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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
Med mgmt of OA
-Acetaminophen/tylenol -NSAID's -Opioids -Capsaicin ointment -Lidoderm patch -Intraarticular injections -Pt/ot
26
Med mgmt of OA, Acetaminophen/tylenol
-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
Med mgmt of OA : NSAID's
-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
Med mgmt of OA : Opioids
-Hydrocodone/Lortab -Treatment of moderate to severe pain/ short term use -Monitor for adverse effects, especially old people
29
Med mgmt of OA : Capsaicin ointment
-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
Med mgmt of OA : Lidoderm patch
-Topical application -Apply to clean/dry skin -Remove after 12 hours, need to wait 12hrs to apply a new dose
31
Med mgmt of OA : Intra-articular injections
-Glucocorticoids may be used to treat localized inflammation -Oral isnt used in this injected into joint -Only temp relief
32
What method are glucocorticoids given for OA
Injected into the joint, its only local swelling due to trauma to the site so a systemic route, like oral wouldnt be effective
33
Med mgmt of OA : PT/OT
_Exercise for muscle strengthening -Transcutaneous electrical nerve stim
34
Rheumatic arthritis (RA)
-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
Clinical features of arthritis
-Inflammation of joint and pain
36
RA patho
-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
Stages of RA
-Synovitis -Pannus -Ankylosis
38
Stages of RA: Synovitis
-Inflammation of the synovium, WBC invade and cause inflammation and thickening leading to degeneration -Joints are red, thickened and boggy
39
Stages of RA: Development of Pannus
-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
Stages of RA: Alkylosis
Bone fusion, severe limited mobility
41
Swan Hands
-Symptom of RA looks like hands are swayed
42
RA risk factors
-Age 20-50 (younger than OA) -Female -Genetic predisposition, genetic variation -Viral infection/smoking -Aging
43
S+S RA
-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
Which form of arthritis has fever and fatigue secondary to anemia
RA
45
RA labs
-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
What form of arthritis has osteophyte formation
OA
47
In RA, the synovial fluid would have high amounts of what type of cell
White blood cell
48
Health history RA
-Onset and evolution of symptoms -Sudden onset -Family history -Past health history (Unexplained fever or anemia?) Fatigue?
49
Physical exam RA
-History and observation -Gait, posture general musculoskeletal size and structure -Gross deformities and abnormalities in movements
50
What joint is not affected in RA
DIP
51
RA Meds
-NSAIDS -Steroids -DMARDs
52
RA Meds: NSAIDs
-Usually first line -Analgesic/ anti inflammatory effects -GI distress and bleeding (monitor for dark stool) -Baseline liver and renal
53
RA Meds: Steroids
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
RA Meds: DMARDS
-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
DMARDs drug names
Plaquenil/ hydroxychloroquine -Methotrexate -Sulfasalazine
56
RA and OA similarities
-Pain -Stiffness -Weakness -Depression
57
Nursing diagnosis and interventions: RA pain
Provide comfort measures -Anti inflammatory analgesics
58
Nursing diagnosis and interventions: RA Fatigue
-Energy conserving techniques -High energy in the morning and chill in afternoon -Form a schedule
59
Nursing diagnosis and interventions: RA Impaired joint mobility
-If joint is inflammed, chill dont exercise -Exercise is good PT/OT -Encourage independence in mobility -May need assistive devices
60
Nursing diagnosis and interventions: RA Self care deficit
-Assist in identifying self care deficits -Provide assistive devices -Consult with community agencies, support group
61
Nursing diagnosis and interventions: RA Disturbed body image
-Assist to identify elements of control over disease -Encourage verbalization of feelings
62
Nursing diagnosis and interventions: RA Ineffective coping
-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
Nursing diagnosis and interventions: RA Complications secondary to meds
-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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