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Foot - HIGH RISK Feet > Unit 3 - Arthritis > Flashcards

Unit 3 - Arthritis Flashcards

1
Q

The word arthritis means “joint swelling” but arthritis isn’t just aches and pains. Arthritis has an enormous impact on quality of life.

It consists of…

A

more than 100 different conditions that can affect the joints.

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2
Q

Is arthritis a disease of the elderly?

A

Arthritis is not just a disease of the elderly; it can strike anyone at any time.

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3
Q

Arthritis costs

How much?
In what?
It is one of Canada's...
Second only to?
Ahead of?
A

more than $4 billion annually

in health care expenses and lost workday

most costly chronic conditions,
second only to cardiovascular disease
and ahead of cancer

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4
Q

Is arthritis common in Canada?

A

It one of the top three most common chronic diseases in Canada.

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5
Q

Compare/contrast disease rate in men/women

A

Arthritis effects nearly twice as many Canadian women as men.

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6
Q

Compare/contrast disease rate in

aboriginal women/non-aboriginal women

A

Aboriginal women are effected the most, with 70% aged 65 and older living with the disease, compared to 50% of non-aboriginal women in the same age group.

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7
Q

Rates of pain in arthritis

A

Over one-third (36%) of people with arthritis
deal with
severe to moderate pain,

compared with only 13% of people with non-arthritic conditions.

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8
Q

What is the most common type of arthritis?

A

Degenerative Arthritis

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9
Q

Degenerative Arthritis includes?

A

osteoarthritis and degenerative disc disease

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10
Q

Degenerative Arthritis etiology

Describe condition
Etiology (4)

A

erosion of the cartilage by

inflammation + breakdown

injury

or prolonged use

or excessive “wear and tear” on a joint

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11
Q

Degenerative Arthritis complications

4

A

bone underneath the worn cartilage thickens and may develop spurs

the joint can become swollen and painful

the loss of cartilage causes

loss of free movement of the joint

loss of shock absorption in weight bearing joints

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12
Q

Degenerative Arthritis main risk factor

A

more common as we age

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13
Q

Degenerative Arthritis

most common sites affected?

may also affect?

A

most common in the back, hips and knees

may effect
neck, shoulders,
fingers and toes, especially the halluxes

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14
Q

Degenerative Arthritis SX

Onset?

How are joints affected?

Describe pain (3)

A

slow onset over a period of years

may effect one or more joints
often asymmetrical

pain, swelling and stiffness of effected joints lasting more that 2 weeks

pain gets worse the more the joint is used

rest provides relief of pain and discomfort

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15
Q

Diagnosis of Degenerative Arthritis (2)

A

physical examination

x-rays

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16
Q

Goals and Treatments for Degenerative Arthritis:

A

maintain function and preserve joints

pain control

anti-inflammatories

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17
Q

Degenerative Arthritis pain control (6)

A

topical creams and gels

non-narcotic analgesic e.g. acetaminophen

non-steroidal anti-inflammatories (NSAIDs);
e.g. ASA, ibuprofen, naproxen

COX 2 inhibitors
e.g., celecoxib (Celebrex)

oral corticosteroids
e.g., prednisone

opiates

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18
Q

Degenerative Arthritis injx - where?

A

intra-articular injection

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19
Q

Degenerative Arthritis injx - what? (2)

A

corticosteroids

viscosupplementation (hyaluronic acid)

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20
Q

Degenerative Arthritis - viscosupplementation (hyaluronic acid) describe (3)

A

used for mild to moderate OA

a clear gel-like substance that lubricates cartilage and restores its viscoelasticity or ability to absorb shock

new and expensive

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21
Q

Degenerative Arthritis - complementary treatments? (2)

A

complementary supplements

e.g., glucosamine, chondroitin sulfate

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22
Q

Degenerative Arthritis - last resort Tx

A

surgery for joint replacement especially hips and knees

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23
Q

Inflammatory Arthritis includes?

SJ LARP

Social justice live action role playing (game)

A 
lupus erythematosus
ankylosing spondilitis
rheumatoid arthritis
psoriatic arthritis
scleroderma

juvenile arthritis

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24
Q

Inflammatory Arthritis - Etiology

Inflammatory arthritis is sometimes called?

A

sometimes called rheumatological disease, connective tissue disease or autoimmune disease

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25
Q

Inflammatory Arthritis - Etiology

Cause?

A

exact cause is unknown but thought that infection, possibly viral agents and heredity play a part

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26
Q

Inflammatory Arthritis - Etiology

Starts with?

Resulting in?

A

starts a faulty immune response
that attacks the synovium lining of the joints

resulting in destruction of cartilage and bone

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27
Q

Inflammatory Arthritis - Etiology

The faulty immune response may also?

A

attack other tissues in the body

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28
Q

Inflammatory Arthritis - SX

Onset?

How are joints affected?

Describe pain (3)

A

may have a slow or sudden onset

may effect several joints at once in a symmetrical pattern, often smaller joints first

may be chronic and steady or be more severe at times with periods of remission in between

aching, pain, stiffness, warmth, and swelling in joints

may have general symptoms of fatigue, fever or weight loss

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29
Q

Inflammatory Arthritis - SX

Does it affect joints only?

