Download Degenerative Joint Disease

DEGENERATIVE JOINT DISEASE
Santhia Mirtyl, SN
INTRODUCTION
Framework of the body
 Supports tissues
 Site of blood cell
formation
 Mineral storage
 Permits movement by
providing points of
attachment for muscles
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PATHOPHYSIOLOGY
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Osteoarthritis is characterized by local areas of
damage and loss of articular cartilage, new bone
formation of joint margins, subchondral bone
changes, and variable degrees of mild synovitis and
thickening of the joint capsule
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Sclerosis of bone underneath cartilage
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Formation of bone spurs (osteophytes)
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Incidence increases with age and trauma
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Primary disease is idiopathic
PREVALENCE
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Osteoarthritis is the most common form of
arthritis.
It affects about 27 million people in the United
States.
It is a leading cause of disability.
Osteoarthritis is more common in people who are
older, overweight, or have injured a joint.
SYMPTOMS AND SIGNS
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Pain
Stiffness
Enlargement of the joint
Tenderness
Limited motion
Deformity
DIAGNOSTICS
X- rays
 Serum calcium
 Serum albumin
 Ionized calcium
 Erythrocyte sedimentation rate
 Magnetic resonance imaging
 Bone scan.
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PAIN MANAGEMENT
Medical Intervention
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Medical Intervention
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Nursing Intervention
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Pharmacologic therapy
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Salicylates
NSAIDs
Prednisone
Physical therapy
 Transcutaneous electric
nerve stimulator
 Surgery
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Arthroplasy
Debridement
Osteotomy
Pain management
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Analgesic administration
Cutaneous stimulation
Heat or cold application
Touch
Exercise therapy
Promote muscle
relaxation
Encourage positive
thinking
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CASE STUDY
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Patient is a 65 year old Caucasian female who is
complaining of unbearable bilateral knee pain.
She states that her knee pain began in 1999 due
to an accidental fall at work when she tripped
over a ball. Her knees were repaired and her pain
had subsided. She reinjured her knees due to
another accidental fall in 2000 and was
diagnosed with Bilateral Degenerative Joint
Disease. She has a burning muscular pain when
she attempts to walk short or long distances. Her
symptoms have been maintained through
physical therapy, antinflammatory medication
such as Selebrex and natacotics such as Percocet.
X-rays were completed
NURSING DIAGNOSIS
Impaired physical mobility related to Bilateral
Knee Replacement as evidence by reluctancy to
ambulate both legs.
 Risk of infection related to decreased WBC count
as evidence by pertinent lab values.
 Acute pain related to Bilateral Knee
Replacement as evidence by grimacing and
guarding of both knees.
 Risk of fall related to Bilateral Knee
Replacement as evidence by past accidental falls
in the work place and home.
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NCLEX QUESTION
A 63 year old female has been an avid runner for the past 45
years. The patient complains of stiffness and unbearable
knee pain daily, particularly in the evening which has
disrupted her ability to go on her evening runs. Her x-ray
and bone scan indicates deterioration of articular
cartilage. Her physician suspects that she has symptoms
and signs associated with degenerative joint disease.
Which one of these objective finding would be presented
during a focused assessment?
A: Decrease in bone cartilage
B: Loss of normal function of the knee
C: “Bone to bone aching pain”
D: Complete blood count
NCLEX QUESTION
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Osteoarthritis and Rheumatoid arthritis present
similar clinical manifestations. What is not a
characteristic of Osteoarthritis? Choose all that
apply.
A: Osteoarthritis is a systemic disease.
B: Women are more likely to be diagnosed with
osteoarthritis.
C: Osteoarthritis is a severe inflammatory disease
D: Pain localized at the joints
E: Onset usually after age 50 years of age
RESOURCES
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Brown, M., T., Murphy, F., T., Radin, D.,
M., Davignon, I., Smith, M., D., West, C., R. (2012).
Journal of Pain. Tanezumab Reduces Osteoarthritic
Knee Pain: Results of a Randomized, Double-Blind,
Placebo-Controlled Phase III Trial.
Huether, S. E., & McCance, K. L.
(2012).Understanding Pathophysiology (5th ed.). St.
Louis, MO: Mosby.
John M Eisenberg Center for Clinical Decisions and
Communications Science. (2012). Managing
Osteoarthritis Pain With Medicines.
Rosenthal A., K. (2006). Calcium crystal
deposition and osteoarthritis. Rheum Dis Clin
North Am. 32(2), 401-12.
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