Osteoarthritis
ATI: pg 461
*Definition: degenerative joint disease (DJD), a disorder characterized by progressive
deterioration of the articular cartilage. It is a noninflammatory (unless localized),
nonsystemic disease
Health promotion/prevention: joint-saving measures (good body mechanics)
- maintain healthy weight to decrease joint degeneration of hips and knees
- recommend stop smoking to reduce cartilage loss (esp. If fam hx)
- avoid or limit repetitive strain on joints (jogging, contact sports)
- recommend well-fitting shoes to prevent falls
Risk Factors:
- adults over 60
- genetic factors
- joint injury due to acute or repetitive stress on joints predisposes to later OA
- obesity (knees- weight bearing joint)
- metabolic dx (DM,SCD)
*Expected findings:
- joint pain and stiffness
- pain with join palpitations or ROM
- crepitus (grating sound caused by the rubbing of bone fragments)
- enlarged joint related to bone hypertrophy
- Heberden’s nodes enlarged at distal interphalangeal joints
- Bouchard’s nodes located at the proximal interphalangeal joints (OA is not a
symmetrical dx, but these nodes can occur bilaterally) can be inflamed and
painful
- Heberden’s and Bouchard’s cause malformation and joint hypertrophy
- inflammation resulting from secondary synovitis indiating advanced dx
- joint effusion (excess joint fluid) easily moved from one area of the joint to
another area
- vertebral radiating pain affected by cervical or lumbar compression of nerve roots
- limping gait
- back pain
Labs:
- usually normal erythrocyte sedimentation rate
- high-sensitivity C-reactive protein can be increased related to secondary
synovitis
Diagnostics:
- X-rays: show worn-down cartilage of joints
- magnetic resonance imaging with or without contrast
- CT scans
- nuclear bone scan
- CT myelogram
- EMG and nerve conduction
- arthrogram
,*Nursing Care:
- Pain Assessment/Monitoring:
- Location, characteristics, quality, severity, precipitating or relieving factors
- Sciatic nerve pain becomes worse when the leg is held straight and lifted
upward
- Musculoskeletal Assessment/Muscle Tone and Strength:
- Inspect back for vertebral alignment and tenderness
- Degree of functional limitation; ability to perform ADLS
- Gait ability and characteristics
- Proper functional/joint alignment
- Levels of fatigue and pain after activity
- ROM
- Neurological Assessment/Sensory Perception:
- Genitourinary: bowel or bladder problems
- Home Barriers
- Psychosocial Assessment:
- Pain interference with sexuality
- Depression related to pain
- Anxiety related to pain
- Alteration in self-esteem and body image due to joint deformities and
nodules
*Meds:
- Analgesic: does not provide anti-inflammatory benefits
- Monitor liver function
- *NSAIDS: relieve pain and synovitis is present
- monitor kidney and liver function (need baseline)
, - educate nephrotoxic, taken when prescribed
- educate patient to report black tarry stool, indigestion, and SOB
- Corticosteroid injections into the joints
- Opioids: tramadol is a weak opioid used for OA. Short term use only.
- Topical analgesics:
- Trolamine salicylate
- Lidocaine 5% patch: use for 12 hr daily
- Capsaicin: must wear nitrile gloves
- Therapies:
- Chiropractic/spinal manipulation
- Glucosamine supplement
- Intra-articular injections: glucocorticoids, hyaluronic acid
Total Joint Arthroplasty
- ATI: pg. 435
*Definition: replacement of all components of an articulating joint (Total joint
replacement)
Indications:
- Eliminate pain
- restore joint motions
- improve functional status & quality of life
Contraindications:
- Recent or active infection (UTI)
- Arterial impairment to the affected extremity
- Inability to follow postsurgical regimen
- Comorbid condition (uncontrolled/unstable DM, HTN)
Preprocedure education:
● Review lab diagnostics to rule out anemia, infection, or organ failure. Chest Xray
to rule out pulmonary surgery contraindications, ECG to identify any
dysrhythmias
● teach about incentive spirometry, transfusion, surgical drains, dressing, pain
control, transfer, exercises, and activity limits
● teach about autologous blood donation
● remind the client to scrub the surgical site with a prescribed antiseptic soap the
night before
● instruct client to wear clean clothes and sleep on clean linens the night before
surgery
● Take antihypertensive another meds the surgeon allows with a sip of water the
morning of surgery
*Post procedure:
- client requires extensive PT to regain mobility
- Can be d/c home or to acute rehab facility. D/C home, outpatient or in-home
therapy must be provided. 4-6 weeks
- Monitor for evidence of incisional infection (fever, increased redness, swelling,
purulent drainage)
- care for the incisional infection (clean with soap and water)
- Monitor for DVT (swelling, redness, pain in calf), Pulmonary embolism (SOB,
chest pain), and bleeding if the client is taking a anticoagulant
*Client education (post-op):
- Home care should be available for 4-6 weeks
- Monitor for infection (fever, increased redness, swelling, purulent drainage)
