1 DEGENERATIVE JOINT DISEASE

2 Objectives Identify non-surgical and surgical interventions for osteoarthritis. Discuss the common complications of osteoarthritis. Identify three nursing interventions to treat osteoarthritis.

3 Question #1 Mrs. Tyler sees her NP for complaints of soreness in both hands and swelling, soreness, and pain in her left knee. Which of the following diagnostic exams will most likely be ordered to confirm a diagnosis of osteoarthritis? –A.CRP, R/A factor, CBC with differential –B.CT of the left knee, X-rays of both hands –C.X-rays of affected extremities –D.MRI of the affected extremity

4 Answer #1 C. X-ray of the affected extremities

5 Classification of Osteoarthritis Primary osteoarthritis - most common in older age group due to degenerative changes in joints Secondary osteoarthritis - results from a previous process that damaged cartilage such as trauma, or inflammatory arthritis

6 Commonly Involved Joints Distal interphalangeal joints First carpometacarpal joint Weight bearing joints: spine, hips, knees

7 Epidemiology Greatest factor: AGE Genetic link Hormonal Factors Obesity Others

8 Question #2 Mrs. Tyler tells the nurse that she will try alternative therapies for treatment of her arthritis symptoms. The nurse: A. Discourages the use of these therapies B. Maintains a nonjudgmental attitude about the therapies.. C. Reports the patient to the doctor. D. Encourages utilization of any form of alternative therapy

9 Answer #2 B. The nurse should maintain a nonjudgmental attitude toward the use of alternative therapies

10 Pathophysiology Cartilage erosion to bone Cartilage digested Nutritional deprivation Osteophyte formation Prostaglandin release Secondary synovitis

11 Imaging Dx by plain films includes identification of: –Asymmetric joint space narrowing –Osteophytes-bony spurs –Degenerative cysts –Sclerosis of subchondral bone CT or MRI are also useful on certain occasions

OA of the Hip

OA of the Fingers

OA of the Knee

OA of the Spine

16 Diagnostic Tests Laboratory –No specific test –ESR might be elevated –Synovial fluid is not specific; may have calcium/crystals

Hallux Valgus

18 Assessment Pain - decreased with rest, localized, at night in late stage Decreased ROM & am stiffness, limp, joint instability Joint swelling/deformity - crepitus, asymmetric, Heberden’s nodes (DIP), Bouchard’s nodes (PIP), flexion contractures, knee varus/valgus

19 Question #3 Mrs Tyler tells the nurse that she wants to include Glucosamine in her daily medications. The nurse knows this is most effective when taken with: A.SAM-E B.Ginger C.Boswellia D.Chondroitin

20 Answer #3 D.Glucosamine should be taken with Chondroitin

21 Treatment Goals Decrease pain & inflammation Maintain or improve joint function Limit disability by preventing or correcting deformity Optimal role function/independent self care Avoidance of adverse drug events

22 Early Therapeutic Modalities Non-pharmacological –Exercise program & weight loss –Ice, heat, topical creams –Joint protection & energy conservation –Splints,braces, assistive devices –TENs Unit –Massage, biofeedback, relaxation

23 Question #4 Mrs. Tyler has been taking a prescribed NSAID for several weeks for increasing pain in her knee. She should report which of the following: –A.Bruising –B.Itching –C.Weight loss –D.Fatigue

24 Answer #4 A.NSAID’s can cause bleeding. Signs such as tarry stools, bruising, petechia should be reported to the health care provider immediately.

25 Intermediate Therapeutic Modalities Pharmacological –Acetaminophen –ASA –NSAIDS –Glucosamine/Chondroitin/MSM etc. –Joint injections Steroid, Hyaluronic Acid –Long acting opiods

26 Complications Pain - “aching”; severe in late stage Decreased ROM Decreased function Decreased ADL status Joint Contractures Depression/isolation

27 Late Therapeutic Modalities Surgery –Osteotomy –Debridement –Arthrodesis –Arthroplasty (TKA, THA) Cemented Cementless Hybrid Minimally invasive

28 Question #5 After total knee replacement, Mrs. Tyler asks why she is has to wear the foot pumps. The nurse explains that these are used to prevent: –A.Infection –B.Bleeding –C.DVT –D.Muscle wasting

29 Answer #5 C Foot pumps, LMWH, and sequential compression devices are routinely utilized after joint replacement to prevent DVT and PE.

30 Nursing Diagnoses Pain Sleep-Pattern Disturbance Alterations in Nutrition Impaired Physical Mobility Self-Care Deficits Impaired Home Maintenance Ineffective Coping Impaired Adjustment Altered Sexuality

31 Question #6 Which of the following is an indication for antibiotic premedication in post TJR patients receiving routine dental work? A. Those with replacement within 2 years. B. All joint replacement patients should premedicate. C. For invasive dentistry only. D. At the dentist’s discretion

32 Answer #6 A.Guidelines now recommend pre-medication prior to routine dental work in patients who have had joint replacement within the previous two years, those patients who have had prior joint infection, and patients who are immuno- suppressed.

33 Nursing Interventions Pain management, PCA Assistance Constipation Management Exercise Therapy: Joint Mobility Fall Prevention Positioning Self-care Assistance Wound care

34 Nursing Interventions Teaching –Wound Care –S/S infection –S/S complications –THA - Abduction, 90* –TKA - Neutral, Extension –WB status –Assistive Devices

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