DEGENERATIVE JOINT DISEASE

1. DEGENERATIVE JOINTDISEASE

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

12. OA of the Hip

13. OA of the Fingers

14. OA of the Knee

15. OA of the Spine

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

17. HalluxValgus

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

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

35. Questions?