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Chronic condition characterized by the breakdown of the joints cartilage.
Osteoarthritis affects which joints most?
Joints that bear weight. Knees, hips, feet, and spine.
How long does it take for Osteoarthritis to occur?
It can take from months to years for cartilage to break down in weight bearing joints which presents as Osteoarthritis.
Factors that increase the risk for Osteoarthritis.
Heredity, Obesity, Sedentary lifestyle, Gender (women more than men), Aging, Repetitive physical activity, Diabetic neuropathy.
What is the difference between Primary and Secondary Osteoarthritis?
- Primary is idiopathic.
- Secondary is caused by trauma to the cartilage and/or joint stability or another condition that damages the joint/cartilage.
What purpose does cartilage serve?
Cartilage covers the ends of bones and acts as a shock absorber.
What drugs are known to cause Secondary Osteoarthritis?
Indocin (NSAID), Colchicine (Antigout), and Corticosteroids (Dexamethasone or Prednisone).
What are Manifestations of Osteoarthritis?
- Asymetrical joint pain that worsens with use, is affected by weather, and may be reffered to groin, buttock, medial side of thigh or knee.
- Joint Stiffness after periods of rest (common in early morning and resolves in 30 approximately).
- Altered gait, Bowlegged appearance, One leg shorter than the other.
What diagnostic tests detect joint changes?
What diagnostic tests confirm Osteoarthritis and staging of joint damage?
In Osteoarthritis, what are synovial fluid characteristics?
- Yellow with little or no inflammation noted.
- May have fragments of cartilage
- Contains low number of white blood cells
List some nonpharmacological managment of Osteoarthritis?
Hot or Cold packs, whirlpool baths, paraffin wax bath, maintain healthy body weight, Yoga, Tai Chi, Massage, acupuncture, guided imagery, glucosamine/chondroitin (nutrition supplements)
What drugs are used to treat Mild to Moderate Osteoarthritis?
- Capsaicin (Zostrix) cream
- Aspercreme (topical salicylate)
What drugs are used to treat Moderate to Severe Osteoarthritis?
- NSAIDs (caution with pts taking coumadin): monitor for bleeding.
- COX 2 inhibitors: Celebrex
- Antibiotics: Vibramycin (decrease cartilage loss)
- Corticosteroid injections: if 4 or more required further intervention indicated.
- Hyaluronic Acid (viscosupplementation): 3 weekly injections into the knee with pain relief up to 1 year.
Nurses should assess the joints of patients' with Osteoarthritis for____?
- Tenderness, swelling, movement limitation, crepitation (cracking sound).
- Compare affected side to unaffected side to note movement, sweeling, etc...
Patients' with Osteoarthritis should be instructed to:
- Change positions as often as possible
- Use good posture and body mechanics
- Use largest and strongest joints and muscles: use both arms to lift objects.
- Use Assistive devices as needed: Jar openers, reachers, dressing sticks, long handled cleaning tools, raised toilet seats, and shower benches.
- Avoid activities that hurt affected joints
- Adjust daily activity levels to their pain level
- Rest as needed
What are some home modifications that can be made for patients' with Osteoarthritis?
- Remove rugs
- Rails in bathtub, halls, and stair wells
- Well-fitting supportive shoes
- Night lights
- Cane, walkersm etc...
A chronic autoimmune disease that causes inflammation of connective tissue.
What procedure performed by a doctor that involves removing synovial fluid for observation with a needle.
How does synovial fluid from a patient with rheumatoid arthritis appear?
- Yellow to greenish
- Large numbers of white blood cells (sign of inflammation in joint).
An abnormal layer of fibrovascular tissue granulation tissue.
Pannus: commonly forms over cornea and joint surfaces, or prosthetic heart valves. Can erode articular cartilage and bone.
With Rheumatoid arthritis joints are affected ___.
What purpose does synovial fluid serve?
- Increase efficiency of the joint
- Lubrication to decrease friction
- Shock absorption
- Transportation of nutrients and waste
Clinical manifesations of Rheumatoid arthritis are...
- Symmetrical pain, inflammation, and limitation of movement in small joints of hands and feet
- Joint stiffness after periods of inactivity (Morning from 60 min to hours post awakening)
- Spindle-shaped fingers
- Warm, tender joints
- Pain increases with movement
- Atrophy of muscles and destruction of tendons around the joint
Occurs with rheumatoid arthritis and causes dry eyes and mouth.