A 
may effect other body systems:
cardiac
pulmonary
renal
neurological
integumentary
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30
Q

Inflammatory Arthritis - DX (5)

A

history and physical exam

bloodwork, often extensive

imaging: x-rays, CT scan, MRI

synovial fluid analysis

often needs referral to a rheumatologist

31
Q

Inflammatory Arthritis - Goals

A

early diagnosis and treatment to avoid severe damage to the joints

32
Q

Inflammatory Arthritis - TX

5 types of meds that are used

A

non-steroidal anti-inflammatories (NSAIDs)

COX 2 inhibitors

corticosteroids

disease-modifying anti-rheumatic drugs (DMARDs)

biologic response modifiers (“biologics” or BRMs)

33
Q

Inflammatory Arthritis - TX

NSAIDs

S/E (1)
Examples (2)

A

ALL can cause GI bleeding or upset

e.g. ASA, ibuprofen

34
Q

Inflammatory Arthritis - TX

COX 2 inhibitors

Example

A

e.g. celecoxib (Celebrex)

35
Q

Inflammatory Arthritis - TX

Corticosteroids

Administration routes (3)
S/E (1)
A

IV, oral or intra-articular injection

IV and oral preparations cause immunosuppression

36
Q

Inflammatory Arthritis - TX

Disease-modifying anti-rheumatic drugs (DMARDs)

What do they do?
S/E?

A

slows the rate of inflammation

cause immunosuppression

37
Q

Inflammatory Arthritis - TX

Disease-modifying anti-rheumatic drugs (DMARDs)

7 Drugs

GLAM HSC

A

gold therapy (Myochrisine)
leflunomide (Arava)
azathioprine (Imuran)
methotrexate (MTX)

hydroxychloroquine (Plaquenil)

sulfasalazine (Azulfidine)
First line Tx, significant S/E in 25% of people

cyclosporine

38
Q

Inflammatory Arthritis - TX

Biologic response modifiers (“biologics” or BRMs)

What do they do?
S/E?

A

block specific hormones to control inflammation

cause immunosuppresion

39
Q

Inflammatory Arthritis - TX

Biologic response modifiers (“biologics” or BRMs)

3 drugs

A

newest drugs and very expensive

Remicade
Enbrel
Humira

40
Q

Gout - Etiology

What type of disorder is gout?

A

gout is a disorder of the body metabolism creating either over production of (10% of cases), or too little excretion of uric acid (90% of cases)

normally purine in the diet is broken down by the body’s metabolism into uric acid and excreted by the kidneys

41
Q

Gout - Etiology

What does the build up of uric acid in the blood cause?

A

the build up of uric acid in the blood causes

uric acid crystals to deposit in tissue

42
Q

Gout - Etiology

Where does uric acid deposit?

A

most common site is the hallux but may affect any joint

43
Q

Gout - Etiology

What causes it? (4)

A

may be hereditary

or as a result of other disorders 
e.g. 
renal disease
psoriasis
cancer treatment
44
Q

Gout - SX (5)

A 
pain
swelling
redness
warmth
may be accompanied by fever
45
Q

Gout - SX

Onset

A

onset is sudden and often effects only one joint

46
Q

Gout - SX

Describe pain

A

pain is sustained, very intense and will last from 3 to 10 days if untreated

47
Q

Gout - SX

Complications (2)

A

may become chronic causing erosion and severe deformity of a joint similar to rheumatoid arthritis

uric acid crystals can form deposits in soft tissue called ‘tophi’ that can irritate and swell locally

48
Q

Gout - DX (3)

A

blood test for uric acid

analysis of aspirated synovial fluid from effected joint

24 hour urinalysis for uric acid

49
Q

Gout - Goals

THREE!!! of them

A

provide symptom relief in acute phase of attack

prevent further attacks and joint damage

prevent the formation of kidney stones or tophi (uric acid crystal deposits in soft tissue)

50
Q

Gout - TX

Acute Phase

A

NSAIDs
e.g., indomethacin

steroids
oral or intra-articular injection

colchicine (causes nausea and diarrhoea)

51
Q

Gout - TX

For Prevention of Reoccurrence

A

probenecid or sulfinpyrazone increase the excretion of uric acid by the kidneys

allopurinol decreases the over production of uric acid by the body

low purine diet (decrease intake of seafood, liver and gravy) to decrease the production of uric acid

52
Q

Effects of Arthritis on the Lower Limb

General (4)

A

pain and swelling leads to decreased range of motion (ROM)

disuse leads to stiffness, decreased muscle strength and weakened ligaments

prolonged disuse leads to contractures and joint deformities

overuse leads to injury of weakened structure

53
Q

Effects of Arthritis on the Lower Limb

Toes

A

deformities of toes:
o claw, hammer or mallet toes
o hallux rigidus and hallux valgus
o subluxation of metatarsal heads

54
Q

Effects of Arthritis on the Lower Limb

Rear foot and ankle

A

rear foot and ankle deformities leading to:
o pronation
o supination

55
Q

Effects of Arthritis
on
Common Foot Pathologies of SKIN (3)

A

altered or stiff gait can lead to callus formation
o medially or laterally
o on one or both feet

toe deformities can create areas of pressure causing callus or skin breakdown:
o tips of toes
o metatarsal heads
o dorsum of toes (PIPs and DIPs)

stiff toes can be hard to dry and lead to maceration and skin breakdown between or under toes

56
Q

Effects of Arthritis
on
Common Foot Pathologies of NAILS (1)

A

altered areas of pressure can lead to nail thickening and/or deformity

57
Q

Effects of Arthritis on the Lower Limb

The effects are?

