Ostoarthritis Rheumatoid

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Ostoarthritis Rheumatoid
2012-04-28 16:03:19

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  1. OsteoArthritis medications
    Mild to Moderate joint pain
    • Acetaminophen (100mg q6h)
    • Topical agent (capsaicin cream [Zostrix])
    • Topical salicylates (Aspercreme)
    • Hyaluroinc acid (HA)
  2. 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
  3. 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.
  4. 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
  5. a slowly progressive noninflammatory disorder of the diarthrodial (synovial) joints.
  6. Risk factors of OA
    • Obesity/mechanicall stress
    • poor nutrition
    • genetics
    • joint overuse
    • sport injuries
    • trama
    • smoking
  7. Most common joints affected with OA
    • Weight bearing joints
    • knees
    • hips
    • vertebral colum
    • Mechanical stress
    • shoulder
    • hands
  8. AKA as degenerative joint disease (DJD)
  9. Diagnostic test for OA
    • History and symptoms
    • artroscopy
    • xrays
    • mri
    • bone scan
    • synovial fluid analysis- looking for RA
  10. When should relief come after cortisone shots in the joints for OA
  11. 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
  12. Fiberoptic tube inserted into a joint for direct visualization. A biopsy or surgical repair of the joint may be accomplished
    • Arthroscopy
    • OA
  13. Total joint arthroplasty
    • Replacing the joint with a prostetic -metal or plastic
    • primary sites ar hips, knees and shoulders
  14. Surgical nursing interventions for OA
    • Monitor S&S of infection-osteomylitis
    • """" of bleeding- and blood clots
    • Monitor neurovascualar stautus
  15. 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
  16. Do NOT do these things post op
    • lay on side of incision
    • cross their legs
    • bend over
  17. DO do these things Post op
    • Raised toliet seats
    • wal with walker or crutches
    • nerve and circulation checks
    • flex and extend foot
  18. bone and supporting tissues degeneratie, causing atrophy of tendons
  19. Chronic SYSTEMIC autoimmune disease with inflammation of connective tissue in diarthrodial (synovial) joints
    Rheumatoid arthritis
  20. what stage
    No destructive changes on xray , possible x-ray evidence of osteoporosisi
    Stage 1-early
  21. What stage
    X-ray evidence of osteoporoisis, with or without slight bone or cartilage destruction
    Stage 2- Moderate
  22. 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
  23. What stage
    Fibrous or bony ankylosos, stage 3 criteria, disabled, totally stiff
    Stage 4: terminal
  24. Symmetrical
    Both sides of the body
    Ulner drift
  25. 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
  26. 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
  27. 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
  28. 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
  29. OA site affected
    Localized to joints
  30. RA site affected
    aricular, systemic and extra-articular manifestations
  31. OA Pathogenisi
    Biomechanical, leads to loss of caritlage matrix
  32. RA pathogenisis
    Autoimmune response leads to joint destruction
  33. OA symptoms
    • Pain
    • stiffness < 20 min
    • limited motion
  34. RA symptoms
    • Pain
    • Joint swelling
    • Stiffness >1 hour
    • Limited motion
  35. OA Inflamation
    Usually limited, may be present in advanced disease
  36. RA inflammation
  37. OA osteophytes
    usually present
  38. RA osteophytes
  39. OA Rheumatoid factors
  40. 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
  41. 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
  42. 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