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45 Cards in this Set
- Front
- Back
What is osteoarthritis?
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A progressive, degenerative disease of joint surfaces that is characterized by erosion of articular cartilage, increased underlying bone density and osteophyte formation
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Osteophyte
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Small abnormal bony outgrowth - affects approximately 17 million Americans
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Prevalence
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More prevalent in males before age 45; More prominent in females after age 55.
In U.S. all races are affected equally; Higher incidence in Japanese population; Lower prevalence in South African blacks, East Indians, and Southern Chinese |
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Clinical Manifestations of Osteoarthritis
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- enlarged joints, due to bony hypertrophy
- Herberned's nodes - at distal interphalangeal joints - Bouchard's nodes - proximal interphalageal nodes - fluid in knee - muscle atrophy possible - radiating pain, stiffness, or muscle spasms due to compressed nerves in lumbar region of spine - Decreased range of motion - Joint pain that improves with rest - Crepitus (knees) |
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Clinical Management of Osteoarthritis
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1. X-Ray confirmation
2. Pharmacologic interventions - NSAIDS, steroids, and adjunctive analgesics 3. Rest 4. Exercise 5. Weight control 6. Heat/Cold - generally heat; cold is reserved for acutely inflamed joints 7. Joint protection 8. Nutrition - high in protein and vitamin C to promote healing, antioxidants C and D 9. Surgery - arthroplasty - joint replacement |
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Non-Pharmacologic Management of Osteoarthritis
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1. Self Management
2. Personalized Social network - online, telephone support groups 3. Aerobic Exercise - weight loss/ management 4. Physical Therapy 5. Range of Motion exercises 6. Muscle strengthening 7. Assist devices 8. Occupational Therapy 9. Joint protection 10. Energy conservation |
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Pharmacological Recommendations
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*Pharmacologic interventions are most effective when combined with non-Pharm. therapy.
1. Initial Therapeutic Aooroach - mild-moderate pain and symptom control = Acetaminophen 2. Topical capsaicin or methylsalicylate cream should be considered for patients who do not respond to systemic therapy |
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Pharm. Interventions for Osteoarthritis - mild- moderate severe
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1. NSAIDS
2. Cooxygenase inhbitors - low doses to higher doses; proton pump inhibitors for patients at high risk for GI issues 3. Tramadol - patients in moderate to severe pain who have contraindications to COX 2 inhibitors and NSAIDS |
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Surgical Management of Osteoarthritis
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Used in patients with severe symptomatic OA who do not respond to medical treatment
1. Arthroscopic debridement 2. Arthroplasty 3. Osteotomy 4. Arthrodesis |
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Arthroscopic Debridement (chondroplasty)
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1. Trim rough edges of cartilage and remove loose fragments
2. It is only intended to be a short-term solution |
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Arthroplasty (joint replacement)
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Partial joint replacement: performed when only one compartment of a joint is replaced
Total joint replacement:both articular surfaces are completely replaced by prosthesis |
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Total hip arthroplasty - goals
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Screws in the acetabulum; stabilize porous coated cup and help bony ingrowth
Nursing Management Goals: 1. Pain Relief 2. Restoration of Mobility 3. Correction of structural deformities |
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Osteotomy
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Procedure in which a surgeon removes a wedge of bone near a damaged joint
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Arthodesis (Joint Fusion)
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Nursing Management Goals:
1. Pain Relief 2. Restor skeletal stability 3. Align in people with advanced arthritis |
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Principles of Joint Protection
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1. do gental range of motion exercises daily
2. Adjust your activity level according to your pain level 3. Make an effort to maintain your ideal weight 4. Pace yourself by balancing rest and activity 5. Use assistive devices to preserve your joints 6. Use the larges or strongest joint possible when doing a specific task 7. Avoid excessive pressure or stress on small joints of the hand 8. Extend your joints as opposed to contracting them. |
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Osteoarthritis at a glance
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1. Joint inflammation that resutls from cartilege degeneration
2. Caused by aging, heredity, and injury from trauma or disease 3. No blood test for diagnosis 4. Most common symptom is pain in the affected joint after repetitive use Goal of treatment: Reduce joint pain and inflammation while improving and maintaining joint function |
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Rheumatoid Arthritis
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A chronic autoimmune disease mainly characterized by inflammation of the lining,or synovium of the joints
It can lead to long-term joint damage, resulting in chronic pain,loss of function and disability |
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Prevalence of rheumatoid arthritis
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1. Affects approximately 1% of population
2. It can affect anyone, including children, but 70% are women 3. 3:1 women: men 4. Onset usually occurs between 30-50 yrs of age 5. Lifespan is significantly less (3-8 years) |
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Rheumatoid Factor Test
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A positive RF test results:
1. endocarditis 2. Sstemic lupus erythematosus 3. TB 4. Syphilis 5.Sarcoidosis 6. Cancer 7. Viral infections 8. Disease of the liver, lung, or kidney |
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Pharmacologic Treatment of Rheumatoid Arthritis
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1. NSAIDS
2. Corticosteroids 3. Remitive agents or DMARDS (disease modifying antirheumatic drugs) |
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Arthroplasty (joint replacement)
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Partial joint replacement: performed when only one compartment of a joint is replaced
