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Flashcards in Osteoarthritis Deck (42):
1

What is Arthritis?

inflammation of a joint

2

Most common types of arthritis?

osteoarthritis
rheumatoid arthritis
gout

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How does Arthritis Affect a Person?

OA is most common type of joint disease in Canada

It is a slowly progressive non-inflammatory disorder of the diarthrodial (synovial) joints.

Symptoms usually start at the age of 50 – 60 years

It is not part of normal aging, but the risk of developing arthritis goes up as a person gets older

4

Fibrous Joints?

articulating surfaces are joined by fibrous tissue.

The DEGREE OF MOVEMENT depends upon the length of collagen fibers uniting the bones.

e.g. inferior tibio- fibular joint ; sutures of the vault of the skull

5

Cartilaginous joints: TYPE 1?

the bones are united by a bar plate of hylaine cartilage.

e. g. the union ( of a growing bone) between the epiphysis and diaphysis of a growing bone.;

first rib and the manubrium sternum.

NO MOVEMENT IS POSSIBLE.

6

Cartilaginous joints: TYPE 2?

the bones are united by a plate of fibrocartilage.

The articular surfaces are covered by a a thin layer of hylaine cartilage .

e. g. intervertebral joints;symohysis pubis .

LIMITED MOVEMENT.

7

*Synovial joints?*

The articular surfaces of the bones are covered by a thin layer of hyaline cartilage, separated by a synovial joint cavity .

e.g. knees, hips, elbows, hands, feet.

GREATER DEGREE OF MOVEMENT.

synovial fluid allows joint movement

8

Etiology of OA

No single cause;

can be idiopathic or triggered by an event (trauma) or condition that damages cartilage in the synovial joint.

9

Risk factors of OA

Age
Obesity
Genetics
Skeletal deformities
Joint injuries
Repetitive stress injuries
Lack of exercise

10


Pathophysiology?

The cartilage damage triggers a metabolic response at the level of the chondrocytes( cells that make up cartilage)

Normally smooth, white cartilage becomes yellow and granular, then softer and less elastic

Fissuring and erosion of the articular surfaces are the next steps in the damage

As the central cartilage breaks down, bits and pieces of cartilage float in the synovial space, causing pain and stiffness

Inflammation may occur as phagocytic cells try to rid the joint of these bits of cartilage

As the cartilage becomes thinner, cartilage and bony growth increase at joint margins

The resulting incongruity in joint surfaces creates an uneven distribution of stress across the joint & contributes to a reduction in motion

11

Clinical Manifestations of joints?

Range from mild discomfort to significant disability;

localized pain and stiffness,

crepitation ( a grating sensation caused by loose particles of cartilage in the joint.

12

Clinical Manifestations of deformity?

Specific to joint involved- Heberden’s nodes on the hands

Can appear as early as 20-30 years of age, majority at 40

Pain & stiffness- “ Ouch I know it’s going to rain!”

Loss of range of motion- altered gait as in OA of the hip 1 leg shorter than the other.

Radiological findings don’t always correlate with the degree of pain experienced by the patient.

13

Progression of OA?

No cure for OA

Collaborative care focuses on managing pain and inflammation

Preventing disability

Maintaining and improving joint function THROUGH
Collaborative care

14

Maintaining and improving joint function THROUGH
Collaborative care?

nutritional and weight management counseling,
rest & joint protection
therapeutic exercise ( with PT),
heat & cold applications
Occupational therapy
accupuncture
nutritional supplements ( glucosamine, chondrotin sulfate), yoga
massage
therapeutic touch
guided imagery

15

Diagnostic Studies
?

Bone scan
Computed tomography (CT)
Magnetic resonance imaging (MRI)
Radiological studies
Blood studies:
Synovial fluid analysis

16

Bone scan?

Injection of a radioactive isotope which is taken up by bone; degree of uptake is related to blood flow

17

Computed tomography (CT)?

X-ray and computer used to provide 3D image; shows soft tissue abnormalities as well

18

Magnetic resonance imaging (MRI)?

radio frequency and magnetic field used to view soft tissue

19

Radiological studies?

X-rays give a 2 dimensional picture

20

Blood studies?

ESR (erythrocyte sedimentation rate)

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Synovial fluid analysis

analyze fluid

22

Review of Treatment for Osteoarthritis?

Focuses on:
Managing pain and inflammation
Preventing disability
Maintaining and improving joint function

Foundation for OA management is non-pharmacological interventions, known as collaborative care. ( see previous slide)

Drug therapy serves as an adjunct

23

Drug Therapy for OA?

Based on severity of symptoms

1st line: starts with acetaminophen (Tylenol), & possibly a topical cream (capsaicin)

2nd line: Nsaids (non-steroidal anti-inflammatory); generic – Ibuprophen (Advil, Motrin), 200mg, QID

Initiated in low doses as it can lead to gastritis ( GI irritation)
GI irritation: dyspepsia, nausea, ulcer hemorrhage.

24

GI irritation?

Nursing considerations:

Adm drug with food, milk or antacids as prescribed.

Teach pt to avoid all alcohol consumption.

Report signs of bleeding e.g. tarry stools, bruising,

nosebleeds, persistent headaches, petechiae, edema, skin rashes, visual disturbances.

