Week 3 Chapter 36 MS Disorders Flashcards
Noninflammatory degenerative disorder of the joints
Osteoarthritis
Most common form of joint disease is sometimes called what?
Degenerative Joint disease
Osteoarthritis is classified as either what?
- Primary - idiopathic - no prior event or disease related to the OA
- Secondary- resulting from previous joint injury or inflammatory disease similar to RA
Primary OA does not involve what?
Autoimmunity or inflammation
- Can occur as an end result of an autoimmune disorder where joint destruction occurs
Limited to the affected joints and no systemic symptoms
OA
What is the pathophysiology of OA?
- Articular cartilage breaks down, leading to progressive damage to the underlying bone and eventual formation of osteophytes( Bone spurs) that protrude into the joint space
- Joint space is narrowed, leading to decreased joint movement and the potential for more damage
- Joint can progressively degenerate
- Previously thought of as simply “ wear and tear” r/t aging
Evolution of OA
- Bone
- Cartilage
- Thinning of cartilage
- Cartilage remnants
- Destruction of cartilage
What can illicit a chondrocyte response?
- Mechanical Injury
- Genetic and hormonal Factors
- Previous joint damage
- other
With a chondrocyte response what happens next?
Release of cytokines
What happens after the release of the cytokines?
-Stimulation production and release of proteolytic enzymes, metalloproteases, collagenase
Then resulting damage predisposes to further damage
Characteristic Degenerative Changes “Degradation”
- Cartilage Particles
- Joint space narrowing
- Osteophytes
Name the clinical manifestations of OA
- Pain, stiffness, and functional impairment
- Joint pain aggravated by movement or exercise and relieved by rest
- Morning stiffness is present; usually brief, lasting less than 30 min
- Onset is routinely insidious, progressing over multiple years
- Affected joint may be enlarged with decreased ROM
- Most often in weight bearing joints, ( hips, knees, cervical and lumbar spine)
In OA spine what occurs?
- Bone Spur
- Narrowed disc
Common sites of OA includes where?
- Spine
- Hip
- Hand
- Knee
- Foot
—-Damage to bone and cartilage
Name the causes of OA
- Endocrine- Diabetics prone to OA (acromegaly, hypothyroidism, hyperparathyroidism, obesity)
- Post- Traumatic- Traumatic - Macro/ micro
- Inflammatory Joint Dz: infected joints, gout, rheumatoid dz
- Metabolic: Paget’s or Wilson’s Disease
- Congenital: Abnormal anatomy
- Genetic: Breakdown protective architecture of cartilage
- Neuropathic : Diabetes - nerve problems
RF for OA include
- Older age, female gender, and obesity
- Certain occupations
- Engaging in sport activities
- Hx of previous injuries, muscle weakness, genetic predisposition and certain diseases
- Most prominent modifiable risk factor for OA is obesity
- Diet and exercise can help minimize symptoms of OA in pt with obesity
Name the S/S of OA
- Pain: aching, stiffness, difficulty moving join (Functional impairment)
- Morning stiffness
- Onset is insidious
- Fingers/ Hands : enlarge first joint
Most often in major wt bearing joints( knees, hips, cervical, and lumbar spine)
Heberden’s Node and Bouchard’s Node found in
OA
Herb- Distal -away body
Bouch- Proximal - closer to the body
Management of OA includes
- Decrease pain and stiffness
- Exercise, especially in the form of CV aerobic exercise and lower extremity strength training
- Wt loss
- Occupational and physical Therapy
- Pharmacological management directed toward symptom management and pain control
- Used in conjunction with nonpharm strategies
What kind of diet would one have with OA?
Mediterranean Diet or sometimes called anti-inflammatory diet
Mediterranean Diet Includes
- Fish- inflammation omega 3s
- Nuts and seeds- Inflammation fighting monosaturated fat
- Fruits and veggies –antioxidants
- Olive oil - Heart healthy fats
- Beans - antioxidant and anti inflammatory compounds
- Whole Grains - Fiber, help maintain healthy weight
Surgical management of OA includes ?
- Moderate to sever OA or loss of function
- Osteotomy
- Arthroplasty
Patient Assessment and Diagnostic Findings OA and RA
Hx- onset and evolution of symptoms, family hx, past health hx, and contributing factors
Functional Assessment
Arthrocentesis
Xrays, bone scans, CTs, and MRIs
Tissue and biopsy or joint fluid
Blood studies
Patient and Assessment Diagnostic Findings OA and RA
Nursing Process Diagnosis of OA and RA
- Acute and Chronic Pain
- Fatigue
- Disturbed sleep pattern
- Impaired physical mobility
- Self care deficits
- Disturbed body image
- Ineffective coping
Nursing Process planning of OA and RA includes what major goals
- Relief of pain and discomfort
- Relief of fatigue
- Promotion of restorative sleep
- Increased mobility
- Maintenance of self care
- Improved body image
- Effective coping
- Absence of complications
Nursing interventions of RA and OA include
- Understanding of the underlying disease process guide, the nurse’s critical thinking to provide interventions
- Extent of the disease and whether it is localized or more systemic, will also affect nursing activities
What are some collaborative problems/ potential complications?
