Download Osteoarthritis

Mobility - Concept
Care of Patients with Arthritis and
Other Connective Tissue
Diseases
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Rheumatology
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Connective tissue disease (CTD) major focus
Noninflammatory or inflammatory
Rheumatic disease = any disease/ condition
involving musculoskeletal system
Arthritis = inflammation of one or more joints
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Rheumatology (cont’d)
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Noninflammatory localized arthritis
(osteoarthritis) is not systemic, not an
autoimmune disease
Inflammatory arthritis:
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Rheumatoid arthritis
Systemic lupus erythematosus
Autoimmune disease
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Osteoarthritis
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Most common arthritis type
Progressive loss of cartilage
Joint pain, loss of function characterized by
progressive deterioration
Osteophytes (bone spurs)
Cartilage disintegrates, bone and cartilage
“float” into joint causing crepitus
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Joint Changes in Degenerative
Joint Disease
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Collaborative Management
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History
 Usually older than 60 years
Physical assessment/clinical manifestations:
 Joint pain and stiffness
 Crepitus
 Heberden's nodes
 Bouchard’s nodes
 Joint effusions
 Atrophy of skeletal muscle
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Heberden’s Nodes
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Assessments
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Psychosocial
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Laboratory
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Severe pain may cause depression/anxiety
ESR
nsCRP
Radiographic
Other diagnostic:
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MRI
CT studies
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Chronic Pain:
Nonsurgical Management
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Drug therapy
Rest, immobilization
Positioning
Thermal modalities
Weight control
Integrative therapies

Glucosamine, chondroitin
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Chronic Pain:
Surgical Management
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Total joint arthroplasty (TJA)
Total joint replacement (TJR)
Arthroscopy
Osteotomy
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Postoperative Care
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Collaborate with patient/family to become
safety partners to prevent complications
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Hip dislocation
 VTE
 Infection
 Anemia
 Neurovascular compromise
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Hip Flexion After Total Hip
Replacement
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Continuous Passive Motion
Machine
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Other Connective Tissue
Diseases
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Polymyositis (dermatomyositis)
Systemic necrotizing vasculitis
Polymyalgia rheumatica and temporal arteritis
Ankylosing spondylitis
Reiter’s syndrome
Marfan syndrome
Infectious arthritis
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Psoriatic Arthritis
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Skin condition characterized by scaly, itchy
rash of elbows, knees, scalp
Joints stiff especially in morning
Treatment focus = managing pain
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Fibromyalgia Syndrome
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Chronic pain syndrome, not an inflammatory
disease
Pain, stiffness, tenderness at certain areas of
neck, upper chest, trunk, low back,
extremities
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Theoretic Pathophysiologic
Model of Fibromyalgia
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Chronic Fatigue Syndrome
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Severe fatigue for 6 months or longer, usually
following flu-like symptoms
Four or more criteria must be met for CFS
diagnosis
Treatment is supportive
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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The patient is a 63-year-old woman admitted to
the acute medical care unit. She is 5’4” and
weighs 211 lb. Her medical history includes
hypertension and GERD. On admission, she
reports pain in her hands and joints that is
unrelieved by OTC medications.
What additional assessment data should you
collect from the patient at this time?
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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(cont’d)
While completing your admission assessment, you observe the
patient’s hands appear as shown.
1. How would you document this finding?
2. What do you suspect the patient may be suffering from?
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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(cont’d)
An hour later, the patient is crying because of
severe joint pain in her hands.
What are your priority actions at this time?
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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(cont’d)
While the patient is in pain, her vital signs are taken and
recorded.
Are any of these vital signs a cause for concern?
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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(cont’d)
Two hours later, laboratory values are drawn to
investigate the patient’s symptoms. The results
are:
Sodium 136 mEq/L
HCT 41.6%
Potassium 4.6 mEq/L
HGB 12.8 g/dL
Calcium 8.9 mg/dL
ESR 28 mm/hr
Are any of these results of concern?
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Audience Response System
Questions
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Question 1
Which population group is most likely to be
diagnosed with fibromyalgia syndrome?
A. Men between 30 and 50 years of age
B. Women between 30 and 50 years of age
C. Men between 50 and 70 years of age
D. Women between 50 and 70 years of age
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
25
Question 2
The assessment of a patient status post total knee
arthroplasty for which continuous femoral nerve
blockade was utilized reveals that the patient is nervous
and vital signs are BP 92/58, HR 62, RR 12, and SpO2
89%. What should the nurse do next?
A.
B.
C.
D.
Take vital signs every 10 minutes
Notify the physician of the vital signs
Anticipate administering IV fluids
Notify the Rapid Response Team
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Question 3
During a health history assessment of a patient with RA,
chronic HTN, and a recent CVA, she states that she
takes 2 fish oil capsules (5 g) daily as a supplement for
her RA. What additional question should the nurse ask?
A. “Have you found the fish oil to help your RA?”
B. “Does your physician know you are taking the fish
oil capsules to treat your RA?”
C. “Are you taking any anticoagulant medications as
well?”
D. “How long have you been taking the fish oil
capsules?”
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