Download Osteoarthritis (Degenerative Joint Disease, DJD)

Osteoarthritis (Degenerative Joint
Disease, DJD)
Progressive degeneration of the joints
as a result of wear & tear.
Causes the formation of bony buidup &
the loss of articular cartilage in
peripheral & axial joints.
Affects the weight-bearing joints &
joints that receive the greatest stress,
such as the knees, toes, & lower spine.
The cause is unknown but may be
trauma, fractures, infections, or obesity.
Osteoarthritis (Degenerative Joint
Disease, DJD)- Assessment
 Joint pain that early in the disease process
diminishes after rest & intensifies after activity
 As the disease progresses, pain occurs with slight
motion or even at rest.
 Symptoms are aggravated by temperature
change & humidity.
 Crepitus
 Joint enlargement
 Limited ROM
 Difficulty getting up after prolonged setting
 Skeletal muscle atrophy
Osteoarthritis (Degenerative Joint
Disease, DJD)
Inability to perform activities of daily living
Compression of the spine as manifested by
radiating pain, stiffness, & muscle spasm in
one or both extremities.
Presence of Heberden’s nodes or Bouchard’s
nodes
Osteoarthritis (Degenerative Joint
Disease, DJD) Implementation
Administer NSAIDs, salicylates, and muscle
relaxants
Prepare for corticosteroid injections into
joints
Place affected joint in functional position
Immobilize the affected joint with splint or
brace
Avoid large pillows under the head or knees
Provide a foot cradle
Position the client prone twice a day
Osteoarthritis (Degenerative Joint
Disease, DJD)
Position the client prone twice a day
Instruct the important of moist heat, hot
packs or compresses & paraffin dips
Apply cold applications when the joint is
acutely inflamed.
Encourage adequate rest
Encourage a well-balanced diet
Encourage weight loss if necessary
Reinforce the exercise program & the
important of participating in the program.
Osteoarthritis (Degenerative Joint
Disease, DJD)
 Instruct to stop exercise if pain is increased with
exercising
 Instruct to decrease the number of of repetitions
in an exercise when the inflammation is severe.
 Surgical Management: Osteotomy- the bone is
cut to correct joint deformity & promote
realignment.
 Total joint replacement: performed when all
measures of pain relief have failed. Hips & knees
are most commonly replaced. Contraindicated in
the presence of infection, advanced osteoporosis,
or severe inflammation.
Rheumatoid Arthritis (RA)
 Chronic systemic inflammatory disease; the
etiology may be related to a combination of
environmental & genetic factors.
 Leads to destruction of connective tissue and
synovial membrane within the joints.
 Weakens & leads to dislocation of the joint &
permanent deformity.
 Exacerbations are increased by physical or
emotional stress
 Risk factors include exposure to infectious
agents; fatigue & stress can exacerbate the
condition.
Rheumatoid Arthritis (RA)
implementation
 Inflammation, tenderness, stiffness of the joints
 Moderate to severe pain & AM stiffness lasting
longer than 30 minutes
 Joint deformities, muscle atrophy & decreased
ROM
 Spongy, soft feeling in the joints
 Low-grade temperature, fatigue,& weakness
 Anorexia, weight loss & anemia
 Elevated ESR & positive RA
 X-ray showing joint deterioration
 Synovial tissue biopsy presents inflammation
Rheumatoid Arthritis (RA)
 Pain-Salicylates (ASA). Monitor for side effects,
including tinnitus, GI upset & prolonged bleeding
time. Administer with meals or a snack. Monitor
for abnormal bleeding or bruising.
 Nonsteroidal antiinflammatory drugs (NSAIDS)
May be prescribed in combination with salicylates
if pain & inflammation have not decreased within 6
to 12 weeks following salicylate therapy.
 Corticosteroids: Administer during exacerbations
or when commonly used agents are ineffective.
Rheumatoid Arthritis (RA)
 Antineoplastic medications: Administer in clients
with life- threatening RA
 Gold salts: Administer in combination with
salicylates & NSAIDS to induce remission &
decrease pain & inflammation.