- Adverse effects of medications
- Depression
How can one teach patients self care of OA and RA?
- Explain the disease and principles of disease management
- Medication teaching
- Monitoring
- Sources of information
- Pain management
- Joint protection
- Self care with assistive devices
- Exercise and relaxation
Cartilage destruction with bone spur growth at joint ends
Degenerative
OA
Pain with activity and improves at rest
OA
Synovial membrane inflammation more than cartilage destruction
Bone erosion and inflammatory
RA
Swelling, redness, warmth, pain at rest or immobility
RA
Affects all joints
RA
Localized inflammatory response
OA
Person body size is underweight
RA
Overweight body size
OA
Nodes include Heberden’s and Bouchard’s
OA
Swan neck and boutonniere deformity
RA
Systems affected are lungs, heart, and skin
RA
No system or symmetrical affected
OA
Use Xrays diagnostic
Symmetrical with ___ factors and xrays diagnostic
Rheumatoid factor
RA
Most prevalent bone disease in the world affecting more than 1.5 million osteoporotic fractures each year
Osteoporosis
Normal homeostatic bone turnover is altered and the rate of bone resorption is greater than the rate of bone formation resulting in loss of total bone mass
Osteoporosis
Bone becomes porous, brittle, and fragile and breaks easily during stress
- Results in compression fractures of the spine, fractures of the neck or intrathoracic region of the femur, and Colles fracturs of the wrist
Osteoporosis
What genetics are predisposed to OP?
Caucasian
Female
Family hx
Small frame
Predisposes to low bone mass
What age categories are affected with OP?
- Post menopause
- Advanced Age
- Low testosterones
- Decreased Calcitonin
Hormones inhibit bone loss
Name the nutrition categories affected with OP?
- Low calcium intake
- Low Vitamin D intake
- High phosphate intake
- Inadequate calories
Reduces nutrients needed for bone remodeling
Name the exercise categories affected RF of OP
Sedentary
Lack of weight bearing exercise
Low weight and BMI
- Bones need stress for bone maintenance
Lifestyle Choices categories RF for OP
- Caffeine
- alcohol
- Smoking
- Lack of exposure to sunlight
Reduces osteogenesis in bone remodeling
What medications affect RF of OP?
- Corticosteroids
- antiseizure
- heparin
- thyroid hormone
Comorbidity
- anorexia
- hyperthyroidism
- malabsorption syndrome
- kidney failure
- Affects calcium absorption and metabolism
What happens wit height with OP?
Loss of height decreases
15 year post menopause- 1.5 inches lost
25 yr pm- 3.5 inches lost
Prevention of OP includes what?
- Balanced diet high in Calcium and vitamin D throughout life
- Use of calcium supplements to ensure adequate calcium intake take in divided doses with vitamin C
- Regular weight bearing exercises 20-30 min/ day
—Increases balance
- Reduces falls/ Fractures
- Weight training stimulates BMD- Bone MineralDensity
Pharmacologic Therapy for OP includes
- Calcium and Vitamin D
- Bisphosphonates
——– -Dronates
—————- Zoledronic acid - Calcitonin
- Estrogen agonists/ Antagonists
- Receptor activator of nuclear factor Kappa- B ligand Inhibitors
Nursing Process for the care of patient with OP assessment includes
- Occurrence of osteopenia
- Family Hx
- Previous Fractures
- Dietary Consumption of calcium
- Exercise patterns
- Onset of menopause
- Use of corticosteroids as well as alcohol, smoking, and caffeine
Assessment of OP includes what tests?
- DEX
WHO FRAX algorithm - Serology and radiography studies
Nursing Process Care of the pt with OP diagnosis includes?
- Deficient knowledge about the osteoporotic process and tx regimen
- Acute pain r/t to fracture and muscle spasm
- Risk for constipation r/t immobility or development of ileus ( intestinal obstruction)
- Risk for injury- additional fractures r/t to OP
What does the planning involve for a pt with OP?
Major goals include
- Knowledge about OP
- Tx regimen
- relief of pain
- Improved bowel elimination
- Absence of additional fx
Nursing Process of a pt with OP Interventions include
- Promoting - Understanding of OP and tx regimen
- Relieving- the pain
-Improving- Bowel elimination-
Preventing- Injury
