Download Chapter 46 Nursing Care of Patients with Musculoskeletal and

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Spring 2013
 Pathophysiology
• Deterioration of articular cartilage and bone
ends of joint
 Smaller joint space
 Bone spurs occur
 Inflammation of joint
• Repair process can’t keep up with cartilage
and bone loss
 Causes joint deformities, pain, immobility
 Functional decline
• Most common: weight-bearing joints, hands,
vertebral column
and Types
• Primary OA (idiopathic)
 Unknown cause
 Risk factors: aging, obesity, physical activities that
cause mechanical stress on joints
 Create prolonged and extreme wear/tear on
synovial joints
• Secondary OA
 Joint degeneration is caused from trauma, sepsis,
congenital anomalies, certain metabolic diseases,
systemic inflammatory connective tissue disorders
• Joint pain
 Increases after activity
 Decreases after rest
• Joint stiffness
• If OA occurs in vertebral column:
 Pain radiating to extremity
 Muscle spasms in extremity
• Bony nodes on finger joints
 Heberden’s, Bouchard’s nodes
Diagnostic Tests
• X-rays
• CT scan/MRI
• Synovial fluid analysis
 Therapeutic
• No cure
• Pain control
 Meds
 NSAIDs, acetaminophen, topical creams
 Complementary therapies
 Surgery
• Rest and exercise
 Exercise helps maintain range of motion and muscle
 With rest, ensure that joints are in functional position to
prevent contractures
Measures, cont.
• Heat/cold
• Diet
 Weight loss lowers stress on weight-bearing joints
• Synvisc
 Injected into knees that have OA
 Works as cushioning synovial fluid
 Decreases pain
 Enhances flexibility
• Joint protection
• Energy conservation
• Health promotion
• Pain control
• Medications
Chronic Pain r/t….?
Activity Intolerance r/t….?
Chronic Sorrow r/t….?
Disturbed Body Image r/t….?
Impaired Physical Mobility r/t….?
Self-Care Deficit r/t….?
Ineffective Health Maintenance r/t….?
inflammatory disease
• Synovial joint and connective tissue
• Synovitis occurs because of inflammatory
cells and chemicals
 Inflammation progresses, synovium becomes
thick, fluid accumulates
 Joint swelling/pain occur
 Destructive pannus erodes cartilage in joint
 Bone in joint is destroyed
 Eventually, pannus converts to bony tissue
 Decreases mobility
Pathophysiology, cont.
• Any connective tissue can have RA
 Blood vessels, nerves, kidneys,
pericardium, lungs, subcutaneous tissue
• Spontaneous
 Exacerbations typically happen with
physical or emotional stress
• Unknown cause
• Autoimmune response affects joint’s
synovial membrane
• Antibodies (rheumatoid factor) typically
are found in patients who have RA
 Thought that rheumatoid factor joins with other
antibodies and creates antibody complexes
 Complexes lodge in synovium and connective
 Results in local and systemic inflammation
• Early symptoms:
 Bilateral, symmetrical joint inflammation
 Joints are slightly red, warm, swollen, stiff,
 Stiffness occurs after rest
 Low-grade fever, malaise, depression,
lymphadenopathy, weakness, fatigue, anorexia,
weight loss
 With disease progression, affects major
organs/body systems
Signs/symptoms, cont.
• Late symptoms:
 Joint deformities
 Fractures
• Associated syndromes
 Sjogren’s syndrome
 Tear duct/salivary gland inflammation
 Felty’s syndrome
 Enlarged liver/spleen, leukopenia
Diagnostic Tests
• No certain test
• Lab values support diagnosis
 High WBCs
 High platelets
 Rheumatoid factor presence
 Low RBC count
 Decreased C4 complement
 High erythrocyte sedimentation rate (ESR)
 Positive antinuclear antibody (ANA) test
 Positive C-reactive protein (CRP) test
Tests, cont.
• X-ray
• Bone scan, joint scan
• Arthrocentesis
 Synovial fluid: cloudy, milky, or dark yellow
with inflammatory cells
Therapeutic Measures
• Medications
 Disease-modifying antirheumatic drugs (DMARDs)
 Able to prevent destruction, deformity, disability
of joints
 Corticosteroids
• Complementary therapies
 Capsaicin cream
 Fish oil
 Magnetic therapy
 Antioxidants
Measures, cont.
• Heat/cold
 Heat: decreases joint stiffness
 Cold: use with inflamed joints
• Balance activity/rest
• Surgery
 Total joint replacement
• Disease process
• Medication management
• Care plan
• Unreliable “cures”
• Rest/exercise
• Vocational counseling
• Community resources
• Acute Pain
• Disturbed Body Image
• Fatigue
• Self-Care Deficit
• Impaired Physical Mobility
• Deficient Knowledge