Osteoarthritis (Degenerative Joint Disease, DJD) Progressive degeneration of the joints as a result of wear & tear. Causes the formation of bony buidup & the.
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Transcript Osteoarthritis (Degenerative Joint Disease, DJD) Progressive degeneration of the joints as a result of wear & tear. Causes the formation of bony buidup & the.
Osteoarthritis (Degenerative Joint
Disease, DJD)
Progressive degeneration of the joints
as a result of wear & tear.
Causes the formation of bony buidup &
the loss of articular cartilage in
peripheral & axial joints.
Affects the weight-bearing joints &
joints that receive the greatest stress,
such as the knees, toes, & lower spine.
The cause is unknown but may be
trauma, fractures, infections, or obesity.
Osteoarthritis (Degenerative Joint
Disease, DJD)- Assessment
Joint pain that early in the disease process
diminishes after rest & intensifies after activity
As the disease progresses, pain occurs with slight
motion or even at rest.
Symptoms are aggravated by temperature
change & humidity.
Crepitus
Joint enlargement
Limited ROM
Difficulty getting up after prolonged setting
Skeletal muscle atrophy
Osteoarthritis (Degenerative Joint
Disease, DJD)
Inability to perform activities of daily living
Compression of the spine as manifested by
radiating pain, stiffness, & muscle spasm in
one or both extremities.
Presence of Heberden’s nodes or Bouchard’s
nodes
Osteoarthritis (Degenerative Joint
Disease, DJD) Implementation
Administer NSAIDs, salicylates, and muscle
relaxants
Prepare for corticosteroid injections into
joints
Place affected joint in functional position
Immobilize the affected joint with splint or
brace
Avoid large pillows under the head or knees
Provide a foot cradle
Position the client prone twice a day
Osteoarthritis (Degenerative Joint
Disease, DJD)
Position the client prone twice a day
Instruct the important of moist heat, hot
packs or compresses & paraffin dips
Apply cold applications when the joint is
acutely inflamed.
Encourage adequate rest
Encourage a well-balanced diet
Encourage weight loss if necessary
Reinforce the exercise program & the
important of participating in the program.
Osteoarthritis (Degenerative Joint
Disease, DJD)
Instruct to stop exercise if pain is increased with
exercising
Instruct to decrease the number of of repetitions
in an exercise when the inflammation is severe.
Surgical Management: Osteotomy- the bone is
cut to correct joint deformity & promote
realignment.
Total joint replacement: performed when all
measures of pain relief have failed. Hips & knees
are most commonly replaced. Contraindicated in
the presence of infection, advanced osteoporosis,
or severe inflammation.
Rheumatoid Arthritis (RA)
Chronic systemic inflammatory disease; the
etiology may be related to a combination of
environmental & genetic factors.
Leads to destruction of connective tissue and
synovial membrane within the joints.
Weakens & leads to dislocation of the joint &
permanent deformity.
Exacerbations are increased by physical or
emotional stress
Risk factors include exposure to infectious
agents; fatigue & stress can exacerbate the
condition.
Rheumatoid Arthritis (RA)
implementation
Inflammation, tenderness, stiffness of the joints
Moderate to severe pain & AM stiffness lasting
longer than 30 minutes
Joint deformities, muscle atrophy & decreased
ROM
Spongy, soft feeling in the joints
Low-grade temperature, fatigue,& weakness
Anorexia, weight loss & anemia
Elevated ESR & positive RA
X-ray showing joint deterioration
Synovial tissue biopsy presents inflammation
Rheumatoid Arthritis (RA)
Pain-Salicylates (ASA). Monitor for side effects,
including tinnitus, GI upset & prolonged bleeding
time. Administer with meals or a snack. Monitor
for abnormal bleeding or bruising.
Nonsteroidal antiinflammatory drugs (NSAIDS)
May be prescribed in combination with salicylates
if pain & inflammation have not decreased within 6
to 12 weeks following salicylate therapy.
Corticosteroids: Administer during exacerbations
or when commonly used agents are ineffective.
Rheumatoid Arthritis (RA)
Antineoplastic medications: Administer in clients
with life- threatening RA
Gold salts: Administer in combination with
salicylates & NSAIDS to induce remission &
decrease pain & inflammation.
