Care of Patients with Arthritis and Other Connective Tissue Diseases Flashcards Preview

Nursing 202 > Care of Patients with Arthritis and Other Connective Tissue Diseases > Flashcards

Flashcards in Care of Patients with Arthritis and Other Connective Tissue Diseases Deck (56)
1

Rheumatic disease:

any disease or condition involving the musculoskeletal system

2

Arthritis:

inflammation of one or more joints

3

Osteoarthritis:

progressive disorder deterioration and loss of cartilage and bone in one or more joints

4

Articular cartilage (hyaline cartilage) contains:

water and a matrix of:
Proteoglycans
Collagen
Chondrocytes

5

The production of __________ which provides joint lubrication and nutrition, also declines because of _______ and ______ in the older adult

synovial fluid
decreased synthesis of hyaluronic acid and less body fluid

6

As cartilage and the bone beneath the cartilage begin to erode, the joint space

narrows and osteophytes (bone spurs) form

7

Eitology and Genetic Risk: Primary and Secondary

Primary OA: caused by aging and genetic factors
Secondary OA: results from joint injury and obesity

8

Incidence and Prevalence: Most people older than 60 years have

joint changes that can be seen on x ray examination

9

Assessment:

History: joint stiffness, joint swelling, control of pain, loss of mobility or difficulty w/ ADLs
Physical assessment/clinical manifestations
Psychosocial assessment: continuous pain from arthritis may develop depression or anxiety
Lab assessment: ESR and hsCRP might be elevated
Imaging: MRI/CT

10

Physical assessment/clinical manifestations: OA

Crepitus might be felt or heard (popping)
The presence of inflammation in patients with OA indicates a secondary synovitis
Heberden's nodes: bony nodules at the distal interphalangeal joints
Bouchard's nodes: bony nodules at proximal interphalangeal joints
Joint effusions (excess fluid)
Atrophy
Loss of function
Immobility
Severe pain

11

Managing chronic pain: Expected outcome

The patient w/ OA is expected to have pain control that is acceptable to the patient (3 on a 0-10 scale)

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Interventions for OA

Combinations of therapies
No drug cab influence course of OA
Recommend regular acetaminophen as the primary drug
Topical drug application may help with temporary relief
Positioning and heat/cold applications
No food that causes or cures arthritis

13

Glucosamine does what and
Chondroitin plays a role in what?

may decrease inflammation
may play a role in strengthening cartilage

14

Most common surgical procedure performed for older adults with OA and other conditions including RA, trauma, congenital anomalies, and osteonecrosis =

total joint arthroplasty TJA also known as total joint replacement TJR

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Osteonecrosis:

bony necrosis secondary to lack of blood flow, usually from trauma or chronic steroid therapy

16

Contradictions for TJA are

active infection anywhere in the body, advanced osteoporosis, and rapidly progressive inflammation

17

Total Hip Arthroplasty:

The first time a patient receives any total joint arthroplasty, it is referred to as primary arthroplasty
If the implant loosens, revision arthroplasty is performed
Most common in people of 60 and older

18

Preoperative care: Drugs that increase the risks for clotting and bleeding are

NSAIDs
Vit C and E
Hormone replacement therapy (HRT)
Oral contraceptive drugs
MUST BE DISCONTINUED A WEEK BEFORE SURGERY

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Operative Procedures: For lower extremity surgery the anesthesiologist or nurse anesthetist places the patient

under general or neuraxial (epidural/spinal) anesthesia

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Postoperative care: complications

Venous thromboembolism (VTE)
Infection
Anemia
Neurovascular compromise
MAJOR complication = Hip Subluxation (partial dislocation) or total dislocation

21

Interventions for Dislocation:

Position correctly
Hip= keep leg slightly abducted, prevent hip flexion beyond 90 degrees
Assess for acute pain, rotation, and extremity shortening
Report physician immediately

22

Interventions for Infection:

Aseptic technique for wound care & draining
Wash hands
Monitor temp
Culture drainage fluid if change
Report excessive inflammation or drainage to physician

23

Interventions for VTE:

Wear stockings per policy
Teach leg exercises
Encourage fluid intake
Look for redness, swelling, pain
Observe for changes in mental status
Adm anticoagulant as prescribed
Do not massage legs
Do not flex knees for prolonged time

24

Interventions for hypotension, bleeding, and infection

Take vital signs at every 4 hr for 1st 24 hr, then 8-12 hr after
Observe for bleeding
Report excessive low BP to physician

25

Teach the patient to perform what kind of exercises by pushing the heels into the bed and achieve what by straightening the legs and pushing the back of the knees into the bed?

