Card Set Information
lccc nursing cc
exam 1 connective tissue
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
: 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
: obesity ( weight on hips, knees ankles, and vertebral columns)
heavy manual occupations = construction/ carpenter
: 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
: 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
: FC, TXM, DVT prevention, assistive devices
: CBC (H&H) UA, CXR
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.
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
assess incision q 8 hr
How can you prevent thromboembolisms in post op?
LMW heparin (aptt not necessary)
compression devices on legs
What are the risk factors for TKA?
OA, reduced joint space
pain, especially with stairs
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
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?
: morning joint stiffness, edema, pain, bilateral ans symmetrical, fatigue, weakness, anorexia, low grade fever
: nodular joint deformity, pulmonary involvement, cardiac involvement
How is the dx of RA made? What is the tx?
: X-ray, Serum Rheumatoid factor; serum ESR
: with Total joint replacement, (silastic components[silicone rubber.])