Total joint replacement:both articular surfaces are completely replaced by prosthesis |
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Total hip arthroplasty - goals
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Screws in the acetabulum; stabilize porous coated cup and help bony ingrowth
Nursing Management Goals: 1. Pain Relief 2. Restoration of Mobility 3. Correction of structural deformities |
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Osteotomy
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Procedure in which a surgeon removes a wedge of bone near a damaged joint
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Arthodesis (Joint Fusion)
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Nursing Management Goals:
1. Pain Relief 2. Restor skeletal stability 3. Align in people with advanced arthritis |
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Principles of Joint Protection
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1. do gental range of motion exercises daily
2. Adjust your activity level according to your pain level 3. Make an effort to maintain your ideal weight 4. Pace yourself by balancing rest and activity 5. Use assistive devices to preserve your joints 6. Use the larges or strongest joint possible when doing a specific task 7. Avoid excessive pressure or stress on small joints of the hand 8. Extend your joints as opposed to contracting them. |
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Osteoarthritis at a glance
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1. Joint inflammation that resutls from cartilege degeneration
2. Caused by aging, heredity, and injury from trauma or disease 3. No blood test for diagnosis 4. Most common symptom is pain in the affected joint after repetitive use Goal of treatment: Reduce joint pain and inflammation while improving and maintaining joint function |
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Rheumatoid Arthritis
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A chronic autoimmune disease mainly characterized by inflammation of the lining,or synovium of the joints
It can lead to long-term joint damage, resulting in chronic pain,loss of function and disability |
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Prevalence of rheumatoid arthritis
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1. Affects approximately 1% of population
2. It can affect anyone, including children, but 70% are women 3. 3:1 women: men 4. Onset usually occurs between 30-50 yrs of age 5. Lifespan is significantly less (3-8 years) |
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Rheumatoid Factor Test
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A positive RF test results:
1. endocarditis 2. Sstemic lupus erythematosus 3. TB 4. Syphilis 5.Sarcoidosis 6. Cancer 7. Viral infections 8. Disease of the liver, lung, or kidney |
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Pharmacologic Treatment of Rheumatoid Arthritis
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1. NSAIDS
2. Corticosteroids 3. Remitive agents or DMARDS (disease modifying antirheumatic drugs) |
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GOUT
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Cause is unknown, but thought to be linked to a genetic defect in pyrine metabolism
Secondary causes include: diabetes, hypertension,obesity, SSA, renal disease and use of HCT |
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Pathophysiology of GOUT
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1. Increased concentration of uric acid leads to trophi (additional tussue that is not supposed to be there) in joints
2. The crystals trigger an immune response 3. Local necrosis and fibrosis |
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Stages of GOUT
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1. Asymptomatic Stage
2. Acute Stage 3. Intercritical Stage 4. Chronic Stage |
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Pharmacological Treatment of COUT
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1. NSAIDS - first line treatment of acute gout depending on patient co-morbidities
2. Colchicine - second line therapy, but in high doses the risks outweigh the benefits 3. Allopurinol (Zyloprim)- first line urate lowering therapy 4. Uricosuric agents are second-line therapy for patients who are intolerant of allopurinol or they may be used in combination with allopurinol 5. Probenecid (Benemid, Probalan) is the most used uricosuric agent in the U.S. |
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Osteomyelitis
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Infection that causes osteomyelitis often is in another part of the body and spreads to the bone via the blood
Chronic osteomyelitis results when bone tissue dies as a result of the lost blood supply, Chronic infection can persis intermittently for years |
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Risk Factors for osteomyelitis
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1. Diabetes
2. Hemodialysis 3. Drug Abuse 4. Splenectomy |
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Symptoms of Osteomyelitis
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1. Pain in bone
2. Swelling 3. Fever 4. Malaise 5. Purulent Drainage |
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Tests for Osteomyelitis
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1. Bone Scan
2. CBC 3. ESR 4. Blood Culture 5. MRI with aspiration 6. Biopsy |
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Treatment of Osteomyelitis
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1. IV antibiotics
2. Chronic infection - surgical removal of necrotic bone tissue 3. Tissue may be filled by bone graft or packing material (antibiotics 3 more weeks) 4. Infection may require prosthesis removal 5.New prosthesis when healed |
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Osteosarcomas
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Malignant tumor of the bone
Progression of local disease on chemotherapy and major motor nerve incolvement that would severely compromise resultant function of the affected limb are also common indications for amputation |
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Post Operative Nursing Care for Osteosarcoma
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1. Vital signs per unit protocol
2. Pain management 3. Infection prophylaxis 4. Monitored activity 5. DVT prophylaxis 6. Anticoagulants 7. Monitor HCT and Hbg 8. Patient and family education |
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Paget's Disease
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Cause: unknown; Theory: early viral infection causes dormant skeletal infection
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Pathophysiology of Paget's Disease
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Early phase - osteoclasitc phase - excessive bone reabsorption
Second Phase- osteoblastic excessive abnormal bone formation |
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Tests for Paget's Disease
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!. X-rays
2. bone scan 3. bone biopsy 4. blood tests 5. Urine tests |
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Treatment for Paget's disease
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1. Calcitronin
2. Etidronate |