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

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