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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
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?
- 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
Nurinsg diagnosis ?
- potential for injury
- impaired phys mobility. Suggest non-weight bearing.
- chronic pain
- activity intolerance
- self-care deficit
- body image disturbance
Diagnostics for oseoarthritis?
- Thorough PE
- Absence of systemic sxs rules out an inflammatory joint disorder
- X-rays may be normal in early stages
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.
- --thermal modalities (hot/cold)-->^circulation & v pain.
- --weight control
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
- 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
- – 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
- Pathophysiology: uric acid precips in joints (usually legs, feet, toes)-->pain, inflammation.
- Clinical Manifestations by Stage
- Outcome Management
- – 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)
- Reduce Hyperuricemia
- 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)