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1

Osteoarthritis is:

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

2

Crepitus:

occurs when the cartilage disintegrates and pieces of bone and cartilage "float" in the diseased joint causing crepitus, a grating sound caused by loosened bone and cartilage

3

Cause of PRIMARY OA:

aging

genetic factors

Hips, knees & hands most commonly affected

4

Cause of SECONDARY OA:

Joint injury (excessive use, trauma or RA)

obesity

5

Typical onset of RA:

35-45 YR

6

Typical onset of OA:

Older than 60 yrs

7

Risk factors of RA

Autoimmune (genetic basis)

Emotional stress (triggers exacerbation)

Environmental factors

8

Risk factors of OA:

Aging

genetic factor (possible)

Obesity

Trauma

Occupation

9

Disease process for RA & OA

RA: Inflammatory

OA: Degenerative

10

Disease pattern for RA:

Bilateral, symmetric, multiple joints

Usually affects upper extremities first

Systemic

11

Disease pattern for OA:

May be unilateral, single joint

Affects weight bearing joints, hands, spine

Nonsystemic

12

Common drug therapy for RA:

NSAIDS (Short term use)

Methotrexate

Leflunomide (Arava)

Corticosteroids

Immunosuppresive agents

13

Common drug therapy for OA:

NSAIDS (Short term use)

Acetaminophen

Analgesics

14

clinical manifestations of OA

Joint pain and stiffness

Crepitus

Herberden's nodes

Bouchard's nodes

joint effusions

Atrophy of skeletal muscle

15

Early: clinical manifestations of RA (joint/systemic)

Joint stiffness/inflammation

Low grade fever

weakness

fatigue

anorexia

paresthesias

swelling

16

Late clinical manifestations of RA (JOINT/SYSTEMIC)

Joints become progressively inflamed and quite painful

deformities (swan neck or ulnar deviation)

moderate to severe pain and morning stiffness

osteoporosis

severe fatigue

anemia

weight loss

17

Lab tests for OA (2)

ESR

HsCRP

18

Lab tests for RA/CTD

Rheumatoid factor

ANA

ESR

Serum complement (C3 &C4)

SPEP

Serum immunoglobulins

19

RA Nonpharmacologic interventions:

adequate rest

proper positioning

ice and heat application

plasmapheresis (not common)

complementary and alternative therapies

promotion of self-management

management of fatigue

enhance body image

20

OA Chronic Pain: Nonsurgical management

Drug therapy (Tylenol) drug of choice

Rest

Immobilization

Positioning

Thermal modalities

Weight control

Integrative therapies (glucosamine, chondroitin)

21

Inflammatory rheumatology

RA

Systemic lupus erythematosus (SLE)

Autoimmune disease

22

OA is

most common arthritis type

progressive loss of cartilage

joint pain
- loss of function characterized by progressive deterioration

Cartilage disintegrates; bone and cartilage "float" into joint, causing crepitus

23

Nursing interventions to prevent dislocation:

position correctly

for hip: keep leg slightly abducted

for hip, prevent hip flexion beyond 90 degrees

assess for acute pain, rotation, and extremity shortening

24

Nursing interventions to prevent infection:

aseptic techniques for wound care and emptying of drains

hand hygiene

culture drainage fluid, if change

monitor temperature

25

Nursing interventions to prevent venous thromboembolism

have patient wear elastic stockings or SCDs

teach leg exercises

encourage fluid intake

observe for signs of thrombosis (redness, swelling or pain)

observe patient for changes in mental status

administer anticoagulant as prescribed

do not massage legs

do not flex knees for a prolonged period of time

26

Nursing interventions to prevent hypotension, bleeding, infection

take vital signs q4hr

observe patient for bleeding

report excessively low bp or bleeding