

37
Q

Stages of RA

A

-Synovitis
-Pannus
-Ankylosis

38
Q

Stages of RA: Synovitis

A

-Inflammation of the synovium, WBC invade and cause inflammation and thickening leading to degeneration
-Joints are red, thickened and boggy

39
Q

Stages of RA: Development of Pannus

A

-Fibrous connective tissue and joint space starts to disappear
-Granulation tissue formation, growing causing dmg to tissue and bone
-Disappearance of space between the bones, leading to the next stage, fusion

40
Q

Stages of RA: Alkylosis

A

Bone fusion, severe limited mobility

41
Q

Swan Hands

A

-Symptom of RA looks like hands are swayed

42
Q

RA risk factors

A

-Age 20-50 (younger than OA)
-Female
-Genetic predisposition, genetic variation
-Viral infection/smoking
-Aging

43
Q

S+S RA

A

-Early S+S are similar to other disorders
-PAIN AT REST
-Morning stiffness, last for a longer period of time (1hr+)
-Once they get their joints moving the pain subsides
-Fatigue
-Systemic inflammation of joints
-Joint inflamation/ limited movement
-Muscle weakness/ atrophy (are not exercising because of pain)
-Joint deformity (ulnar deviation swan neck hands)
-Contracture of hands

44
Q

Which form of arthritis has fever and fatigue secondary to anemia

A

RA

45
Q

RA labs

A

-Rheumatoid factor (75% of people)
-ESR: Non specific inflammatory marker, say there is general inflammation in the body, dont know where
-CRP: non specific inflammatory marker, says there is general inflammation in the body
-CBC (WBC): Elevated, if you take a sample of synovial fluid it would be high in wbc from autoimmune response.
-Anti CCP: another set of antibodies that are present with RA, present early on
-X rays: wont see osteophyte formation

46
Q

What form of arthritis has osteophyte formation

A

OA

47
Q

In RA, the synovial fluid would have high amounts of what type of cell

A

White blood cell

48
Q

Health history RA

A

-Onset and evolution of symptoms
-Sudden onset
-Family history
-Past health history (Unexplained fever or anemia?) Fatigue?

49
Q

Physical exam RA

A

-History and observation
-Gait, posture general musculoskeletal size and structure
-Gross deformities and abnormalities in movements

50
Q

What joint is not affected in RA

A

DIP

51
Q

RA Meds

A

-NSAIDS
-Steroids
-DMARDs

52
Q

RA Meds: NSAIDs

A

-Usually first line
-Analgesic/ anti inflammatory effects
-GI distress and bleeding (monitor for dark stool)
-Baseline liver and renal

53
Q

RA Meds: Steroids

A

Oral (its systemic)
-Strong anti-inflammatory used in exasperations
-Not meant for long term use
-Monitor blood sugar, weight and blood pressure (may need to adjust other meds)
-Slows boney erosion

54
Q

RA Meds: DMARDS

A

-Disease modifying anti-rheumatic drug
-Slows progression of RA
-Controls symptoms, no wbc attacking synovium
-Suppresses the immune systems reaction to RA (decreases pain and inflammation)
-May take weeks to recognize the effects

55
Q

DMARDs drug names

A

Plaquenil/ hydroxychloroquine
-Methotrexate
-Sulfasalazine

56
Q

RA and OA similarities

A

-Pain
-Stiffness
-Weakness
-Depression

57
Q

Nursing diagnosis and interventions: RA pain

A

Provide comfort measures
-Anti inflammatory analgesics

58
Q

Nursing diagnosis and interventions: RA Fatigue

A

-Energy conserving techniques
-High energy in the morning and chill in afternoon
-Form a schedule

59
Q

Nursing diagnosis and interventions: RA Impaired joint mobility

A

-If joint is inflammed, chill dont exercise
-Exercise is good
PT/OT
-Encourage independence in mobility
-May need assistive devices

60
Q

Nursing diagnosis and interventions: RA Self care deficit

A

-Assist in identifying self care deficits
-Provide assistive devices
-Consult with community agencies, support group

61
Q

Nursing diagnosis and interventions: RA Disturbed body image

A

-Assist to identify elements of control over disease
-Encourage verbalization of feelings

62
Q

Nursing diagnosis and interventions: RA Ineffective coping

A

-Identify areas of life affected by disease
-Develop plan for mgmt of symptoms and enlisting support of family and friends to promote daily function
-Local support groups

63
Q

Nursing diagnosis and interventions: RA Complications secondary to meds

A

-Periodical clinical assessment and lab eval
-Provide education about correct self admin, side effects, and importance of monitoring
-Counsel regarding methods to reduce side effects and manage symptoms
-Administer meds in modified doses as prescribed if complications occur
-What to report to the provider

NSG 470 (26 decks)

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