ATI: pg 461
*Definition: degenerative joint disease (DJD), a disorder characterized by progressive
deterioration of the articular cartilage. It is a noninflammatory (unless localized),
nonsystemic disease
Health promotion/prevention: joint-saving measures (good body mechanics)
- maintain healthy weight to decrease joint degeneration of hips and knees
- recommend stop smoking to reduce cartilage loss (esp. If fam hx)
- avoid or limit repetitive strain on joints (jogging, contact sports)
- recommend well-fitting shoes to prevent falls
Risk Factors:
- adults over 60
- genetic factors
- joint injury due to acute or repetitive stress on joints predisposes to later OA
- obesity (knees- weight bearing joint)
- metabolic dx (DM,SCD)
*Expected findings:
- joint pain and stiffness
- pain with join palpitations or ROM
- crepitus (grating sound caused by the rubbing of bone fragments)
- enlarged joint related to bone hypertrophy
- Heberden’s nodes enlarged at distal interphalangeal joints
- Bouchard’s nodes located at the proximal interphalangeal joints (OA is not a
symmetrical dx, but these nodes can occur bilaterally) can be inflamed and
painful
- Heberden’s and Bouchard’s cause malformation and joint hypertrophy
- inflammation resulting from secondary synovitis indiating advanced dx
- joint effusion (excess joint fluid) easily moved from one area of the joint to
another area
- vertebral radiating pain affected by cervical or lumbar compression of nerve roots
- limping gait
- back pain
Labs:
- usually normal erythrocyte sedimentation rate
- high-sensitivity C-reactive protein can be increased related to secondary
synovitis
Diagnostics:
- X-rays: show worn-down cartilage of joints
- magnetic resonance imaging with or without contrast
- CT scans
- nuclear bone scan
- CT myelogram
- EMG and nerve conduction
- arthrogram
,*Nursing Care:
- Pain Assessment/Monitoring:
- Location, characteristics, quality, severity, precipitating or relieving factors
- Sciatic nerve pain becomes worse when the leg is held straight and lifted
upward
- Musculoskeletal Assessment/Muscle Tone and Strength:
- Inspect back for vertebral alignment and tenderness
- Degree of functional limitation; ability to perform ADLS
- Gait ability and characteristics
- Proper functional/joint alignment
- Levels of fatigue and pain after activity
- ROM
- Neurological Assessment/Sensory Perception:
- Genitourinary: bowel or bladder problems
- Home Barriers
- Psychosocial Assessment:
- Pain interference with sexuality
- Depression related to pain
- Anxiety related to pain
- Alteration in self-esteem and body image due to joint deformities and
nodules
*Meds:
- Analgesic: does not provide anti-inflammatory benefits
- Monitor liver function
- *NSAIDS: relieve pain and synovitis is present
- monitor kidney and liver function (need baseline)
, - educate nephrotoxic, taken when prescribed
- educate patient to report black tarry stool, indigestion, and SOB
- Corticosteroid injections into the joints
- Opioids: tramadol is a weak opioid used for OA. Short term use only.
- Topical analgesics:
- Trolamine salicylate
- Lidocaine 5% patch: use for 12 hr daily
- Capsaicin: must wear nitrile gloves
- Therapies:
- Chiropractic/spinal manipulation
- Glucosamine supplement
- Intra-articular injections: glucocorticoids, hyaluronic acid
Total Joint Arthroplasty
- ATI: pg. 435
*Definition: replacement of all components of an articulating joint (Total joint
replacement)
Indications:
- Eliminate pain
- restore joint motions
- improve functional status & quality of life
Contraindications:
- Recent or active infection (UTI)
- Arterial impairment to the affected extremity
- Inability to follow postsurgical regimen
- Comorbid condition (uncontrolled/unstable DM, HTN)
Preprocedure education:
● Review lab diagnostics to rule out anemia, infection, or organ failure. Chest Xray
to rule out pulmonary surgery contraindications, ECG to identify any
dysrhythmias
● teach about incentive spirometry, transfusion, surgical drains, dressing, pain
control, transfer, exercises, and activity limits
● teach about autologous blood donation
● remind the client to scrub the surgical site with a prescribed antiseptic soap the
night before
● instruct client to wear clean clothes and sleep on clean linens the night before
surgery
● Take antihypertensive another meds the surgeon allows with a sip of water the
morning of surgery
*Post procedure:
- client requires extensive PT to regain mobility
- Can be d/c home or to acute rehab facility. D/C home, outpatient or in-home
therapy must be provided. 4-6 weeks
- Monitor for evidence of incisional infection (fever, increased redness, swelling,
purulent drainage)
- care for the incisional infection (clean with soap and water)
- Monitor for DVT (swelling, redness, pain in calf), Pulmonary embolism (SOB,
chest pain), and bleeding if the client is taking a anticoagulant
*Client education (post-op):
- Home care should be available for 4-6 weeks
- Monitor for infection (fever, increased redness, swelling, purulent drainage)