Monitor BP for elevations related to fluid retention.

Drug must be administered regularly for maximal effect.

25

Treatment for Osteoarthritis?

Arthroscopic surgery ( knee)
Debridement (removal of unhealthy tissue) is usually not recommended
However, can be effective in reducing pain and improving function when it is used to
Repair ligament tears
Remove bone bits or cartilage

26

Nursing assessment?

Carefully assess and document patient’s joint pain and stiffness
Type
Location
Severity
Frequency
Duration
Physical examination

Acute and chronic pain
Insomnia
Impaired physical mobility
Imbalanced nutrition: more than body requirements
Chronic low self-esteem
Self-care deficits

27

Planning?

Overall goals:
Maintain or improve joint function through a balance of rest and activity

Use joint-protection measures to improve activity tolerance

Achieve independence in self-care and maintain optimal role

Pharmacological and non-pharmacological pain control

28

Nursing Interventions?

Health promotion:

Community education should focus on alteration of modifiable risk factors.

Athletic instruction and physical fitness programs should include safety measures.

29

Other Aids for Patients with OA?

Orthoses: devices that help keep joints aligned and functioning correctly.

Examples:
Well-cushioned shoes and shoe inserts may reduce stress on leg and spinal joints
Splits that immobilize the joints may reduce pain and inflammation
Assistive devices: canes, walkers, raised toilet seats, bars in showers

30

Nursing Interventions?

Acute interventions:

Frequent complaints of patients with OA include pain, stiffness, limitation of function, frustration

Instruct the pt to REST the JOINT when there is active inflammation ( Limit activity )

Ambulatory and home care

Home and work environment modification

Sexual counseling if necessary

31

Positive Outcomes?

Experience adequate amounts of rest and activity

Achieve satisfactory pain management

Maintain joint flexibility and muscle strength through joint
protection and therapeutic exercise

Verbalize acceptance of OA as a chronic disease, collaborating with health care providers in disease management

32

Rheumatoid Arthritis?

Inflammation of the connective tissues in the synovial joints with periods of exacerbation and remission.

33

What is Rheumatoid Arthritis (RA)?

Chronic, systemic autoimmune disease

RA usually develops between 25 and 50 years of age.

1% of Canadians have RA.

Women are 2–3 times more likely to have RA

Cause is unknown
Autoimmunity
Genetic factors

34

What happens in RA?

Antigen triggers the formation of abnormal IgG (Immunoglobulin)

Autoantibodies known as RF, are made against this abnormal IgG, combine with the IgG and land on ( deposited upon) the synovial membrane of the joints.

This immune complex formation leads o the activation of complement and an inflammatory response results with consequent destruction of the articular cartilage.

35

Clinical Manifestations RA?

Onset is insidious: fatigue, anorexia, weight loss, generalized stiffness

Occasionally precipitated by a stressful event (infection, work stress, childbirth, etc)

Joint symptoms occur symmetrically, especially in the small joints of the hands and feet

Larger peripheral joints may then be affected: wrists, shoulders, ankles, etc

Joint stiffness in the morning

Joints are tender, painful, warm to touch

36

Extra-articular manifestations RA?

Most common:

Rheumatoid nodules

Rheumatoid nodules develop in up to 25% of all patients with RA.

Those affected usually have high titres of rheumatoid factor (RF)

37

Complications RA?

Joint destruction begins as early as first year of disease without treatment

Flexion contractures and hand deformities

Nodular myositis and muscle fiber degeneration

Cataracts and loss of vision

Later, cardiopulmonary effects

38

Diagnostic Studies RA?

Accurate diagnosis is essential to initiation of appropriate treatment and prevention of unnecessary disability.

Diagnosis is often made from the following:

History and physical findings

Some laboratory tests are useful for confirmation and to monitor disease progression

Positive RF occurs in ~80% of patients tested
Titres rise during active disease
Antinuclear antibody (ANA) titres
Synovial fluid analysis
Bone scan

39

Collaborative Care RA?

Care begins with a comprehensive program of education and drug therapy.

Drug treatment is imitated as soon as there is a diagnosis to prevent joint destruction.

Physiotherapy helps maintain joint motion and muscle strength.

Occupational therapy develops extremity function and encourages joint protection.

A caring, long-term relationship with an arthritis health care team can increase the patient’s self-esteem and positive coping.

Balanced nutrition is important.

40

Nursing Management: 
Rheumatoid Arthritis

Self-Care deficits:

Chronic pain

Impaired physical mobility

Disturbed body image

Ineffective self-health management

41

Nursing Management: 
Rheumatoid Arthritis Planning?

Overall goals:

Satisfactory pain relief

Minimal loss of functional ability of affected joints

Participate in planning and carrying out therapeutic regimen

Maintain a positive self-image

Perform self-care

42

Nursing Management: 
Rheumatoid Arthritis Nursing implementation?

Health promotion:

Education focuses on symptom recognition

Acute intervention:

Primary focus is reduction of inflammation, pain, maintenance of joint function: rest the joint(s), meds, joint protection

Ambulatory and home care:

Joint protection, heat and cold therapy, exercise, psychological support