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NU 340 > Ch. 43 > Flashcards

Ch. 43 Flashcards

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1
Q

osteoarthritis

A
  • most common arthritis type
  • progressive loss of cartilage
  • joint pain, loss of function characterized by progressive deterioration
  • osteophytes (bone spurs)
  • cartilage disintegrates, bone and cartilage “float” into joint causing crepitus
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2
Q

osteoarthritis primary etiology (causes)

A

aging
genetic factors

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3
Q

osteoarthritis secondary etiology

A
  • joint injury
  • obesity
  • repetitive stress to joints
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4
Q

most common joints affected by osteoarthritis

A

weight-bearing joints mostly
- knees
- hips

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5
Q

osteoarthritis incidence and prevalence

A

33 million in US
- 5th most common cause of disability worldwide
people > 60 years old: higher risk
F>M: higher risk

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6
Q

osteoarthritis health promotion

A

maintain proper nutrition
avoid injuries
stay active
take work breaks: think construction workers who bend their joints all day at work

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7
Q

joint changes in degenerative joint disease

A
  • bone hypertrophy (bone spurs)
  • cartilage particles
  • loss of cartilage

joint thickens, decrease in synovial fluid: think bone on bone

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8
Q

osteoarthritis assessment: history

A
  • joint pain: localized, unilateral
  • may be secondary to another dx
  • age: usually older than 60 years old
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9
Q

osteoarthritis assessment: physical assessment/ s/sx

A

Persistent joint pain and stiffness
Crepitus: grating sound from bone on bone
Joint effusions
Heberden’s nodes (in hand)
Bouchard’s nodes (in hand)
Atrophy of skeletal muscle

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10
Q

osteoarthritis assessment: psychosocial assessment

A

lifestyle changes
- can’t walk as well
- not socializing or going out as much

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11
Q

osteoarthritis assessment: labs

A
  • aspirated joint fluid: analyzed under microscope
  • ESR: generic blood level showing inflammation in the body, may be elevated
  • hsCRP: generic blood level showing inflammation in the body, may be elevated
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12
Q

osteoarthritis assessment: imaging

A

X-ray: arthritic changes in the joints
MRI

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13
Q

hebern’s nodes

A

bony nodules at the distal interphalangeal joints (closer to end of the fingers/nail beds)

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14
Q

bouchard’s nodes

A

bony nodules at the proximal interphalangeal (closer to the hand)

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15
Q

priority problems for patients with osteoarthritis

A
  • persistent pain (once you have arthritic, it does not go away- unless you have a joint replacement)
  • potential for decreased mobility
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16
Q

(arthritis) chronic pain: non-surgical management

A

Drug therapy
- most commonly: Acetaminophen (arthritis 500mg)
- OTC NSAID like ibuprofen
Rest, immobilization
Positioning
Thermal modalities: heating pad or ice
Weight control: getting weight stable, nutrition/diet
Integrative therapies
- Glucosamine, chondroitin (let PCP know! interactions!)

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17
Q

chronic joint pain: surgical management

A

total joint arthroplasty (TJA)/total joint replacement (TJR)
- knees: outpatient
- hip: inpatient

arthroscopy: osteotomy
- less invasive, use scope to clean up cartilage

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18
Q

osteoarthritis care coordination and transition management

A
  • home care management
  • health care resources
  • self-management education
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19
Q

post-op care for TJR

A
  • abductor position (triangle foam pillow) while in bed: prevent dislocation of hip
  • watch for VTE, leg exercises, use of compression devices/socks
  • assess signs of infection: redness, edema, inflammation, drainage
  • monitor Hgb, Hct (normal for slight decrease), watch for need of blood transfusion
  • check limb for: color, pulses, temperature, sensation
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19
Q

post-op complications for TJR

A

Collaborate with patient/family to become safety partners to prevent complications
- Hip dislocation
- VTE** (very common w/ ortho surgeries)
- Infection
- Anemia
- Neurovascular compromise

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20
Q

exercise after THR

A

hip flexion no greater than 90° (want < 90°)
- leg exercises

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21
Q

continuous passive motion machine

Study These Flashcards
A
  • patient comes up from OR with
  • computerized iPad with settings: compare with computer to ensure that they match
  • used after THR
22
Q

osteoarthritis evaluation

Study These Flashcards
A
  • Achieves pain control to a pain intensity level of 2 to 3 on a scale of 0 to 10 or at a level that is acceptable to the patient
  • Does not experience complications associated with total joint arthroplasty (if performed)
  • Moves and functions in own environment independently with or without assistive devices
23
Q

rheumatoid arthritis (RA)

