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

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Preoperative care for TKA: PT & OT provide info about

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


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

peripheral nerve blockade (PNB)


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


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


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

subluxation or complete dislocation


What is ab alternative to TSA:

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


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

Neurovascular assessments at least every 4-8 hr


The pannus is:

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


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


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


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


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


Peripheral neuropathy associated w/ decreased circulation can cause

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


Respiratory complication may manifest as

pleurisy, pneumonitis, diffuse interstitial fibrosis, and pulmonary hypertension


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

Sjogren's syndrome


Sjogren's syndrome includes a triad of:

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


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


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
Serum complement proteins
Albumin levels: 3.5-5.0


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)


What are one of the newest DMARDs:

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


Other drugs: Glucocorticoids

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


Chronic steroid therapy can result in numerous complications:

Diabetes mellitus
Fluid and electrolyte imbalances


Nonpharmacologic interventions for RA:

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


Alternative medicine:

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


Older white women are most likely to experience

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


Principles of energy conservation:

Pacing activities
Allowing rest periods
Setting priorities
Obtaining assistance when needed