DEGENERATIVE JOINT

DISEASE

1

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

2

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
3

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

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

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

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

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

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

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

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 11 .

OA of the Hip .

OA of the Fingers .

OA of the Knee .

OA of the Spine .

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

Hallux Valgus .

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

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

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

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 21 .

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

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

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

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

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

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

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

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

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

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

those patients who have had prior joint infection. and patients who are immuno- suppressed. 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. 32 .

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

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

35 .