Preserve joint function
Balance rest and activity
Prevent flexion contractures
Apply heat or cold therapy
Apply paraffin bath & massage
Rheumatoid Arthritis (RA)
Exercise only to the point of pain
Avoid weight bearing on inflamed joints
Identify factors that may contribute to fatigue
Monitor for signs of anemia
Administer iron, folic acid & Vitamin supplement
Monitor for drug-related blood loss by testing the
stool for occult blood
Asses the client’s reaction to the body change
Encourage to verbalize feelings
Rheumatoid Arthritis (RA)
Surgical intervention: Synovectomy= removal of
the synovia to help maintain joint function.
Arthrodesis: Bony fusion of a joint to regain
some mobility.
Joint replacement (arthroplasty): removal
of diseased joints with artificial joints; performed
to restore motion to a joint & function to the
muscles, ligaments & other soft tissue structures
that control a joint.
Gout
A systemic disease in which urate crystal
deposit in joints & other body tissues
Leads to abnormal amounts of uric acids in
the body
Primary gouts results from a disorder of
purine metabolism
Secondary gout involves excessive uric acid
in the blood that is caused by another
disease.
Gout (phases)
Asymptomatic: No symptoms. Serum uric acid
is elevated.
Acute: Excruciating pain & inflammation of
one or more small joints, especially the great
toe.
Intermittent: Asymptomatic period between
acute attacks
Chronic: results from repeated episodes of
acute gout. Deposits of urate crystal under the
skin and within the major organ, especially the
renal system.
Gout (assessment)
Excruciating pain in the involved joints
Swelling & Inflammation of the joints
Tophi (hard, fairly large, & irregularly shaped
deposits in the skin) that may break open &
discharge a yellow gritty substance
Low-grade fever
Malaise & headache
Pruritis
Presence of renal stones
Elevated uric acid levels
Gout (implementation)
Provide a low purine diet
Instruct to avoid foods, such as organ
meats, wines, aged cheese
Encourage a high fluid intake of 2000 ml
to prevent stone formation
Encourage weight-reduction diet
Instruct the client to avoid alcohol 7
starvation diets because they may
precipate a gout attack.
Provide bedrest during the attack
Gout
Monitor the joint in mild flexion during
acute attack.
Elevate the affected extremity
Protect the affected joint from excessive
movement or direct contact with sheets
or blankets
Provide heat or cold for local treatments
to affected joints
Administer NSAIDs & antigout
medications.
Systemic Lupus Erythematosus
(SLE)
A chronic progressive systemic inflammatory
disease that can cause major organs & systems to
fail.
Connective tissue & fibrin deposits in blood
vessels, collagen fibers & organs
Leads to necrosis &/ or inflammation of blood
vessels, lymph nodes, GI tract, pleura.
There is no cure for the disease.
Cause is unknown although the disease is due to
defect in the immunological mechanisms or to
have a genetic origin
Systemic Lupus Erythematosus
(SLE)
Precipitating factors include medications,
stress, genetic factors, sunlight or ultraviolet
light & pregnancy.
Assessment: Dry scaly raised rash on the face
or upper body
Fever, weakness, malaise, fatgue
Anorexia, weight loss, photosensitivity
Joint pain, erythema of the palms, anemia
Positive antinuclear (ANA) & LE prep.
Elevated ESR.
Systemic Lupus Erythematosus
(SLE) (Implementation)
Monitor skin integrity & provide frequent
oral care
Instruct to clean skin with mild soap,
avoiding harsh & perfumed substances
Assist with the use of ointments & creams
for rash
Instruct inmeasures to conserve energy,
such as pacing activities & balancing rest
with exercise.
Systemic Lupus Erythematosus
(SLE)
Administer topical or systemic
corticosteroids, salicylates & NSAIDs.
Administer hydroxychloroquine (Plaquenil)
to decrease the inflammation.
Instruct to avoid exposure to sunlight &
ultraviolet light
Monitor for proteinuria & red cell casts in
the urine
Monitor for brusing, bleeding & injury.
Systemic Lupus Erythematosus
(SLE)
Assist with plasmapheresis to remove
autoantibodies & immune complexes from the
blood before organ damage occurs.
Monitor for signs of organ involvement, such as
pleuritis, nephritis, pericarditis, neuritis, anemia
& peritonitis.
Provide supportive therapy as major organs
become affected.
Provide emotional support & encourage to
verbalize feelings.
Provide group information regarding support
groups, & encourage utilization of community
resources.