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Download Chapter 46 Nursing Care of Patients with Musculoskeletal and
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N124IN 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 Etiology 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 Signs/symptoms • 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 Measures • No cure • Pain control Meds NSAIDs, acetaminophen, topical creams Complementary therapies Surgery • Rest and exercise Exercise helps maintain range of motion and muscle strength With rest, ensure that joints are in functional position to prevent contractures Therapeutic 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 Patient Education • Joint protection • Energy conservation • Health promotion • Pain control • Medications Nursing • • • • • • • Diagnoses 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….? Chronic Progressive Systemic inflammatory disease • Synovial joint and connective tissue destruction Pathophysiology • 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 remissions/exacerbations Exacerbations typically happen with physical or emotional stress Etiology • 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 tissues Results in local and systemic inflammation Signs/symptoms • Early symptoms: Bilateral, symmetrical joint inflammation Joints are slightly red, warm, swollen, stiff, painful 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 Diagnostic Tests, cont. • X-ray • MRI • 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 NSAIDs Corticosteroids • Complementary therapies Capsaicin cream Fish oil Magnetic therapy Antioxidants Therapeutic Measures, cont. • Heat/cold Heat: decreases joint stiffness Cold: use with inflamed joints • Balance activity/rest • Surgery Total joint replacement Patient Education • Disease process • Medication management • Care plan • Unreliable “cures” • Rest/exercise • Vocational counseling • Community resources Nursing Diagnoses • Acute Pain • Disturbed Body Image • Fatigue • Self-Care Deficit • Impaired Physical Mobility • Deficient Knowledge http://www.youtube.com/watch?v=EPmF 4vWkuCk
