osteoarthritis

After teaching a group of clients with osteoarthritis about using regular exercise, which of the following client statements indicates effective teaching?

"RATIONALE: Weight-bearing exercise plays a very important role in stimulating regeneration of cartilage, which lacks blood vessels, by driving synovial fluid through the joint cartilage. Joint mobility is increased by weight-bearing exercises, not range of-motion exercises, because surrounding muscles, ligaments, and tendons are strengthened. Pain is an early sign of degenerative joint bone problems. Swelling may not occur for some time after pain, if at all. Osteoarthritic pain is worsened in cold, damp weather; therefore, exercising outdoors is not recommended year round in all settings.

The client diagnosed with osteoarthritis states, "My friend takes steroid pills for her rheumatoid arthritis. Why don't I take steroids for my osteoarthritis?" Which of the following is the best explanation?"

RATIONALE: Corticosteroids are used for clients with osteoarthritis to obtain a local effect. Therefore, they are given only via intra-articular injection. Oral corticosteroids are avoided because they can cause an acceleration of osteoarthritis. Rheumatoid arthritis and osteoarthritis are two different diseases.

Which findings best correlate with a diagnosis of osteoarthritis? Anorexia and weight loss Erythema and edema over the affected joint Joint stiffness that decreases with activity Fever and malaise

Joint stiffness that decreases with activity

A 69-year-old client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct? OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints. OA and RA are very similar. OA affects the smaller joints and RA affects the larger, weight-bearing joints. OA affects joints on both sides of the body. RA is usually unilateral. OA is more common in women. RA is more common in men.

OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints. Explanation: OA is a degenerative arthritis, characterized by the loss of cartilage on the articular surfaces of weight-bearing joints with spur development. RA is characterized by inflammation of synovial membranes and surrounding structures. OA may occur in one hip or knee and not the other, whereas RA commonly affects the same joints bilaterally. RA is more common in women; OA affects both sexes equally. Remediation: Rheumatoid arthritis Osteoarthritis

Which of the following statements indicates that the client with osteoarthritis understands the effects of capsaicin (Zostrix) cream?"

RATIONALE: Capsaicin cream, which produces analgesia by preventing the reaccumulation of substance P in the peripheral sensory neurons, is made from the active ingredients of hot peppers. Therefore, clients should wash their hands immediately after applying capsaicin cream if they do not wear gloves, to avoid possible contact between the cream and mucous membranes. Clients are instructed to avoid wearing tight bandages over areas where capsaicin cream has been applied because swelling may occur from inflammation of the arthritis in the joint and lead to constriction on the peripheral neurovascular system. Capsaicin cream should be stored in areas between 59° F and 86° F (15° C and 30° C). The cabinet over the stove in the kitchen would be too warm. Capsaicin cream should not come in contact with irritated and broken skin, mucous membranes, or eyes. Therefore it should not be used on cuts or burns.

At which of the following times should the nurse instruct the client to take ibuprofen (Motrin), prescribed for left hip pain secondary to osteoarthritis, to minimize gastric mucosal irritation?"

RATIONALE: Drugs that cause gastric irritation, such as ibuprofen, are best taken after or with a meal, when stomach contents help minimize the local irritation. Taking the medication on an empty stomach at any time during the day will lead to gastric irritation. Taking the drug at bedtime with food may cause the client to gain weight, possibly aggravating the osteoarthritis. When the client arises, he is stiff from immobility and should use warmth and stretching until he gets food in his stomach.

Which of the following should the nurse assess when completing the history and physical examination of a client diagnosed with osteoarthritis?"

RATIONALE: Osteoarthritis is a degenerative joint disease with local manifestations such as local joint pain, unlike rheumatoid arthritis, which has systemic manifestation such as anemia and osteoporosis. Weight loss occurs in rheumatoid arthritis, whereas most clients with osteoarthritis are overweight.

A physician orders a lengthy X-ray examination for a client with osteoarthritis. Which of the following actions by the nurse would demonstrate client advocacy?

RATIONALE: Shorter sessions will allow the client to rest between the sessions. Changing the physician's order to a different examination will not provide the information needed for this client's treatment. Acetaminophen is a nonopioid analgesic and an antipyretic, not an anti-inflammatory agent. Thus, it would not help this client avoid the adverse effects of a lengthy X-ray examination. Although the X-ray table is hard, there are other options for making the client comfortable, rather than canceling the examination.

he client has just had a total knee replacement for severe osteoarthritis. Which of the following assessment findings should lead the nurse to suspect possible nerve damage?"

RATIONALE: The nurse should suspect nerve damage if numbness is present. However, whether the damage is short-term and related to edema or long-term and related to permanent nerve damage would not be clear at this point. The nurse needs to continue to assess the client's neurovascular status, including pain, pallor, pulselessness, paresthesia, and paralysis (the five P's). Bleeding would suggest vascular damage or hemorrhage. Dislocation would suggest malalignment. Pink color would suggest adequate circulation to the area. Numbness would suggest neurologic damage.

A client with osteoarthritis will undergo an arthrocentesis on his painful edematous knee. What should be included in the nursing plan of care? Select all that apply.

RATIONALE: To prepare a client for an arthrocentesis, the nurse should tell the client that 1 a local anesthetic administered by the physician will decrease discomfort. 2 There may be bleeding after the procedure, so the nurse should check the dressing. 3 The client may experience pain. The nurse should offer pain medication and evaluate outcomes for pain relief. Because a local anesthetic is used, the client will not require preoperative medication. 4 The client will rest the knee for 24 hours and then should begin range-of-motion and muscle strengthening exercises.

In preparation for total knee surgery, a 200-lb client with osteoarthritis must lose weight. Which of the following exercises should the nurse recommend as best if the client has no contraindications?"

RATIONALE: When combined with a weight loss program, aquatic exercise would be best because it cushions the joints and allows the client to burn off calories. Aquatic exercise promotes circulation, muscle toning, and lung expansion, which promote healthy preoperative conditioning. Weight lifting and walking are too stressful to the joints, possibly exacerbating the client's osteoarthritis. Although tai chi exercise is designed for stretching and coordination, it would not be the best exercise for this client to help with weight loss.

An older adult client is seen in the clinic with reports of right hip pain that worsens after activity, decreased range of motion (ROM) of the right hip, and difficulty getting up after sitting for long periods. The nurse hears crepitus in the right hip upon movement and determines that these symptoms are associated with which condition? gout osteoarthritis rheumatoid arthritis hip fracture

osteoarthritis Explanation: Osteoarthritis of the hip is associated with joint pain that worsens with activity, diminished ROM, joint crepitus, and difficulty arising after long periods of rest. Gout is associated with intermittent periods of joint pain that resolve. Rheumatoid arthritis is a systemic disease that affects multiple joints. Clients with hip fractures have severe pain in the hip or groin and are unable to bear weight, and the leg may be externally rotated. Remediation: Osteoarthritis