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2013-02-28 13:51:44

Adult MedSurg 2
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  1. What is osteoarthritis?
    aka degenerative joint disease (DJD)
    • 􏰀Progressive deterioration and loss of cartilage
    • 􏰀Primary (idiopathic): Part of the normal aging process, i.e. "Wear and tear disease, metabolic, genetic, chemical, mechanical."
    • 􏰀Secondary: 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
  2. 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.
  3. What are some irreversible changes related to osteoarthritis?
    • Interpharangeal joints:
    • 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
  4. Nurinsg diagnosis ?
    • potential for injury
    • impaired phys mobility. Suggest non-weight bearing. 
    • chronic pain
    • activity intolerance
    • self-care deficit
    • body image disturbance
  5. Diagnostics for oseoarthritis?
    • Thorough PE
    • Absence of systemic sxs rules out an inflammatory joint disorder
    • X-rays may be normal in early stages
  6. Goals of treatment for osteoarthritis?
    • Goal: relieve pain, maintain or improve mobility, minimize disability
    • Medications: 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.
    • Nonsurgical:
    • --thermal modalities (hot/cold)-->^circulation & v pain. 
    • --weight control
  7. What is arthrodesis?
    Surgical fusion of bones
  8. Study a bit about total hip/knee replacement care, esp about postop positioning.
    Also estimated volume loss.
  9. Nursing care for pt postop ortho surgery
    • Promote rest: moderation is key. Work with/around pt/ot schedules. 
    • Hand: apply hot soaks and paraffin dips to relieve pain
    • Spine: recommend firm mattress to decrease morning pain
    • Hip:
    • – 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
  10. 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
  11. What is Gouty Arthritis
    • 􏰁Etiology and Risk Factors
    • – Inherited Defect in Purine Metabolism
    • 􏰁 Pathophysiology: uric acid precips in joints (usually legs, feet, toes)-->pain, inflammation. 
    • 􏰁 Clinical Manifestations by Stage
    • 􏰁Outcome Management
    • – Pain Control
  12. Who is at gouty risk for gouty arthritis?
    • Men over 30 and post menopausal women.
    • Elderly
  13. Diagnostics for gouty A.
    • Presence of monosodium urate monohydrate crystals in synovial fluid
    • 􏰁  Serum uric acid level above normal
    • 􏰁  X-rays 
    • rminate an acute attack (colchicine)
    •  􏰁 Reduce Hyperuricemia
    •  􏰁 Prevent recurrence, complications and formation of renal calculi (allopurinol and avoid ETOH and purine rich foods)
  14. 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)
  15. 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)