 Preserve joint function
 Balance rest and activity
 Prevent flexion contractures
 Apply heat or cold therapy
 Apply paraffin bath & massage
Rheumatoid Arthritis (RA)
 Exercise only to the point of pain
 Avoid weight bearing on inflamed joints
 Identify factors that may contribute to fatigue
 Monitor for signs of anemia
 Administer iron, folic acid & Vitamin supplement
 Monitor for drug-related blood loss by testing the
stool for occult blood
 Asses the client’s reaction to the body change
 Encourage to verbalize feelings
Rheumatoid Arthritis (RA)
 Surgical intervention: Synovectomy= removal of
the synovia to help maintain joint function.
 Arthrodesis: Bony fusion of a joint to regain
some mobility.
 Joint replacement (arthroplasty): removal
of diseased joints with artificial joints; performed
to restore motion to a joint & function to the
muscles, ligaments & other soft tissue structures
that control a joint.
Gout
A systemic disease in which urate crystal
deposit in joints & other body tissues
Leads to abnormal amounts of uric acids in
the body
Primary gouts results from a disorder of
purine metabolism
Secondary gout involves excessive uric acid
in the blood that is caused by another
disease.
Gout (phases)
 Asymptomatic: No symptoms. Serum uric acid
is elevated.
 Acute: Excruciating pain & inflammation of
one or more small joints, especially the great
toe.
 Intermittent: Asymptomatic period between
acute attacks
 Chronic: results from repeated episodes of
acute gout. Deposits of urate crystal under the
skin and within the major organ, especially the
renal system.
Gout (assessment)
 Excruciating pain in the involved joints
 Swelling & Inflammation of the joints
 Tophi (hard, fairly large, & irregularly shaped
deposits in the skin) that may break open &
discharge a yellow gritty substance
 Low-grade fever
 Malaise & headache
 Pruritis
 Presence of renal stones
 Elevated uric acid levels
Gout (implementation)
Provide a low purine diet
Instruct to avoid foods, such as organ
meats, wines, aged cheese
Encourage a high fluid intake of 2000 ml
to prevent stone formation
Encourage weight-reduction diet
Instruct the client to avoid alcohol 7
starvation diets because they may
precipate a gout attack.
Provide bedrest during the attack
Gout
Monitor the joint in mild flexion during
acute attack.
Elevate the affected extremity
Protect the affected joint from excessive
movement or direct contact with sheets
or blankets
Provide heat or cold for local treatments
to affected joints
Administer NSAIDs & antigout
medications.
Systemic Lupus Erythematosus
(SLE)
 A chronic progressive systemic inflammatory
disease that can cause major organs & systems to
fail.
 Connective tissue & fibrin deposits in blood
vessels, collagen fibers & organs
 Leads to necrosis &/ or inflammation of blood
vessels, lymph nodes, GI tract, pleura.
 There is no cure for the disease.
 Cause is unknown although the disease is due to
defect in the immunological mechanisms or to
have a genetic origin
Systemic Lupus Erythematosus
(SLE)
 Precipitating factors include medications,
stress, genetic factors, sunlight or ultraviolet
light & pregnancy.
 Assessment: Dry scaly raised rash on the face
or upper body
 Fever, weakness, malaise, fatgue
 Anorexia, weight loss, photosensitivity
 Joint pain, erythema of the palms, anemia
 Positive antinuclear (ANA) & LE prep.
 Elevated ESR.
Systemic Lupus Erythematosus
(SLE) (Implementation)
Monitor skin integrity & provide frequent
oral care
Instruct to clean skin with mild soap,
avoiding harsh & perfumed substances
Assist with the use of ointments & creams
for rash
Instruct inmeasures to conserve energy,
such as pacing activities & balancing rest
with exercise.
Systemic Lupus Erythematosus
(SLE)
Administer topical or systemic
corticosteroids, salicylates & NSAIDs.
Administer hydroxychloroquine (Plaquenil)
to decrease the inflammation.
Instruct to avoid exposure to sunlight &
ultraviolet light
Monitor for proteinuria & red cell casts in
the urine
Monitor for brusing, bleeding & injury.
Systemic Lupus Erythematosus
(SLE)
 Assist with plasmapheresis to remove
autoantibodies & immune complexes from the
blood before organ damage occurs.
 Monitor for signs of organ involvement, such as
pleuritis, nephritis, pericarditis, neuritis, anemia
& peritonitis.
 Provide supportive therapy as major organs
become affected.
 Provide emotional support & encourage to
verbalize feelings.
 Provide group information regarding support
groups, & encourage utilization of community
resources.