Osteoarthritis/RA (Module 5) Flashcards
OA/DJD Patho
joint pain, long term damage and loss of function leading to joint mobility issues
includes progressive deterioration and loss of cartilage in 1+ joints (articular or hyaline cartilage) especially hips and knees, vertebral columns and hands
enzymes such as stromelysin break down articular matrix
joint space narrows and bone spurs form as cartilage and bones begin to erode
fissures, calcifications and ulcerations develop and cartilage thins
cartilage disintegrates, debris floats in joint causing crepitus
joints become painful and stiff and body’s repair process can’t overcome degeneration
OA Causes
age of joints (long term wear and tear, repetitive stress, overuse and hyperextension) >60 yrs
production of synovial fluid declines with age (less body fluid, less hyaluronic acid synthesis)
genetics
obesity
joint trauma
smoking
occupational risks
females: males (2:1)
metabolic disorders, DM
OA S/S
likely degenerative with secondary inflammation (nonsystemic, may be unilateral, affects weight bearing joints, metacarpophalangeal joints spared)
joint pain and stiffness
pain with palpation or ROM (observe for atrophy, loss of function, limp, restricted activity due to pain)
crepitus (continued grating sensation)
enlarged joint due to bone hypertrophy
heberdens and bouchard nodes
inflammation from secondary synovitis
joint effusion
vertebral radiating pain from compressed nerve roots
limping gait
change in role and self esteem
depression, anger, stress
OA Labs and Diagnostics
ESR and CRP might be slightly elevated
X Ray
CT scan
nuclear bone scan
CT myelogram
arthrogram
MRI
might see slight increase in ESR and CRP
OA Meds
Analgesics (acetaminophen) because OA isn’t primarily inflammatory
NSAIDs for short term (COX-2 inhibitors like celecoxib and nonselective COX inhibitors like ibuprofen)
muscle relaxants
opioids
glucosamine and chondroitin
topical applications (lidocaine 5% patches, topical gel or cream (apercreme or voltran))
OA Procedures
total joint replacement (arthroplasty) (most common!!)
total hip, knee, shoulder arthroplasty
discectomy
kyphosis
laminectomy
arthrodesis/spinal fusions
OA Complications
chronic pain due to joint swelling and deterioration
potential for decreased mobility due to joint pain and muscle atrophy
OA Nursing Care
nonpharmacologic (joint rest, using joint immobilizer/support)
balancing rest and activity to promote 8-10 hrs of sleep/rest and avoiding prolonged inactivity
position the joint to avoid excessive flexion of the involved joint and maintain normal extension (teach pt to position joints in their functional position to avoid flexion contracture formation (1), supportive shoes/foot insoles can relieve pressure on painful metatarsal joints (2))
heat/cold applications (hot showers and baths, hot packs, compresses, moist heat pads)
weight control
topical applications, acupuncture, tai chi, music therapy
CBTs (imagery, prayer, meditation)
reinforce the techniques and principles of exercise, ambulation and ADLs
collab with PT to implement regular exercises
low impact activities (swimming, walking)
refer to OT/PT for help with ADLs
orthopedic devices if needed
active ROM exercises
RA Patho
chronic progressive altered immunity disease —> transformed autoantibodies (rheumatoid factors [RF]) cause inflammation primarily in synovial joints
connective tissue problem with exacerbations and remissions
same process may occur in organs
joint involvement and functional decline in stages (may prevent or minimize damage if treated early) (synovium if inflamed and thickened leading to fluid accumulating in joint space causing pannus to form (1), pannus tissue erodes cartilage and destroys the joint (2))
inflammatory factors can also contribute to anorexia, weight loss and nutritional imbalances
RA Causes
autoimmune (genes, usually associated with human leukocyte antigen (HLA) proteins are thought to combine with environmental conditions to trigger RA)
emotional stress
environmental factors
RA S/S
inflammatory (systemic; bilateral, symmetric, multiple joints; usually affects UE first, distal interphalangeal joints of hands spared)
prolonged morning stiffness (pleuritic pain, anorexia/weight loss, fatigue, parasthesia, joint pain)
joint swelling and deformity
RA Risk Factors
onset 35-45
female (3:1)
RA Labs and Diagnostics
anti-CCP antibody
high RF antibody
high ESR/hs-CRP
high ANA antibodies
high WBCs
arthrocentesis
X-ray
bone scan
Arthrocentesis
a procedure to aspirate a sample of the synovial fluid to relieve pressure and analyze the fluid for inflammatory cells and immune complexes including RF
RA Meds
NSAIDS (short term)
COX2 inhibitors
corticosteroids
disease modifying anti-rheumatic drugs (DMARDs) used to slow progression of RA
biological response modifiers (BRMs) to neutralize the activity of tumor necrosis factor-alpha (TNFA)
immunosuppressants (glucocorticoids aka prednisone can help due to quick anti inflammatory and immunosuppressive effects)
Methotrexate (DMARD)
immunosuppressive, once a week dose is a mainstay of therapy for RA because it is effective and relatively inexpensive
leflunomide is similar
BRMs
etanercept, infliximab, adalimumab, certolizumab
teach to avoid crowds and sick to avoid infections, especially respiratory
RA Procedures
plasmapheresis (plasma exchange) to remove antibodies causing disease
total joint arthroplasty
synovectomy (removal of inflamed synovium may be needed for joints like knee or elbow)
RA Complications
chronic inflammation and pain
decreased ROM
joint deformity, muscle atrophy and fatigue
self esteem, self care, work and recreation
sjorgens syndrome (obstruction of secretory ducts: triad- dry mouth/eyes/vagina)
secondary osteoporosis
vasculitis (organ ischemia: inflammation disrupting blood flow)
felty syndrome (splenomegaly, anemia, neutropenia, thrombocytopenia)
RA Nursing Care
goal is to relieve pain, preserve joint mobility and muscle strength
use warm compresses for stiffness
use cold compresses for inflammation
rest/immobilization for acutely inflamed joints
ROM and weight bearing exercises to reduce pain from immobility
anti inflammatory meds before activity and with meals
use larger muscle groups for tasks (use flat of hand to squeeze toothpaste tube)
easy open med containers
