Osteoarthritis

A nurse is assessing a client who has osteoarthritis of the knees and fingers. Which of the following manifestations should the nurse expect to find? (Select all that apply.) A. Heberden's nodes B. Swelling of all joints C. Small body frame D. Enlarged joint size E. Limp when walking

A. Heberden's nodes D. Enlarged joint size E. Limp when walking Rationale: Heberden's nodes are enlarged nodules on the distal interphalangeal joints of the hands and feet. Swelling and pain of all joints is a manifestation of rheumatoid arthritis. A local inflammation of a joint is related to osteoarthritis. Obesity is a risk factor for osteoarthritis. A client can manifest enlarged joints due to bone hypertrophy.A client can manifest a limp when walking due to pain from inflammation in the localized joint.

Which condition or action represents a modifiable risk factor for prevention of osteoarthritis? A. Obesity B. Hypertension C. Cigarette smoking D. Walking as exercise

A. Obesity Rationale: Obesity increases the stress on weight-bearing joints and contributes to the development of degenerative joint disease.

How do assistive devices assist in optimizing mobility?

Assistive devices play a key role in helping clients maintain independence in performing ADLs. Assistive devices can also help reduce stress on affected joints, which may help slow the progression of disease.

A nurse is providing information about capsaicin cream to a client who reports continuous knee pain from osteoarthritis. Which of the following information should the nurse include in the discussion? A. Continuous pain relief is provided. B. Inspect for skin irritation and cuts prior to application. C. Cover the area with tight bandages after application. D. Apply the medication every 2 hours during the day.

B. Inspect for skin irritation and cuts prior to application. Rationale: Inspect the skin for irritation and cuts before applying capsaicin cream, because hot peppers in the cream can cause a painful burning sensation in areas of skin breakdown.

Which physical change in the client with osteoarthritis indicates disease advancement? A. The hands are involved. B. The hip shows subluxation. C. Hip involvement is bilateral. D.The client is older than 65 years.

B. The hip shows subluxation. Rationale: Partial joint dislocation or subluxation is an indication of progressive disease in which the repair processes stimulated by the continuing damage are unable to keep pace with the rapid degeneration. Severely damaged joints do not keep the proximal and distal bones in anatomic alignment.

Which joints are most frequently affected by osteoarthritis? A. Jaw and ankles B. Neck and wrists C. Hips and knees D. Elbows and shoulders

C. Hips and knees Rationale: Degenerative joint disease is known as the "wear and tear" consequences of joint use. Weight-bearing joints are most commonly affected by degenerative joint disease.

Capsaicin cream (Capzasin, Zostrix)

Class: Adverse reactions: Nursing Interventions:

Diclofenac gel (Voltaren)

Class: Adverse reactions: Nursing Interventions:

Glucosamine supplement

Class: Adverse reactions: Nursing Interventions:

Salicylates (Aspercreme, Bengay)

Class: Adverse reactions: Nursing Interventions:

Hyaluronic Acid Injections

Class: Hyaluronic acid derivative, absorption and dispersing enhancer Adverse reaction: Edema Interventions: Monitor for hypersensitivity

Celebrex (celecoxib)

Class: NSAID (COX-2 Inhibitor) Adverse reactions: Nursing Interventions:

Naproxen (Aleve)

Class: NSAID, anti-inflammatory, antipyretic Adverse reactions: HA, drowsiness, dizziness, heartburn Nursing Interventions:

Menthol (Icy Hot, Biofreeze)

Class: Topical analgesic Adverse reactions: Skin rash Nursing Intervention: Avoid use on damaged, broken, or irritated skin

Cortisone Injections

Class: adrenocortical steroid, anti-inflammatory, immunosuppressant Adverse reactions: edema, compression fracture, cataracts, thrombocytopenia Interventions: Monitor for S/S of Cushing's Cortisone may mask some sgns of infection Be alert to clinical indications of infection Report ecchymotic areas, unexplained bleeding, easy bruising Monitor labs

What teaching should be provided to the client who is receiving cortisone injections?

