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Flashcards in Chapter 65: Med Surg Deck (63)
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slowly progressive noninflammatory disorder of synovial joints r/t age, genetics, obsesity, frequent kneeling, lack of exercise


Men with OA

men after more often affected than women before age 50, hip OA more common after 55, knee OA more common in men before age 45


women with OA

affected more after age 50 thought to be caused by estrogen reduction at menopause


OA results from

cartliage damage leading to cartilage and bony growth increasing at joint margins causing uneven distribution of stress across joint and reducing motion


s/s of OA

no systemic (unlike RA!), joint pain and may be referred to groin, butt, thigh or knee, early morning stiffness but resolves within 30 min


heberden's nodes

occur in distal interphalangeal joints as an indication of osteophyte formation and loss of joint space, red, swollen, tender


bouchard's nodes

affects proximal interphalangeal joints, red, swollen, tender


diagnostics of OA

bone scan, CT, MRI detect early joint changes and x rays confirm disease and stage progression such as joint space narrowing and osteophyte formation, synovial fluid clear yellow and not inflammed (unlike RA!)


tx of OA

managing pain, preventing disability, and maintaining and improving joint fx, rest should not exceed 1 week, heat used more than ice, arthroscopy to repair cartilage or remove bone bits


alternative therapy of OA

glucosamine and chondroitin sulfate helpful in resolving moderate to severe arthritis pain and improving joint mobility


drug therapy for OA

tylenol 1000 mg q6h do not exceed 4 g/day, Zostrix topical cream, no NSAIDs with Coumadin or anticoagulants or Aspirin


hyaluronic acid

viscosupplementation contributes to viscosity and elasticity of synovial joints



inflammatory disorder that affects the spin, peripheral joints, negative for rheumatoid factor, HLA-B27 gene associated, difficult to distinguish types early in disease


ankylosing spondylitis

chronic inflammatory disorder affecting axial skeleton, highest incidence 25-34 yeras of age, men more likely to develop


s/s of ankylosing spondylitis

low back pain, stiffness, limitation of motion, pain in other areas such as hands, extraarticular inflammation in eyes, lungs, heart, etc


diagnostics for ankylosing spondylitis

pelvic x ray is essential for characteristic changes of sacroiliitis, may see "bamboo spine" which is the result of calcifications that bridge from one vertebra to another


tx of ankylosing spondylitis

maintain maximum mobility while decreasing pain and inflammation, local corticosteroid injections, once pain and stiffness are gone exercising is essential, spinal osteotomy and total joint replacement are most frequent procedures


nursing management of ankylosing spondylitis

ROM should include chest expansion (breathing exercises), no smoking, firm mattress and sleep on back with flat pillow avoiding flexion, swimming, racquet games


psoriatic arthritis

progressive inflammatory disease that can involve primary small joints of hands and feet, can involve asymmetric extremities resembling OA, can involve symmetric extremities resembling RA, can involve sacroiliac joints and spine


diagnostics of psoriatic arthritis

x ray looks similiar to erosion in RA, widened joint spaces, elevated ESR, mild anemia, elevated blood uric acid (gout must be excluded)


tx of psoriatic arthritis

splinting, joint protection, physical therapy, DMARDS such as methotrexate


reactive arthritis

occurs more commonly in young men, urethritis, conjuncitvitis, and mucocutaneous lesions included, etiology unknown but associated with GI infections


tx for reactive arthritis

prognonsis is favorable, pt recovers in 2-16 weeks, Vibramycin 100 mg BID


diagnostic for reactive arthritis

up to 50% of people have a recurring disease, x ray in chronic conditions resemble ankylosing spondylitis


septic arthritis

invasion of joint cavity with microorganisms resulting in hematogenous seeding of joint, can be caused by gonorrhea, large joints frequently involved


s/s of septic arthritis

severe pain, erythema, swelling, fever, chills


diagnostics for septic arthritis

arthrocentesis to do a culture of synovial fluid


tx for septic arthritis

antibiotics promptly to prevent joint destruction, monitor joint inflammation, pain, and fever


lyme disease

spirochetal infection transmitted by the bite of an infected deer tick, not transmitted person to person, occurs most during the summer


s/s of lyme disease

erythema migrans (EM) is a skin lesion that occurs at the site of the tick bite within 2-30 days of exposure, low grade fever, stiff neck, swollen lymph noteds, migratory joint and muscle pain, untreated can migrate to- CNS, heart, and joints