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OsteoArthritis medications
Mild to Moderate joint pain
- Acetaminophen (100mg q6h)
- Topical agent (capsaicin cream [Zostrix])
- Topical salicylates (Aspercreme)
- Hyaluroinc acid (HA)
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Osteoarthritis medications
Moderate to severe pain
- NSAIDS-ulcers and liver damage
- Antibiotics (dec enzymein cartilage destruction)
- Corticosteroids - Injected into the joint cavity
- Disease modifying agents- mainly RA but can be used to treat OA
- Gold Compounds-injectable or oral, primarily for RA
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Nursing interventions with OA
- Heat and cold applications (can burn with cold worse than hot)
- Perventive exercises
- encourage weight control or loss
- assess and document patients joint pain
- education
- assessment of psychosocial issues (due to chronic pain)
- Teaching should include information about nature and treatment of OA, pain management, posture and body mechanics, use of assistive devices, principles of joint protection and energy conservation.
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Symptoms of OA
- Deep aching joint pain that gets worse after exercise or putting weight on it, and is relieved by rest ·
- Pain that is worse when you start activities after a period of no activity ·
- Over time, pain is present even when you are at rest · Grating of the joint with motion · (crepitus)
- Increase in pain during humid or moist weather ·
- Joint swelling ·
- Limited movement ·
- Muscle weakness around arthritic joints
- Heberden's nodes
- Bouchard's nodes
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a slowly progressive noninflammatory disorder of the diarthrodial (synovial) joints.
OA
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Risk factors of OA
- Obesity/mechanicall stress
- poor nutrition
- genetics
- joint overuse
- sport injuries
- trama
- smoking
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Most common joints affected with OA
- Weight bearing joints
- knees
- hips
- vertebral colum
- Mechanical stress
- shoulder
- hands
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AKA as degenerative joint disease (DJD)
OA
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Diagnostic test for OA
- History and symptoms
- artroscopy
- xrays
- mri
- bone scan
- synovial fluid analysis- looking for RA
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When should relief come after cortisone shots in the joints for OA
24hours
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Medical Management for OA
- Joint injections
- cortisone
- Transcutanous electrical nerve stimulation (tens)(strengthen muscles and tendons and joints)
- Alternative therapies
- rest and joint mobility
- heat and cold
- weight reduction
- physical therapy
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Fiberoptic tube inserted into a joint for direct visualization. A biopsy or surgical repair of the joint may be accomplished
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Total joint arthroplasty
- Replacing the joint with a prostetic -metal or plastic
- primary sites ar hips, knees and shoulders
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Surgical nursing interventions for OA
- Monitor S&S of infection-osteomylitis
- """" of bleeding- and blood clots
- Monitor neurovascualar stautus
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Post op care for OA
- Prevent infection- monitor the insision line and drain (hemovac)
- Prevent dislocation (abductor pillow)
- Prevent DVT-scds, lovenox, heparin, warfarin (4weeks-3months)
- Get out of bed!- first day post op
- Pysical therapy
- promote joint mobility
- -cpm
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Do NOT do these things post op
- lay on side of incision
- cross their legs
- bend over
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DO do these things Post op
- Raised toliet seats
- wal with walker or crutches
- nerve and circulation checks
- flex and extend foot
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bone and supporting tissues degeneratie, causing atrophy of tendons
OA
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Chronic SYSTEMIC autoimmune disease with inflammation of connective tissue in diarthrodial (synovial) joints
Rheumatoid arthritis
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what stage
No destructive changes on xray , possible x-ray evidence of osteoporosisi
Stage 1-early
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What stage
X-ray evidence of osteoporoisis, with or without slight bone or cartilage destruction
Stage 2- Moderate
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What stage
Xray evidence of cartilage and bone distruction in addition to osteoporosis; joint deformity; extensive muscle atrophy; possible presence of extra-articular soft tissue lesions, disabled
Stage 3: severe
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What stage
Fibrous or bony ankylosos, stage 3 criteria, disabled, totally stiff
Stage 4: terminal
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Symmetrical
Both sides of the body
Ulner drift
RA
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Diagnostic testing for RA
- Positive RF occurs in ~80% of patients
- Titers rise during active disease -Antinuclear antibody (ANA titers)
- Indicators of active infection
- -ESR erythrocyte sedimitation rate
- -C-reactive protein (CRP)
- CBC and Labs
- Synovial fluid analysis
- X-rays
- Tissue biopsy
- Bone Scans
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RA diagnostic criteria
- Following must be present for at least 6 weeks in a row
- 1. morning stiffness that lasts longer than 1 hour
- 2. Swelling in 3 or more joints
- 3. Swelling in hand joints
- 4. Symmetrical joint sweeling
- 5. Exosions or decalcification seen on hand xrays
- 6.Rheumatoid nodules
- 7. Presence of serum RF
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Drug therapy for RA
- NSAIDS
- Disease modifying anitheumatic drugs (DMARDs)
- Methotrexate (Rheumatrex) is a drug of choice
- -rapid anti-inflammatory effect decreases clinical symptoms in days to weeks
- -inexpensive
- -lower toxicity compared to other drugs
- -increases risk for infection
- Corticosteriods
- -oral and injected in the joint
- Aspirin in high doses
- -4-5g/day (10-18 tablets)
- Apherisis
- -removes ra factor once weekly for 12 weeks
- Enbrel
- -slows progress is biological agent +SE's
- Plaquenil
- -Antimalaria drug + SE's even ager drug
- -with inflammatory process
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Nursing Interventions for RA
- Education
- symptom managment
- maintain joint function
- hot and cold therapy
- medication compliance and management
- encourage rest and exercise
- post op management of reconstructive surgery
- psychosocial support- no cure
- alternative therapy education (gold injections)
- Proper body and joing alignment
- education on splinitn and casting and use of assistantive devices
- encourage activity pacing
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OA site affected
Localized to joints
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RA site affected
aricular, systemic and extra-articular manifestations
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OA Pathogenisi
Biomechanical, leads to loss of caritlage matrix
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RA pathogenisis
Autoimmune response leads to joint destruction
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OA symptoms
- Pain
- stiffness < 20 min
- limited motion
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RA symptoms
- Pain
- Joint swelling
- Stiffness >1 hour
- Limited motion
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OA Inflamation
Usually limited, may be present in advanced disease
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OA osteophytes
usually present
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OA Rheumatoid factors
absent
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Nursing pre-op education on RA
- Avoid position flexion
- use firm mattress or bedboard
- teach partial weight bearing use of crutches, isometric exercises, and transfer techniques familiarize patient with overbed traction frame, trapeze, abduction splint
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Postop care RA
- flat in bed with affected exremity in abduction
- apply ice to operative area to reduce edema
- assess circulation
- encourage active fuoot and ankle motion the day following surgery to prevent ciruculatory stasis
- Help pt ambulate gradually with walker, then crutches, using 3-point gait
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Postop discharge teaching ra
- maintain abdution
- avoid stooping
- dont sleep on operated side
- flex hip only to 1/4 circle
- never cross legs
- avoid postition of flexation
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