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What are the two categories of connective tissue disorders
- Inflammatory (rheumatoid & systemic lupus erythematosus)
- non inflammatory (osteo-arthritis)
what is osteoarthritis? what are the signs and symptoms?
- degenerative joint disease
- progressive deterioration and loss of cartilage
- decreased synovial fluid- declines with age
- joint space narrows, and osteophytes(a bony outgrowth) form
- deterioration occurs faster than repair
- S&S: joint pain, typically with movement at first and then continuously, overall decreases mobility because causes stiffness and soreness, especially in morning
In osteoarthiritis what causes crepitus?
pieces of bone and cartilage break off of joint surface and cause crepitus
What are the causes of oseteoarthritis?
- age- especially in hands
- genetics: obesity ( weight on hips, knees ankles, and vertebral columns)
- heavy manual occupations = construction/ carpenter
- sports: football, skiing, runners
What will you fin upon Physical assessent?
- Chronic pain that is decreased with rest and increased with acticity at first, but then continuously, pain with ROM, even when sleeping; stiffness of joint capsules
- Joint may be enlarged R/T hypertrophy
- Joint effusions (treatment is aspiration with needle
What are the drugs that are used for osteoarthirits?
How does it work?
Class? What is the adverse affect to watch for? How effective is its anti-inflam properties?
- Lowers the hypothalmic set point to reduce fever, and activates descending inhibitor serotonergic pathways to produce analgesia
- it is an analgesic and antipyretic
- It is not an anti-inflmmatory
- watch for hepatoxicity
Salicylic Acid (Aspirin)
How does it work? Class?
- inhibits platelet generation of thromboxane, resulting in anti-thromboyic effect; blocks prostaglandin production, has analgesic effect
- class: NSAID, Analgesic, antipyretic, anti-inflam, platelet inhibitor
- blocks the enzyme that makes prostaglandins which results in lesser prostaglandin concentration; lowers inflammation, pain, fever; edema, and tenderness are reduced
- causes less inflammation and ulceration of the stomach and intestine (at least with short term use)
- Does not interfere with the clotting of blood
- decreases firing of the alpha motor neuron; results in decreased muscular tone.
- is a muscle relaxant primarily;y on the CNS
- half life is doubled over age 65; excreted through the kidneys;
- nutritional supplement used for OA; may decrease inflammation; made of glucose and amino acids, forms joint cartilage
- Stimulates cartilage production and inhibits degradation
- Modulates the synthesis and release of a number of chemical mediators of inflammation, including prostaglandins and histamine
- anti-inflammatory; used to tx OA and RA
What are other treatments of OA?
- Rest, heat/cold (prevent burns, can use frozen peas
What is the surgical management of OA?
- TJA (total joint arthroplasty) aka TJR (total joint replacement)
- THA aka THR
- TKA aka TKR
- TEA Total elbow???
- indicated when pain/mobility are uncontrolled
What is the dif between primary and revision arthroplasty?
- primary- initial surgery
- revision- loosened component, fractured component
What is the necessary pre-op care for OA surgery?
- DC all anticoags (aspiring) 1-2 weeks prior
- Autologos blood is banked
- Cefazolin (Ancef) 1 hr prior to cut time
- PRE-OP teaching: FC, TXM, DVT prevention, assistive devices
- labs: CBC (H&H) UA, CXR
- pt teaching
- Safety of machinery: drills, saws, irrigation, cauterize
What is the necessary intra- operative nursing care for OA surgery?
- pre-op vitals, allergies, hx, site marking
- type of anesthesia gen or spinal
- FC- sterile technique
- autologous blood administered
- prevention of infection (maintain sterile technique
- contact with family
What are the different types of hip replacements? what is the diff between cement and friction?
- Anterolateral- for obese pts, less risk of dislocation
- Anterior- primary only, decreased muscle damage
- Acetabular cup- screwed or cemented in
- femoral head- friction fit to shaft or one piece
- femoral shaft- bone grows into trochanteric area
methyl methacrylate sets in 7 minutes, can cause sudden BP drop
What is the post op care for hip replace.
- prevent subluxation
- abduction of hips
- no hip flexion greater than 90 degrees
- no crossing of legs
- assess for external rotation and shortening
- use elevated toilet seats
- do neuro checks distal to incision site
How can you prevent infection in post op?
- use sterile technique for dressing/drains
- maintain hemovac vacuum
- monitor temperature
- assess incision q 8 hr
- monitor WBC
How can you prevent thromboembolisms in post op?
- LMW heparin (aptt not necessary)
- compression devices on legs
- TED hose
- Leg exercises
What are the risk factors for TKA?
- OA, reduced joint space
- pain, especially with stairs
- decreased mobility/Adls
What is the care for TKA?
- General or spinal anesthesia
- IV antibiotics 1 hr before cut
- components are usually friction
- Continuous passive motion (CPM)- helps keep prosthetic in-place
- ice packs
- no special positioning
- neuro checks distal to site
What is rheumatoid arthritis?
- chronic progressive, systemic, inflammatory autoimmune disease that affects synovial joints
- more common in European Americans
- fluid accumulates in joint space
- articular cartilage eroded and calcifications form
- forms permanent joint damage
- there is remissions and exacerbations
What are the early signs of RA? Late s&s?
- early: morning joint stiffness, edema, pain, bilateral ans symmetrical, fatigue, weakness, anorexia, low grade fever
- Late: nodular joint deformity, pulmonary involvement, cardiac involvement
How is the dx of RA made? What is the tx?
- dx: X-ray, Serum Rheumatoid factor; serum ESR
- tx: with Total joint replacement, (silastic components[silicone rubber.])