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osteoarthritis is
a slowly progresive NONINFLAMMATORY disorder of the synovial joints
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what is important about osteoarthritis' location in the body
- it is localized, only affects the joint
- it is asymmetrical
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causes of osteoarthritis
- age
- obesity
- injury or overuse
- genetics
- muscle weakness
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when does pain worsen in osteorthritis
with use of the joint
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in early stages of OA does rest relieve pain
yes but in later stages no
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when does joint stiffness occur in OA
after periods of rest or static position
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early morning stiffness in OA usually resolves within
30 minutes
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Heberden's and Bouchard's nodes are
- red, swollen, and tender joints
- visible disfigurement of joint
- doesn't cause significant loss of function
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contrast Heberden's nodes to Bouchards
- Heberden's = distal
- Bouchards = proximal
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would inflammatory lab tests show an increase in OA
NO osteoarthritis is a non inflammatory disease
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what happens to cartilage in OA
it is worn away and bone rubs against bone
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some diagnostic tests for OA are
- bone scan
- CT scan
- MRI
- x-rays
- synovial fluid analysis
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what is treatment of OA
- NON-pharmacological
- localized treatment of corticosteroids
- care focuses on managing pain preventing disability, and maintaining and improving joint function
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what is hyaluronic acid
- med that is put into joint of OA to cushion joint
- works about 3 months
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osteoarthritis treatment includes
- heat and cold
- rest and joint protection
- pain management
- nutritional therapy and exercise
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for every one pound of weight loss what is the reduction in the knee
4 lbs of weight load off the knees
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surgery for OA
arthroscopic surgery
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teaching about OA
- provide information about the disease
- pain management
- correct posture and body mechanics
- correct use of assitive devices
- principles of joint protection and energy conservation
- nutritional choices
- stress management
- therapeutic exercise program
- home management
- sexual counseling
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what is RA
- Rheumatoid arthritis
- chronic systemic autoimmunne disease
- inflammation of connective tissue synovial joints
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morning stiffness may last how long in RA
60 minutes to several hours
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what is unique about onset of RA
- typically insidious (slow onset)
- happens after a stressful life event
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signs and symptoms of RA
- fatigue
- anorexia
- weight loss
- joint deformity
- extraarticular manifestations
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OA VS RA
- OA = non-inflammatory, localized pain, asymmetrical, relief of stiffness after 30 min, non-drug therapy
- RA = inflammatory, systemic disease, symmetrical, takes 60 minutes or more to relieve stiffness,drug therapy
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swans neck
ulnar shift of fingers
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rheumatoid nodules are
- subcu, firm, nontender, granuloma-type masses
- usually located over extensor surfaces of joints
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Sjogrens syndrome
- seen in 10 - 15% of RA cases with RA
- dry eyes and dry mouth
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positive RF occurs in
80% of patients with RA
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difference in synovial fluid color in RA and OA
- RA = strawberry colored
- OA = straw colored
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what is cornerstone of RA treatment
DRUG THERAPY
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DMARDS are
- diseases modifying antirheumatic drugs
- must be started when 1st year to prevent joint damage
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nursing management of RA
- rest - sleep 8-10 hours at night with naps
- good body alignment
- encourage joint extention and not flexion
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what is important in joint protection with RA
- maintaining joint in neutral position to minimize deformity
- use strongest joint
- distribute weight evenly
- change postions frequently
- avoid repetitious movements
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when is cold therapy beneficial?
during disease exacerbation
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how long should cold therapy be applied
10 - 15 minutes
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when is heat therapy beneficial
chronic stiffness
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how long should heat be applied
20 minutes
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what can you tell a patient to decrease morning stiffness
- warm shower or bath in the morning
- pain relief before self care activities
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never use what with heating device to prevent burning
heat producing cream
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exercise for RA
- preserve joint function
- range of motion exercises
- balance rest and activity
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during peiord of remmision in RA you should encourage
regular exercise
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Parameter
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RA
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OA
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Age of onset
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Young to middle age
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Usually > age 40
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Gender
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More females than males
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Before age 50, more men after age 50 more females
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Weight
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Lost or maintained
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Often overweight
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Disease
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Systemic
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Localized
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Affected Joints
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Small joints first: bilateral, symmetric
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Weight bearing, asymmetric
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Pain characteristics
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Stiffness lasts 1 hr. to all day, variable
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Stiffness subsides in 30 min., worsens with use, relieved with rest
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Effusions
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common
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uncommon
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Nodules
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Present
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Heberdens’s and Bouchard’s
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Synovial fluid
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WBC > 20,000
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WBC < 2000
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X-Rays
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Joint space narrowing
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Joint space narrowing, osteophytes
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Labs
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+RF, CRP-inflammation
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--RF, transient ↑ in ESR
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difference in age of onset between RA and OA
- RA = young to middle age
- OA = usually > age 40
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SLE =
- systemic LUPUS erythematosus
- chronic multisystem inflammatory autoimmune disease
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LUPUS is more common in who
- women 90%
- people of color
- genetic factors
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what is fever in LUPUS
> 100
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common clinical manifestations in lupus
- fever> 100
- butterfly rash
- anemia
- hair loss
- memory problems
- sun or light sensitivity
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FLARES are
- sudden outbreaks of SLE and may be triggered by
- fatigue, stress, sunlight, infection, pregnancy
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what is butterfly rash
common rash across face and bridge of nose in LUPUS
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signs of upcoming flare in LUPUS
- overtires and overstressed
- frequent fever and higher than normal
- muscle aches and pains
- swollen joints
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antimalarial-hydroxychloroquine
- common treatment in LUPUS
- ***patient must have regular eye exams because it can cause issues with retina (6-12 Months)***
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drug treatment in LUPUS
- NSAIDS
- Plaquenil
- corticosteriods
- immunosuppressives
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things that can cause flares
- fatigue
- sun exposure
- emotional upset
- infection
- drugs
- surgery
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patient education in LUPUS =
- Disease process
- Drugs
- Pain management
- Rest/exercise/quit smoking
- Avoidance of physical and emotional stress
- Avoidance of people with infections
- Avoidance of drying soaps, powders, & household chemicals that come into contact with the skin
- Use of sunscreen and minimal sun exposure from 11am-3pm.
- Regular medical checkups
- Pregnancy counseling as needed
- Community resources
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GOUT =
systemic disease in which urate crystals deposit in the joints and other body tissues, causing inflammation
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GOUT may be due to
overproduction or under excretion of uric acid
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primmary disease =
- don't know why someone has something
- ie primary HTN, primary gout
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intake of foods high in what can cause gout
purines
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what causes primary gout
don't know (majority of cases)
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secondary gout can be casued by
- obesity
- HTN
- Diuretic use
- alcohol consumption
- diet high in purines
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foods high in purines =
- shellfish
- spinach, lentils, asparagus
- beef chicken and pork
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TOPHI =
joint, cartilage, soft tissue deposit in someone with gout
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diagnostic tests with GOUt
- presece of sodium urate crystals in synovial fluid
- elevated serun uric acid levels
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Colchicine =
- med given in gout
- must be given with NSAID because it doesn't have pain relieving agent
Often DR give this to diagnose pt with gout because the inflammation goes away quickly
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management of gout
- increased fluids and joint rest
- drug therapy
- nutrition
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nursing management of gout
- ¢Avoid all forms of aspirin and diuretics because they may precipitate an attack.
- ¢Excessive physical or emotional stress can exacerbate the disease (surgery)
- ¢Increase fluids
- ¢Low purine diets
- ¢Avoidance of alcohol
- ¢Prompt treatment of acute gout
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