Card Set Information
Adult MedSurg 2
What is osteoarthritis?
aka degenerative joint disease (DJD)
Progressive deterioration and loss of cartilage
: Part of the normal aging process, i.e. "Wear and tear disease, metabolic,
: Trauma, obesity, congenital deformity, etc.
Chronic, causing deterioration of the joint cartilage and formation of reactive new bone at the margins and subchondral areas of the joints
Degeneration results from a breakdown of chondrocytes
SnSs of osteoarthritis?
Deep, aching joint pain, relieved at rest.
Morning stiffness, not to be confused with morning stiffies.
Aching during weather changes
Grating of the joint, ie crepitous.
Altered gait/Limited movement-->joint breakdown.
What are some irreversible changes related to osteoarthritis?
Nodes may be painless at first but eventually become red, swollen, and tender
– Can have sudden flare-ups, too
– Can lead to numbness and loss of dexterity
Nurinsg diagnosis ?
potential for injury
impaired phys mobility. Suggest non-weight bearing.
body image disturbance
Diagnostics for oseoarthritis?
Absence of systemic sxs rules out an inflammatory joint disorder
X-rays may be normal in early stages
Goals of treatment for osteoarthritis?
: relieve pain, maintain or improve mobility, minimize disability
: ASA, phenylbutazone, indomethacin, fenoprofen, ibuprofen, propoxyphene
Injections of corticosteriods given q 4-6 months may delay development of nodes in the hands. Will have to step down dose to dc.
--thermal modalities (hot/cold)-->^circulation & v pain.
What is arthrodesis?
Surgical fusion of bones
Study a bit about total hip/knee replacement care, esp about postop positioning.
Also estimated volume loss.
Nursing care for pt postop ortho surgery
: moderation is key. Work with/around pt/ot schedules.
: apply hot soaks and paraffin dips to relieve pain
: recommend firm mattress to decrease morning pain
– Use moist heat pads to relieve pain
– Assist with ROM and strengthening exercises
– Check crutches (two finger widths below axilla, cane, braces, and walker for proper fit/use
– Use cane or walker on normal side
– Use cushion when sitting and elevated toilet seat
What sort of home safety is needed postsurg.
Explain need for adequate rest during the day, after exertion, and at night
Remind patient to take medications as prescribed and to report adverse reactions immediately
Describe proper posture
Encourage patient to wear well-fitting shoes
Install safety devices at home
What is Gouty Arthritis
Etiology and Risk Factors
– Inherited Defect in Purine Metabolism
: uric acid precips in joints (usually legs, feet, toes)-->pain, inflammation.
Clinical Manifestations by Stage
– Pain Control
Who is at gouty risk for gouty arthritis?
Men over 30 and post menopausal women.
Diagnostics for gouty A.
Presence of monosodium urate monohydrate crystals in synovial fluid
Serum uric acid level above normal
rminate an acute attack (colchicine)
Prevent recurrence, complications and formation of renal calculi (allopurinol and avoid ETOH and purine rich foods)
Nursing care for gouty A
Encourage bedrest: Use bed cradle to keep bedcovers off inflamed joints
Give pain meds, apply hot or cold packs, watch for GI disturbances
Urge patient to drink up to 2 L/d to prevent formation of renal calculi
Watch for acute gout attacks 24 to 96 hours after surgery; administer colchicine
Instruct patient to have serum uric acid levels checked periodically
Teach patient to avoid high-purine foods,
such as anchovies, liver, sardines, kidneys,
sweetbreads, lentils, and
ETOH (especially beer and wine)
, all of which raise urate level
Advise patient who is receiving allopurinol and other drugs to report adverse effects (drowsiness, dizziness, N/V, urinary frequency and dermatitis)
Pt education for gouty A.
Warn patient taking probenecid or sulfinpyrazone to avoid ASA/salicylates
– Combined effect causes urate retention
Inform patient that long-term colchicine therapy is essential during the first 3-6 months of treatment with uricosuric drugs or allopurinol (d/c cochicine for diarrhea)