Sample Class Presentation Using Concepts as Focus

1. Sample Class Presentation Using Concepts as Focus Welcome! Please read the following pre-webinar notes: Audio? Dial 1-877-783-2009 (Passcode: 936785) Attendees will be muted during the webinar until the Q&A session(s). Control Panel Large? Click the right arrow to hide the Control Panel. Handout(s)? http://www.diassociates.com/media/webinars/Iggy_Webinar_120512.ppt http://www.diassociates.com/media/webinars/Class_Objectives.doc http://www.diassociates.com/media/webinars/Case_Study.doc Need Help? Dial 1-877-341-4788 or Email help@diassociates.com. Questions? Comments? Use the Chat pane or Email us at info@diassociates.com. Contact Information? http://www.diassociates.com donna@diassociates.com

2. Absence of Conflict of Interest As required by the American Nurses Credentialing Center’s Accreditation Program, we would like to make you aware of all potential conflicts of interests. This educational activity’s planners and the presenter have indicated they have no bias or conflict of interest. The host for this webinar is DI Associates, Inc. (owned by Donna Ignatavicius). Donna is also the speaker for this series of webinars. DB Productions is the provider for nursing contact hours for DI Associates and is owned by Deanne Blach. Both Donna and Deanne are nurse planners for the webinar.

3. ANCC Disclosures • Off-label product usage – The speaker, Donna Ignatavicius, has attested that she will not discuss off-label usage of products. • Commercial support - There is no sponsorship (e.g. commercial support) for this activity. • Successful completion - Criteria for judging successful completion of the webinar are attendance at the entire activityand submission of a completed evaluation tool. • Expiration date - This workshop has been recognized for 1.25 contact hours and is valid for presentation for a period of two years beginning December 5, 2012.

4. Purpose of the Webinar The purpose of each webinar is to assist faculty to design a class on arthritis using a concepts-based approach. Objectives The attendees will be able to: • Select appropriate concepts for exemplar health problem. • Explain how to use key concepts in sample class presentation.

5. Alterations in Mobility: Care of Adult Patients with Arthritis Donna Ignatavicius, MS, RN, ANEF

6. What does the concept of mobility mean?

7. What does a person with impaired mobility or immobility look like?

8. What body systems can be affected by impaired mobility and how? LET’S DISCUSS!

9. What is the Nurse’s Role in Preventing or Managing Impaired Mobility? Think-pair-share • Write down your own answer to this question by making a list of nursing and ID interventions. • Share and compare your list with your partner. • What related curricular concepts did you identify in your shared list? (e.g., safety)

10. Terminology related to Arthritis -- Arthritis = inflammation of joints -- Synovitis = inflammation of synovium -- Subluxation = partial joint dislocation -- Connective tissue = tissue that connects and supports parts of the body

12. Osteoarthritis • Most common type of arthritis (local not systemic; degenerative joint disease) • Chronic joint pain, stiffness, and possible loss of function characterized by progressive deterioration and loss of cartilage in the joints (which joints most affected?)

13. Joint Changes in Osteoarthritis: How Would They Affect Mobility?

14. Nursing Assessment • History (risk factors???) • Physical assessment • Joint involvement (Which ones?) • Heberden's and Bouchard’s nodes (bony nodules at joints on fingers, especially women) • Joint effusions and inflammation(swelling) • Psychosocial assessment/Functional assessment

15. Other Diagnostic Assessment • Laboratory assessment of erythrocyte sedimentation rate (ESR) and C-reactive protein (may be slightly elevated) • Radiographic assessment • MR imaging (especially spine)

16. Priority for Care: Managing Chronic Pain (How do these interventions increase mobility?) • Rest intermittent with exercise • Positioning (protect joints) • Heat/ice • Analgesics (NSAIDs) • Custom-made shoes

17. Priority for Care: Managing Chronic Pain (How do these interventions increase mobility?) • Weight control • PT/OT • Complementary and alternative therapies (e.g, acupuncture, glucosomine, chondroitin) (See Chart 20-2, p. 328)

18. Chronic Pain: Surgical Management (Last Resort) • Total joint arthroplasty (TJA)/total joint replacement (TJR) (Who are candidates?) (minimally invasive surgery [MIS] or traditional) • Arthroscopy • Osteotomy/fusion (toes most often)

19. Test Item Check Which assessment findings would the nurse expect for a client diagnosed with late osteoarthritis? Select All That Apply. • Painful joints • Skin rash • Subcutaneous nodules • Decreased mobility • Bony joint nodes

20. Rheumatoid Arthritis • One of the most common connective tissue diseases and the most destructive to the joints! • Chronic, progressive, systemic inflammatory autoimmune disease affecting primarily the synovial joints (remissions and exacerbations) • Autoantibodies (rheumatoid factors) form that attack healthy tissue, especially synovium, causing inflammation

21. Nursing Assessment VENN diagram to compare and contrast OA and RA assessment findings (Pair activity)

22. Other Assessment • Imaging tests, including x-ray • Laboratory Assessment: • ESR (erythrocyte sedimentation rate, or “sed” rate) • RF (rheumatoid factor) • ANA (anti-nuclear antibody)

23. Early RA of hands

24. Advanced RA Joint Involvement

25. Examples of Late RA Complications • Subcutaneous nodules

26. Examples of Late RA Complications • Vasculitis • Anemia • Major organ involvement • Sjogren’s syndrome (sicca syndrome)

27. What are the Most Common Priority Problems for Patients with RA and How Are They Managed? • Chronic Pain • Decreased Mobility • Stress response

28. Case Study on Collaborative Management of RA (small group work)