Gluteal exercises
Achieve quadriceps-setting exercises

26

An older patient may not have a fever with infection but instead may experience

an altered mental state

27

The total amount of drainage is usually

less than 50 mL/8hr

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Managing pain:

Includes extended release epidural morphine (EREM) or patient controlled analgesia (PCA)
-Patients may receive additional analgesic drugs for chronic arthritic pain in other joints

29

Promoting self management: Traditional surgery vs minimally invasive THA

Traditional: length of stay is typically 2-3 days
-Acute rehab takes 1-2 wk or longer, takes 6 wk or longer for full complete recovery

THA: discharged on the second postoperative day or the day of surgery (23 hr stay)

30

Expected life for a Total Knee Arthroplasty (TKA)

20 years or more

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Preoperative care for TKA: PT & OT provide info about

transfers, ambulation, post-op exercises, and ADL assistance

32

One of the most recent advances in post-op pain management for lower extremity total joint arthroplasty is

peripheral nerve blockade (PNB)

33

In the procedure of PNB, the anesthesiologist does what

Injects the femoral or sciatic nerve w/ local anesthetic; the patient may receive continuous infusion of the anesthetic by portable pump

34

Other joint arthroplasties:

Total shoulder arthroplasty (TSA)
Total elbow arthroplasty (TEA)
Any joint of the hand or foot can be replaced, often for patients w/ RA
Any bone of the wrist can be replaced, plus radius and ulna

35

Because shoulder joint is complex and has many articulations (joint surfaces), what is a major potential complication?

subluxation or complete dislocation

36

What is ab alternative to TSA:

Hemiarthroplasty (replacement of part of the joint), typically the humeral component

37

As for other total joint arthroplasty, perform frequent what for how many hours?

Neurovascular assessments at least every 4-8 hr

38

The pannus is:

vascular granulation tissue composed of inflammatory cells; it erodes articular cartilage and eventually destroys bone

39

If blood vessel involvement (vasculitis) occurs,

the organ supplied by that vessel can be affected, leading to eventual failure of the organ or system in late disease

40

Assessment - Early disease manifestations of RA:

Inflammation, generalized weakness, and fatigue.
Anorexia and a weight loss of 2-3 lbs usually occur
May report migrating symptoms known as migratory arthritis
Presence of only one hot, swollen, painful joint = infected -- refer to health care provider immediately

41

Assessment -Late disease manifestations of RA:

frequent morning stiffness (gel phenomenon)
Synovitis and effusions (joint swelling w/ fluid, especially the knees)
Muscle atrophy
Decreased ROM
Joint deformity
Baker's cyst (enlarged popliteal bursae behind the knee
moderate - severe weight loss, fever, extreme fatigue = exacerbations (flare-ups)
Subcutaneous nodules: usually on ulnar surface of arm, on fingers, and Achilles tendon

42

Assess for ischemic skin lesions that appear

in groups of small, brownish spots, most commonly around the nail bed (periungual lesions)
Monitor number of lesions, note location each day, and report vascular changes to the health care provider

43

Peripheral neuropathy associated w/ decreased circulation can cause

foot drop and paresthesias (burning and tingling sensations) = usually in older adults

44

Respiratory complication may manifest as

pleurisy, pneumonitis, diffuse interstitial fibrosis, and pulmonary hypertension

45

Several syndromes are seen in patient w/ advanced RA, the most common is

Sjogren's syndrome

46

Sjogren's syndrome includes a triad of:

Dry eyes
Dry mouth (xerostomia)
Dry vagina (in some cases)

47

Less common syndromes are:

Felty's syndrome: characterized by RA, hepatosplenomegaly (enlarged liver and spleen), and leukopenia

Caplan's syndrome: characterized by the presence of rheumatoid nodules in the lungs

48

Lab Assessment for RA:

Rheumatoid factor - RF: Presence of unusual antibodies of IgG & M
Antinuclear antibody (ANA): test measures the titer of a group of antibodies that destroy nuclei of cells and cause tissue death in patients w/ autoimmune disease
ESR
hsCRP
Serum complement proteins
Albumin levels: 3.5-5.0

49

Interventions of RA:

-Synovectomy: to remove inflamed synovium may be needed for joints like the knee or elbow
-Disease-modifying antirheumatic drugs (DMARDs): slow the progression of the disease
-Strict birth control
-Leflunomide (Arava)

50

What are one of the newest DMARDs:

biological response modifiers (BRMs), biologics
-Etanercept (Enbrel)
-Infliximab (Remicade)
-Adalimumab (Humira)
-Anakinra (Kineret)
-Abatacept (Orencia)

51

Other drugs: Glucocorticoids

Steroids
-Usually Prednisone: may be given in high does for short duration (pulse therapy) or as a low chronic dose

52

Chronic steroid therapy can result in numerous complications:

Diabetes mellitus
Infection
Fluid and electrolyte imbalances
Hypertension
Osteoporosis
Glaucoma

53

Nonpharmacologic interventions for RA:

Apply ice packs
Heated paraffin (Wax) dips
Hot packs
Plasma exchange: plasmapheresis

54

Alternative medicine:

-Cold water fish or fish oil capsules containing omega-3 fatty acids
-Gamma-linolenic acid (GLA) omega-6 fatty acid

55

Older white women are most likely to experience

GI bleeding as a result of taking NSAIDs - reason is unknown

56

Principles of energy conservation:

Pacing activities
Allowing rest periods
Setting priorities
Obtaining assistance when needed