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Flashcards in Osteoarthritis/Test 4 Deck (21):
1

Osteoarthritis is

a progressive non-inflammatory disease that affects joints and surrounding tissues. No single cause has been identified.

2

Modifiable risk factor for osteoarthritis:

Obesity- moderate exercise and weight control has been shown to decrease the likelihood of disease development and progression.

3

Cartilage destruction can begin between ages

20 and 30. More than half >65 years have xray evidence in at least one joint.
-before age 50, men affected more than women. Incidence greater in women after age 50

4

Etiology and Pathophysiology-

*OA results from cartilage damage and narrowing of the joint space

5

No significant inflammatory component but

synovial fluid may become inflamed from cartilage and bone erosion- loss of cartilage and body cannot repair cartilage because of ongoing destruction. Known to involve formation of new joint tissue in response to cartilage destruction

6

Etiology and pathophysiology- cartilage and bony growth

increase at joint margins. Resulting incongruity in joint surfaces. Contributes to reduction in motion.

7

Pain

-inflammatory change contributes to early pain and stiffness.
-later in disease pain results from contact between exposed bony joint surfaces after articular cartilage has completely deteriorated.

8

Types and causes: Idiopathic (Primary)

-etiology unknown
-age is factor (wear and tear on joints)

9

Secondary

any condition that damages cartilage-
*Obesity, athletics, dancing, performing repetitive actions and infections. (Trauma, mechanical stress, inflammation, joint instability, neurologic disorders, skeletal deformities, hematologic/endocrine disorders and use of selected drugs)

10

Prevention is not

possible. Community education should focus on- alteration of modifiable risk factors, weight loss, occupational and recreational hazards.
*Athletic instruction and physical fitness program safety measures

11

Nursing assessment:

*Type
*location
*severity
*and duration of pt's joint pain and stiffness.
-questions on extent these symptoms affect abilities to perform ADLs
-pain relieving practices
-physical exam of affected joints (tenderness, swelling, limitation of movement, crepitation). Compare to the unaffected side.

12

Systemic S/S:

None!!!
-fatigue, fever, organ involvement are not present in OA
-important distinction between OA and inflammatory joint disorders such as RA

13

Nursing Implementation/Acute intervention:

-Usually treated on an outpatient basis
-health assessment questionnaires are often used to pinpoint areas of difficulty

14

Frequent complaints of OA patients-

*pain
*stiffness
*limitation of function
*frustration of coping with physical difficulties on a daily basis

15

Clinical manifestations of joints:

-most commonly involved joints.
*joints of fingers, weight bearing joints (hips, knees), metatarsophalangeal (MTP) joint of foot, cervical and lower lumbar vertebrae

16

Nursing Assessment-Joints

*asymmetrical- joint pain is predominant symptom- ranging from mild discomfort to significant disability and loss of function.
*pain worsens with joint use- early stages: rest relieves pain. Later stages- pain and rest and sleep is disturbed because of pain and increased joint discomfort.
*Bones worse as barometric pressure decrease.
*pain may be referred to groin, buttock, or medial side of thigh or knee.
*Sitting down becomes difficult, as does getting up from a chair when hips are lower than knees.
*Joint stiffness occurs after periods of rest or static position- early morning stiffness usually resolves within 30 minutes. Overactivity can cause mild joint effusion, temporarily increase stiffness.

17

Nursing assessment: deformity-Knee

OA often leads to joint malalignment- result of cartilage loss in medical compartment. Bowlegged appearance, altered gait, and crepitation (in 90%)

18

Nursing assessment deformity- Hip

*Advanced hip OA may cause one leg to be shorter

19

Nursing assessment deformity- Hand's

*Heberden's nodes-DIP joints
*Bouchard's nodes- PIP joints- deformity : red, swollen, tender nodules. Does not cause significant loss of fx. Visible disfigurement can be distressing can appear as early as age 40. Tends to be seen in family members.

20

Diagnostic studies:

-In early OA tests- detect joint changes on bone scan, computed tomography (CT) scan, magnetic resonance imaging (MRI)
-In progressed OA- xray findings: will show joint space narrowing, bony sclerosis & osteophyte formation.
*Changes do not always correlate with degree of pain patient is experiencing
*No lab abnormalities are a specific diagnostic indicator of OA- serological and synovial fluid examination will be essentially normal

21

Non pharmacologic interventions:

-managing pain and inflammation
-preventing disability
-maintaining and improving joint function
-achieve independence in self care and maintain optimal role function
-use pharmacologic strategies as an adjunct to manage pain