Study These Flashcards
A
  • Common connective tissue disease, destructive to joints
  • Chronic, progressive, systemic inflammatory autoimmune disease
  • affects primarily synovial joints; affects joints throughout the body (not just one, not unilateral)
  • Characterized by remissions and exacerbations
  • Transformed autoantibodies (rheumatoid factors) form, attack healthy tissue causing inflammation
24
RA: causes
- combination of environmental and genetic factors - physical and emotional stressors are linked to exacerbations
25
RA pathology
bone erosion decreased synovial fluid - may be unilateral, single joint - affects weight-beating joints and hands, spine - metacarpophalangeal joints spared - systemic autoimmune inflammatory d/o
26
RA incidence and prevalence
- 1.5 million people - more common in Euro-Americans - women 2-3x more likely to have RA than men
27
RA assessment: history
Acute and severe, or slow and progressive
28
RA assessment: physical assessment/ s/sx
Joint and systemic symptoms Generalized weakness and fatigue: malaise Morning stiffness Advanced disease symptoms
29
RA assessment: psychosocial assessment
body changes mobility changes - go out less/ less social
30
RA assessment: labs
Rheumatoid Factor Anti-CCP ANA: can be elevated due to inflammation in the body ESR: can be elevated due to inflammation in the body hsCRP: can be elevated due to inflammation in the body Serum complement (C3 & C4) Serum protein electrophoresis Serum immunoglobulins Thrombocytosis can occur with late RA
31
RA assessment: diagnostic tests
X-rays CT scan Arthrocentesis (fluid analysis in the lab) Bone Scan
32
RA joint involvement progression (s/sx early vs late)
Early—joint stiffness, swelling, pain, fatigue, generalized weakness, low-grade fever (99°) Late—joints become progressively inflamed and quite painful, SQ nodules; OT involvement, assistive devices
33
priority problems for patients with RA
- Chronic inflammation and persistent pain - Potential for decreased mobility - Potential for decreased self-esteem
34
RA plan/interventions
Managing chronic inflammation and pain - Drug therapy Promoting mobility Enhancing self-esteem
35
RA systemic complications
Weight loss, fever, extreme fatigue - Exacerbations Subcutaneous nodules Respiratory, cardiac complications Vasculitis: inflammation of the blood vessels- pulmonary and cardiac problems Periungual lesions Paresthesias: numbness and tingling to extremities
36
RA- associated syndromes
Sjögren’s syndrome Felty’s syndrome Caplan’s syndrome
37
Sjögren’s syndrome: triad of sx
triad of sx - dry eyes, dry mouth, vaginal dryness
38
Felty’s syndrome
associated with RA triad of disorders/diagnoses RA, splenomegaly: enlarged spleen, elevated WBC
39
Caplan’s syndrome
a combination of rheumatoid arthritis and pneumoconiosis that manifests as intrapulmonary nodules, which appear well-defined and homogenous on chest x-ray. It is defined as lung nodules in dust-exposed personnel, either with a history of rheumatoid arthritis or develops RA after 5-10 year
40
RA nonpharmacologic interventions
Adequate rest Proper positioning Ice and heat application Plasmapheresis (not common): machine takes plasma out of body and removes rheumatoid antibodies and then puts plasma back into body Complementary and alternative therapies Promotion of self-management Management of fatigue Enhance body image
41
RA drug therapy
DMARDs (disease modifying antirheumatic drugs) - methotrexate: decrease inflammation, immunosuppressive agent: decrease immune system/low platelet/low WBC- stay out of public places, stay away from sick people; teratogenic agent: pregnancy test before using, need to be on strict birth control - hydroxychloroquine: decrease inflammation, immunosuppressive agent: decrease immune system/low platelet/low WBC- stay out of public places, stay away from sick people; retinal vessel damage- regular eye exams needed, look behind retina for damage NSAIDs BRMs (biological response modifiers) - affects immune system: look for s/sx of infection, call PCP if develop a sx of infection (ie cough) Other: - Glucocorticoids (taper off, don't stop suddenly) - Immunosuppressive agents (prednisone- hyperglycemia sugar levels) - E788 awaiting approval
42
gout
aka gouty arthritis - urate crystals deposit in joints and other body tissues, causing inflammation - primary or secondary - M > F higher risk - men > 50 years at higher risk
43
primary gout
related to underexcretion or overproduction of uric acid, often associated with a mix of dietary excesses or alcohol overuse and metabolic syndrome
44
secondary gout
hyperuricemia: high levels of uric acid - causative diet: steak, wine, red meats - use of diuretics: thiazide
45
gout assessment: phase 1
asymptomatic hyperuricemia high levels of uric acid levels in the blood
46
gout assessment: phase 2
acute gouty arthritis - painful attack - affects 1 joint; usually the great toe but can affect any joint - severe pain, swollen, red (no sheet on feet so painful)
47
gout assessment: phase 3
tophaceous arthritis (aka tophi)
48
gout interventions
Maintain serum uric acid level less than 6 mg/dL Drug Therapy - Colchicine Nutrition therapy - Limit proteins - Avoid trigger foods: seafood, red meat, alcohol - Plenty of fluids - pH increased with alkaline foods - Low purine diet
49
tophi
stage 3 gout - most common in great toe - can affect hand - swollen nodule-type things
50
hip flexion after THR
- don't want hip flexion > 90°: causes dislocation - use abductor pillow - can do leg exercises - stand up with leg extended out and support with hands on either side to push off - slide on shoes/ have someone that can help with putting them on - no crossing legs: hip dislocation
51
gout drug therapy: acute attack
- NSAIDs - colchicine *pain treatment, but no uric acid treatment
52
gout drug therapy: chronic attack
- allopurinol - finoxbasat *decrease uric acid levels

NU 340 (26 decks)

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