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Osteoarthritis

Osteoarthritis. Progressive degeneration of articulating cartiledge Hyaluronidase- enzyme in synovial fld may digest proteoglycans via cracks Excessive use of jt, age, congenital defects, metabolic (DM), repeated intraarticular hemorrhage, inflam & septic arthritis Genetic- Heberden’s nodes.

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Osteoarthritis

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  1. Osteoarthritis • Progressive degeneration of articulating cartiledge • Hyaluronidase- enzyme in synovial fld may digest proteoglycans via cracks • Excessive use of jt, age, congenital defects, metabolic (DM), repeated intraarticular hemorrhage, inflam & septic arthritis • Genetic- Heberden’s nodes

  2. Osteoarthritis • S/S- pain r/t movement, relieved by rest, jt stiffness after rest, crepitation, deformity, subluxation, loss of function • Heberden’s & Bouchard’s nodules • Hip- pain buttock, groin, medial side of leg or knee • Knees- limited ROM, flexion deformity • Vertebral Column- herniation, spurs

  3. Osteoarthritis • Dx- x-ray-> narrow jt space,spurs, subluxation • Tx- rest, heat, cold, exercise • Meds-acetaminophen 1 Gm qid, creams, low dose ibuprofen • Full dose NSAIDs, Cytotec + NSAID= Arthrotec, COX-2 inhibitor- Celebrex

  4. Osteoarthritis • Corticosteroids- intraarticular injections • Knee intraarticular hydraluronic acid derivatives • Assistive devices • Orthopedic surgery- debridement, arthrodesis, arthroplasty, osteotomy, total joint replacement

  5. Nursing Care • Assessment- jt pain, effect on ADL, meds, swelling, tenderness, ROM, crepitation • H. Promotion- teach body mechanics, good posture, wt reduction, occupational hazards, avoid stress on jts & painful activities, rest & pace activities, athletic & exercise programs teach ways to reduce stress on jts

  6. Nursing Care • Pain- application of heat for muscle relaxation, cold to decr swelling, meds, rest & pace activities, guided imagery, distraction, PT • Proper body alignment, don’t rush pt, care when moving & positioning, use assistive devices • Teaching- meds

  7. Rheumatoid Arthritis • Recurrent inflammation of diarthrodal jts • Remissions & exacerbations • May also have rh nodules, arteritis, neuropathy, pericarditis, scleritis, enlarg spleen, lymphadenopathy • Etiology- poss infection, autoimmune, genetic, nutrition, environmental, biochemical, occupation

  8. Rh. Arthritis Progression • Joint inflammation or synovitis • Pannus at synovium & cartilage & spreads to jt capsule & bone • Fibrous tissue replaces pannus & occludes jt space-> decr jt motion, deformity • Fibrous tissue calcifies, bony ankylosis ->total jt immobilization

  9. Clinical Manifestations • Fatigue, anorexia, wt loss, stiffness • Articular s/s- pain, stiff, limited ROM, inflammation • Jt s/s bilateral esp hands & feet, lg jts, cervical spine • Wrist tenosynovitis ->carpal tunnel synd • Deformities & disability • Extraarticular

  10. Dx Rheumatoid Arthritis • History & physical • CBC, ESR hi, + titer serum rheumatoid factor, small % pts ANA & lupus cell test + • Synovial fld analysis- thick, hi WBC • X-rays-> demineralization, narrow jt space, erosion, subluxation

  11. Collaborative Care • Meds & rest • Education- disease, meds, home management • PT & OT • Follow up care with MD, labs • Surgery- joint replacement

  12. Drug Therapy • Disease-modifying drugs- Methotrexate, • Plaquenil- mild disease, safest • Corticosteroids- bridge therapy, burst therapy, intraarticular, pulse therapy • Remission inducing therapy- gold therapy, Imuran, D-Penicillamine • ASA & NSAIDs, Cox-2 inhibitors • New meds- Arava, Enbrel

  13. Nursing Care • Assessment of physical, psychological & environmental needs • Rehab & education • Pain relief & adeq rest • Monitor labs, meds • Plan care around pts s/s, pace activities • Skin care, splints

  14. Nursing Care • Good body alignment, exercise • At home, learn ways to put decr stress on jts • Rest during day, conserve energy • If flare up->ice, not more than 10-15 min • Heat- not to exceed 20 min, check temp • Eval family support, psychol support • Community resources

  15. Psoriatic Arthritis • 10-15% people with psoriasis have arthritis, usually mild • Severe erosive form-> asymmetrical, resoption at distal phalanges of hands feet, metatarsals • Hyperuricemia • Rx- splints, PT, gold, methotrexate