Rare disorder involving rheumatoid arthritis causing swollen spleen, decreased WBC count, and repeated infections.
- Firm, non-tender, subcutaneous nodules.
- Found commonly at pressure points like elbow, posterior forearm, and metacarpophangeal joints.
Rheumatoid arthritis home can be managed at home with ____.
- Physical therapy : maintain joint motion and muscle strength
It is important to teach patients' with Rheumatoid arthritis ___.
Importance of exercise to maintain mobility and prevent contractures and deformity to joints. The use of heat and cold for pain management.
Describe drug therapy for rheumatoid arthritis.
Disease modifying antirheumatic drugs (DMARDs) lessen the permanent effects of RA : joint erosion and deformity
- Methatrexate (Rheumatrex) is the drug of choice
- Sulfasalazine (Azulifidine) and hydroxychloroquine (Plaquenil): used for mild to moderate RA
- Other Drugs: etanercept (Enbrel), infliximab (Remicaide), cortiosteroid therapy.
An infrequently used treatment for Rheumatoid arthritis that fliters harmful immune complexes from the patient's blood.
Apheresis: Once a week for 12 weeks
Nurses should focus on pain and inflammation management, maintaining function and preventing/ correcting deformity in patients with ___
In patients' with Rheumatoid arthritis, heat therapy is used for ___.
In patients' with Rheumatoid arthritis, cold therapy is used for ___.
Periods of acute exacerbation.
Polypharmacy in the elderly can result in ___
- Iatrogenic Arthritis
- To prevent: simplify drug regimen and ensure adequate support system of elderly patients
A chronic disease that causes inflammation of the joints between spinal bones and between the spine and pelvis.
Ankylosing Spondylitis: affects males more than females
Blood test that tests the speed of blood cell sediment, an indication of inflammation.
Erythrocyte Sedimentation Rate (ESR)
Test used to detect a protein made by the liver during an inflammation response.
C-reactive protein (CRP)
Patients with Ankylosing Spondylitis may present with ____
- Symmetric sacroiliitis with progressive inflammatory arthritis
- Begins with intermitent lower back pain.
- Pain lessens with activity
- May lose mobility in the lower spine
- May lose ability to expand chest
Swelling and irritation of the uvea, middle layer of the eye that may occur with Ankylosing Spondylitis, RA, infection, or exposure to toxins.
Uveitis: Uvea provides most of the blood supply to the retina. Can be asymmetrical.
Treatment for Ankylosing Spondylitis is focused on maintaining mobility.
- NSAIDs, corticosteroids, enbrel, remicade, and humira are drug therapys that may be effective.
- Heat for local symptoms
- Education: Disease process, exercise, medicines, deep breathing.
- Physical therapy: Stretching and strengthening to improve flexion and extension.
Low-fat and low cholesterol diets are recommended for patients with
Systemic Lupus Erythematous (SLE)
A Severe complication of Systemic Lupus Erythematous ____ presents with sudden and unexplained swelling (Feet, ankles, legs, fingers, arms, or eyes), Blood in urine, elevated blood pressure, foamy urine, increased night urination, and proteinuria
Patients are at increased risk for fluid retention, elevated blood pressure, mood swings, and weight gain while taking ____.
Corticosteroids: monitor I&O, blood pressure, daily weights.
A widespread connective tissue disease that involves changes in the skin, blood vessels, muscles, and internal organs.
Scleroderma: patients with this have a build up of collagen in the skin and other organs leading to the symptoms of the disease.
Manifestations of Scleroderma (Systemic Sclerosis).
- Blanching, blueness, or redness of fingers and toes in response to heat and cold (Raynaud's Phenomenon)
- Hair loss
- Skin hardness, thickening, stiffness, and tightness of fingers, hands and forearm
- Skin that is abnormally dark or light
- Sores (ulcerations) on fingertips or toes
- Tight mask-like skin on the face causing loss of facial expression, and puckering of the mouth.
Immune suppressing drugs along with corticosteroids and NSAIDs can prevent complications from ____ even though there is no treatment for the disease.
A subtype of Scleroderma, a condition that literally means "hardened skin"
- CREST syndrome: these skin changes typically affect only fingers and toes. Sometimes the face and throat.
- Skin may be shiny
- Bending fingers and toes or opening your mouth becomes difficult.
- PRIORITY: protect hands and feet from injury