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.