UNIT 7 OSTEOARTHRITIS AND RHEUMATOID ARTHRITIS, GOUT, TOTAL JOINT ATHROPLASTY CHAPTER 46 Flashcards
The client is diagnosed with osteoarthritis. Which sign/symptom should the nurse expect the client to exhibit?
1. Severe bone deformity.
2. Joint stiffness.
3. Waddling gait.
4. Swan-neck fingers.
- Joint stiffness.
What is Osteoarthritis?
Osteoarthritis is the most common arthritis and a major cause of impaired mobility, persistent pain, and disability among adults in the United States and the world. It is sometimes referred to as osteoarthrosis or degenerative joint disease (DJD).
Osteoarthritis is the progressive deterioration and loss of articular (joint) cartilage and bone in one or more joints. Articular cartilage contains water and a matrix of:
What are the risk factors for Osteoporosis?
*older age , over 60
*aging,
*smoking,
*obesity,
*trauma.
*congenital anomalies,
* trauma, joint sepsis,
*metabolic disease (diabetes mellitus).
What are the S/S of Osteoporosis?
S/S
* Joint pain
* Joint effusions
* Atrophy of skeletal muscle
* Limited movement
* Joint enlargemen
*Joint stiffness
UNILATERAL JOINT SWELLING PAIN OR INFLAMMATION
May be unilateral, single joint
Affects weight-bearing joints and hands, spine Metacarpophalangeal joints spared (HANDS NOT AFFECTED)
Nonsystemic
Which patient is more at risk for Osteoarthritius
A. A NBA player who has been playing basketball for the past 10 years
B. a receptionist
C. a zoom teacher
D. a 3 year old athlete
A. A NBA player who has been playing basketball for the past 10 years
Common caused by repetitive motion and stress to the joint
Medical Treatment for Osteoarthritis
Medical Treatment relates to pain
management, reduce joint pain swelling and inflammation
* Acetaminophen
* Lidocaine patch
* Topical capsaicin cream (OTC) applied to the joints
* NSAIDS
* Celebrex
* Opioids
* Injections
* Cortisone, artificial joint fluid
Which of the following can be an finding during assessment for a pt with Osteoporosis?
A. Crepitus
B. Loss of weight 2-3 inches
C. Lordosis
D. Sacral edema
A. Crepitus
Eventually the cartilage disintegrates, and pieces of bone and cartilage “float” in the diseased joint, causing crepitus, a grating sound caused by the loosened bone and cartilage in a synovial joint. The resulting joint pain and stiffness can lead to decreased mobility and muscle atrophy. Muscle tissue helps support joints, particularly those that bear weight (e.g., hips, knees).
Which of the following is the drug of choice to treat Osteoarthritis joint pain
A. Acetominophen
B. Benztropine
C. Cyclobenzabrine
D. Digibind
A. Acetominophen
The standard ceiling dose of acetaminophen is 4000 mg each day. However, patients may be at risk for liver damage if they take more than 3000 mg daily, have alcoholism, or have liver disease. Older adults are particularly at risk because of normal changes of aging such as slowed excretion of drug metabolites. Remind patients to read the labels of over-the-counter (OTC) or prescription drugs that could contain acetaminophen before taking them. Teach them that their liver enzyme levels may be monitored while taking this drug.
NO MORE THAN 4 GRAMS A DAY
Drug therapy for Osteoarthritis
- Acetaminophen
- Lidocaine patch
- Topical capsaicin cream (OTC) applied to the joints
- NSAIDS
- Celebrex
- Opioids
- Injections
- Cortisone, artificial joint fluids
46.1
The primary health care provider prescribes daily celecoxib for a client experiencing persistent joint pain in both knees. Which health teaching will the nurse provide for the client regarding this drug for long-term pain control? Select all that apply.
A. “Take the prescribed drug before breakfast each day.”
B. “Report any sign of bleeding, including bloody or dark, tarry stool.”
C. “Do not take other NSAIDs while on celecoxib.”
D. “Report any major changes in the amount of urine you excrete each day.”
E. “Follow up with lab tests to assess liver function.”
Nonpharmacological Interventions for Osteoartritis?
Non-pharmacological
* Rest
* Splint or brace
* Heat or cold packs
* Weight control
* Alternatives (acupuncture, tai chi, etc.)
- Supplements
- Glucosamine
- Chondroitin
Dietary supplements may complement traditional drug therapies. Glucosamine and chondroitin are widely used and are the most effective nonprescription supplements taken to decrease pain and improve functional ability.
To support their use is inconsistent (Arthritis Foundation, 2019). These natural products are found in and around bone cartilage for repair and maintenance. Glucosamine may decrease inflammation, and chondroitin may play a role in strengthening cartilage.
Nonpharmacologic interventions.In addition to analgesics, many nonpharmacologic measures can be used for patients with OA, such as rest balanced with exercise, joint positioning, heat or cold applications, weight control, and a variety of complementary and integrative therapies. Minimally invasive regenerative therapies, such as stem cell
Many patients apply heat or cold for temporary relief of pain. Heat may help decrease the muscle tension around the tender joint and thereby decrease pain and stiffness. Suggest hot showers and baths, hot packs or compresses, and moist heating pads. Regardless of treatment, teach him or her to check that the heat source is not too heavy or so hot that it causes burns. A temperature just above body temperature is adequate to promote comfort.
If needed, collaborate with the PT to provide special heat treatments, such as paraffin dips, diathermy (using electrical current), and ultrasonography (using sound waves). A 15- to 20-minute application is usually sufficient to temporarily reduce pain, spasm, and stiffness. Cold packs or gels that feel hot and cold at the same time may also be used.
Cold therapy has limited use for most patients in promoting comfort. Cold works by numbing nerve endings and decreasing secondary joint inflammation, if present.
What is Rheumatoid arthritis?
Rheumatoid arthritis (RA) is a chronic, progressive, systemic inflammatory autoimmune disease process that affects primarily the synovial joints. Systemic means this disease can affect any or all parts of the body while affecting many joints.
Ends in “itis” so you know there is
inflammation.
AUTOIMMUNE
Chronic and progressive inflammatory
disease which affects connective tissue
Affects joints BILATERALLY
Exacerbations and remissions
S/S of Rheumatoid Arthritis
*Fatigue
* Lack of appetite
* Low-grade fever
* Muscle and joint stiffness and loss of ROM
* Red, swollen, painful joints
* Deformity
*Swan neck deformities
Bilateral,
symmetric,
multiple joints
Usually affects upper extremities first
Distal interphalangeal joints of hands spared
Systemic
Drug therapy for Rheumatoid Arthritis
NSAIDs (short-term use)
Methotrexate
Leflunomide
Biological response modifiers
Other immunosuppressive agents
First-line disease-modifying antirheumatic. What is the drug?
First-line disease-modifying antirheumatic drugs. Methotrexate (MTX), an immunosuppressive medication, in a low, once-a-week dose is the mainstay of therapy for RA because it is effective and relatively inexpensive. It is a slow-acting drug, taking 4 to 6 weeks to begin to control joint inflammation (Burchum & Rosenthal, 2019). Observe for desired therapeutic drug effects such as a decrease in joint pain and swelling.
Monitor patients for potential adverse effects such as decreasing WBCs and platelets (as a result of bone marrow suppression) or elevations in liver enzymes or serum creatinine.
