Osteoarthritis/Test 4 Flashcards
Osteoarthritis is
a progressive non-inflammatory disease that affects joints and surrounding tissues. No single cause has been identified.
Modifiable risk factor for osteoarthritis:
Obesity- moderate exercise and weight control has been shown to decrease the likelihood of disease development and progression.
Cartilage destruction can begin between ages
20 and 30. More than half >65 years have xray evidence in at least one joint.
-before age 50, men affected more than women. Incidence greater in women after age 50
Etiology and Pathophysiology-
*OA results from cartilage damage and narrowing of the joint space
No significant inflammatory component but
synovial fluid may become inflamed from cartilage and bone erosion- loss of cartilage and body cannot repair cartilage because of ongoing destruction. Known to involve formation of new joint tissue in response to cartilage destruction
Etiology and pathophysiology- cartilage and bony growth
increase at joint margins. Resulting incongruity in joint surfaces. Contributes to reduction in motion.
Pain
- inflammatory change contributes to early pain and stiffness.
- later in disease pain results from contact between exposed bony joint surfaces after articular cartilage has completely deteriorated.
Types and causes: Idiopathic (Primary)
- etiology unknown
- age is factor (wear and tear on joints)
Secondary
any condition that damages cartilage-
*Obesity, athletics, dancing, performing repetitive actions and infections. (Trauma, mechanical stress, inflammation, joint instability, neurologic disorders, skeletal deformities, hematologic/endocrine disorders and use of selected drugs)
Prevention is not
possible. Community education should focus on- alteration of modifiable risk factors, weight loss, occupational and recreational hazards.
* Athletic instruction and physical fitness program safety measures
Nursing assessment:
- Type
- location
- severity
- and duration of pt’s joint pain and stiffness.
- questions on extent these symptoms affect abilities to perform ADLs
- pain relieving practices
- physical exam of affected joints (tenderness, swelling, limitation of movement, crepitation). Compare to the unaffected side.
Systemic S/S:
None!!!
- fatigue, fever, organ involvement are not present in OA
- important distinction between OA and inflammatory joint disorders such as RA
Nursing Implementation/Acute intervention:
- Usually treated on an outpatient basis
- health assessment questionnaires are often used to pinpoint areas of difficulty
Frequent complaints of OA patients-
- pain
- stiffness
- limitation of function
- frustration of coping with physical difficulties on a daily basis
Clinical manifestations of joints:
- most commonly involved joints.
- joints of fingers, weight bearing joints (hips, knees), metatarsophalangeal (MTP) joint of foot, cervical and lower lumbar vertebrae
Nursing Assessment-Joints
- asymmetrical- joint pain is predominant symptom- ranging from mild discomfort to significant disability and loss of function.
- pain worsens with joint use- early stages: rest relieves pain. Later stages- pain and rest and sleep is disturbed because of pain and increased joint discomfort.
- Bones worse as barometric pressure decrease.
- pain may be referred to groin, buttock, or medial side of thigh or knee.
- Sitting down becomes difficult, as does getting up from a chair when hips are lower than knees.
- Joint stiffness occurs after periods of rest or static position- early morning stiffness usually resolves within 30 minutes. Overactivity can cause mild joint effusion, temporarily increase stiffness.
Nursing assessment: deformity-Knee
OA often leads to joint malalignment- result of cartilage loss in medical compartment. Bowlegged appearance, altered gait, and crepitation (in 90%)
Nursing assessment deformity- Hip
*Advanced hip OA may cause one leg to be shorter
Nursing assessment deformity- Hand’s
- Heberden’s nodes-DIP joints
- Bouchard’s nodes- PIP joints- deformity : red, swollen, tender nodules. Does not cause significant loss of fx. Visible disfigurement can be distressing can appear as early as age 40. Tends to be seen in family members.
Diagnostic studies:
- In early OA tests- detect joint changes on bone scan, computed tomography (CT) scan, magnetic resonance imaging (MRI)
- In progressed OA- xray findings: will show joint space narrowing, bony sclerosis & osteophyte formation.
- Changes do not always correlate with degree of pain patient is experiencing
- No lab abnormalities are a specific diagnostic indicator of OA- serological and synovial fluid examination will be essentially normal
Non pharmacologic interventions:
- managing pain and inflammation
- preventing disability
- maintaining and improving joint function
- achieve independence in self care and maintain optimal role function
- use pharmacologic strategies as an adjunct to manage pain