A

ongoing and progressive

58
Q

Effects of Arthritis on General Health and Mobility

A

pain and fatigue lead to decrease exercise tolerance

joint deformity leads to altered gait and decreased mobility

difficulty with ADL can lead to psychological effects of depression and social isolation

59
Q

General Treatments and Interventions for Arthritis

A

control pain

prevent or minimize joint deformity

maintain function and mobility

good nutrition and weight management

60
Q

General Treatments and Interventions for Arthritis

Physical and occupational therapists work with and teach clients how to:

(Just memorize a few?)

A

use correct body mechanics for joint preservation

use splints correctly for joint protection

do ROM exercises

use heat and cold

safely build up endurance and strength

pace and arrange activity to conserve energy

modify their environment to maximize functioning

61
Q

General Treatments and Interventions for Arthritis

Social Workers help clients manage

A

stress and emotional needs

financial issues

transportation or home services needs

62
Q

Nursing Foot Care for Clients with Arthritis

AX
Identify (6)

A

any history of arthritic disease

client’s understanding of condition and any current treatments

if taking med(s) that cause immunosuppression

other health care providers involved e.g. rheumatologist, physiotherapist

any risk factors or foot abnormalities related to arthritis

how well client is coping

63
Q

Nursing Foot Care for Clients with Arthritis

Planning (4)

A

realistic goals for treatment
in consultation with client
and based on their preferences for treatment

interventions
in consultation with client
including education and referrals

plan foot care to not interfere with other treatments
delay treatment in an acute attack if necessary

64
Q

Nursing Foot Care for Clients with Arthritis

Intervx - General (2)

A

refer client to doctor if you identify any joint pain, redness or swelling that has not been diagnosed

question the client about any changes

65
Q

Nursing Foot Care for Clients with Arthritis

Intervx - Footwear (2)

A

identify any areas of pressure from footwear and work with client to minimize or prevent skin breakdown

refer client for footwear or orthotic modification as needed
o

66
Q

Nursing Foot Care for Clients with Arthritis

Intervx - Footcare (1)

A

exercise particular caution to protect fragile skin during foot and nail care

67
Q

Nursing Foot Care for Clients with Arthritis

Intervx - Teaching (2)

A

teach client how to manage self care of feet using creative problem solving as needed (e.g. using reaching aid or q-tips to dry well between toes)

consider increased risk of infection with immunosuppression when teaching client to monitor minor injury

68
Q

Nursing Foot Care for Clients with Arthritis

Evaluation (3)

A

evaluate effectiveness of interventions including teaching and referrals

identify changes in client’s behaviour or lack of change (e.g. they have new shoes and insoles but aren’t wearing them)

document changes to care plan along with any new goals or interventions

69
Q

Role of the Foot Care Nurse as a Member of the Health Care Team

SCARF

A 
Supportive
Communication
Advocating
Referrals
Follow-Up
70
Q

Role of the Foot Care Nurse as a Member of the Health Care Team

SCARF
Suportive (2)

A

demonstrate support for whatever treatment and caregivers are currently in place

encourage clients to ask questions and be active participants in their own care

71
Q

Role of the Foot Care Nurse as a Member of the Health Care Team

SCARF
Communication (2)

A

if concerns are urgent or more detail is required consider a phone call, letter or fax to clarify communication

keep a record of communications

72
Q

Role of the Foot Care Nurse as a Member of the Health Care Team

SCARF
Advocating (4)

A

Advocate for:

clients to have a family physician to mange degenerative arthritis or gout

clients to have a rheumatologist to manage inflammatory arthritis

Home Care assessment through family physician if needed

call Health Links or Manitoba Medical Association for a list of physicians taking new clients

73
Q

Role of the Foot Care Nurse as a Member of the Health Care Team

SCARF
Referrals

A

Family physician

  • diagnosis and treatment of joint pain, swelling or redness that does not start to resolve in 2 to 3 days, has not been diagnosed or is recurrent
  • questions about making changes to their medications

“The Arthritis Society”

  • questions about treatment options
  • financial assistance available locally
  • programs and services
    e. g., Arthritis Self-Management classes
74
Q

Role of the Foot Care Nurse as a Member of the Health Care Team

SCARF
Follow-Up (1)

A

document referrals and ask the client about outcomes at subsequent visits

Foot - HIGH RISK Feet (6 decks)

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