  16. Septic Arthritis • Invasion of joint cavity with bacteria->bacteremia • Trauma, arthritis, leukemia, DM, meds- immunosuppressive or corticosteroids • Jt red, swollen, pain, fever • Aspirate jt-> C&S synovial fld, bld C&S • Aseptic technique, antibiotics, resting splint, gentle ROM

  17. Lyme Disease • Spirochete- Borrelia burgdorferi, tic bite • S/S- Erythema migrans, fever, chills, jt pain, headache, stiff neck • Arthritis, AV conduction defects, myocarditis, neuro abnorm, Bell’s palsy • Dx- history, + B. burgdorferi antibodies • Rx-early Amoxicillin, Doxycycline, later- 20-30 days rx, neuro s/s- Rochephin

  18. Gout • High serum uric acid assoc with arthritis • S/S- arthritis in less than 4 jts, jt tender, dusky, inflam of great toe, lo fever • Chronic gout- tophi • Dx- monosodium urate monohydrate crystals in synovial fld, hi uric acid serum & 24 hr urine

  19. Drug therapy • Colchicine- relief of s/s in 24-48hrs • Benemid- incr uric acid excretion –ASA inactivate this, use Acetaminophen • Need adeq urine output to prevent precipitation in renal tubules • Allopurinol- blocks production uric acid • Check uric acid, s/s- eval effectiveness

  20. Nursing Care • BR, assess pain, inflammation & ROM • Be gentle when touching, moving • Bed cradle or foot board • Teach precipitating factors- over eating, alcohol, purines, ASA & diuretics, fasting, stress, surgery, major illness • Chronic prob- see MD, labs, take meds

  21. Scleroderma • Systemic sclerosis- conn tissue fibrotic, inflammation of skin, changes bld vessels synovium, muscle, organs • Chief s/s- skin thickening & tightening • Overproduction of collagen • CREST syndrome- benign form • Can also rapidly affect organs-kidney, heart, lungs,GI

  22. Clinical Manifestations • Raynaud’s Phenomenon • Skin taut, shiny,thick- hands, fingers flexed, wrist tight, face expressionless, AM stiffness, tendon friction rubs • GI- prob swallowing, reflux, constipation • Lungs-pleural thickening, pul hyperten • Heart-pericaditis, myocardial fibrosis • Renal-hi BP, renal insufficiency & failure

  23. Scleroderma • Dx- elev ESR, + ANA, nail bed capillary microscopy, x-rays->sub-q calcification, pul fibrosis, skin biopsy, u/a • RX- PT, vasodilators, calcium channel blockers, antihypertension meds

  24. Nursing Care • Explain dx procedures, assess VS, I&O, wt, jt ROM, resp, renal, cardiac function • No FS blood testing, heat therapy, protect hands & feet from cold, treat cuts, no smoking, lotions for dry skin, wear gloves, padded utensils, assistive devices • Small freq. feedings, eat slow, chew food, antacids, sit up after eating, HOB elev

  25. Nursing Care • See dentist, good oral hygiene • Psychol support, referral to support group • Sexual dysfunction, refer to counseling • Teach how to live with disease- eg job modification, changes in ADL

  26. Fibromyalgia • Musculoskeletal chronic pain syndrome • Fatigue, stiffness, myalgia, arthralgia, headache, irritable bowel syndrome, sleep disturb, stress related component • 18 tender points, dx h/o widespread pain & 11 tender pts • Rest, NSAIDs, Elavil, muscle relaxants, stress managemt, Zoloft, exercise, yoga, psychol counseling

  27. Systemic Lupus Erythematosus • Chronic multisystem inflammatory disease • Alterations in the immune system – autoimmune reactions against the cell nucleus • Etiology is unknown • Genetic, environmental, Infectious agents, drugs

  28. SLE manifestations • Variable – mild to severe, affecting various organs • Skin – cutaneous vascular lesions usually in sun exposed areas, butterfly rash over the cheeks and bridge of the nose, photosensitivity, oral and nasal lesions, alopecia • Musculoskeletal – arthitis • Cardiopulmonary – tachypnea and cough, pleurisy, arrhythmias, HTN, CAD • Renal – Lupus nephritis, • Nervous system – seizures, peripheral neuropathy, organic brain syndrome • Hematologic – antibodies against blood cells > anemia, leukopenia, thrombocytopenia • Infection – increased susceptibility to infection. Major cause of death

  29. SLE • Dx – pt hx, physical exam, laboratory tests see table 63-13 • Rx – treat both active phases and effects of long term complications • NSAIDs, antimalarial agents, corticosteroids, methotrexate, folic acid,

  30. SLE Nursing management • Good assessment • Health promotion • Treat exacerbations • Patient and family teaching • Psychological issues

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