Corticosteroids can cause joint damage, clients should receive injections no more than three or four times per year.

The client with arthritis and all the following allergies is prescribed to take celecoxib (Celebrex) daily. Which allergy is most important for the nurse to report to the physician? A. Latex B. Peanut C. Shellfish D. Sulfa drugs

D. Sulfa drugs Rationale: Many clients with an allergy to sulfa drugs have a cross-reactivity with celecoxib. This drug should be avoided in clients who have a known allergy to sulfa drugs in order to prevent a serious allergic reaction or anaphylaxis.

What is the pathophysiology of osteoarthritis?

Erosion of the cartilage within joints. With age, cartilage breaks down, becomes rough and wears away, bones rub against each other. Particles break off irritating the synovial tissues, causes pain, stiffness, inflammation, and swelling.

What outcomes should the client be evaluated on with follow-up appointments?

Expected outcomes for the care of a client with OA include independence with activities of daily living, minimal lifestyle impact because of OA, and controlled pain that allows for rest and sleep.

What non-pharmacologic therapies can be used in the management of osteoarthritis?

Heat and cold application, use of assistive technology, weight reduction, adequate sleep and rest, and mild exercise program.

What is the difference between idiopathic and secondary osteoarthritis?

Idiopathic OA has no identifiable cause and is localized or generalized. localized OA = one or two joints and generalized OA = three or more joints. Secondary OA is caused by an underlying condition, such as injury; congenital malformation; metabolic, endocrine, or neuropathic disease; or other medical cause.

Describe arthroplasty

Joint replacement, the surgeon removed the damaged joint surfaces and replaces them with plastic, metal, or ceramic prostheses.

Describe what joint resurfacing is.

Joint resurfacing, which involves removing a small amount of bone at the articulating surface of the joint and fitting a metal replacement over the end of the bone, is often performed for hip and shoulder joints.

Describe osteotomy surgery.

Mostly knee and hip Entails surgical removal of a wedge of bone above or below the joint to realign the joint and shift the weight away from the damaged portion of the joint.

What is the warning that must be provided on all OTC medications containing acetaminophen?

Must include the information that exceeding a dosage of 4000 mg/day may result in severe liver damage.

What are nursing interventions that can help a patient with OA?

NSAIDs, moist heat, active range-of-motion exercises, proper posture and body mechanics, and assistive devices to safely maintain independence with activities of daily living. Interventions: install grab bars in the bathroom near the commode and in the shower. Scatter rugs are a hazard to mobility and should be avoided. The client should also be instructed to sit in a straight-back chair, avoid slumping, and avoid use of a recliner.

Describe joint fusion

Permanently fuses two or more bones together at a joint using pins, plates, screws, and rods. Recommended for badly damaged smaller joints, such as the spine, wrist, ankle, finger, or toe..

What causes crepitus?

Rough surfaces rubbing against each other, and bone spurs that contribute to joint swelling.

What referrals can the nurse make regarding the use of assistive devices?

The nurse may need to refer the client to a physical or an occupational therapist for instruction about proper use of the assistive device. Assistive devices are items used to maintain, increase, or improve function.

Should a client with OA exercise?

Yes, exercise can increase flexibility, improve blood flow, and help clients lose weight. Over time, these factors can help protect the joints against further deterioration and pain.

A client who is obese and who has degenerative joint disease is being managed pharmacologically with acetaminophen therapy. The nurse determines that additional teaching is needed when the client makes which statement? 1. "I take my acetaminophen when I have extreme pain or stiffness." 2. "I use heat sometimes to help reduce my pain and stiffness." 3. "I realize the importance of quality rest and sleep to feel my best." 4. "I started an exercise program to lose weight."

1."I take my acetaminophen when I have extreme pain or stiffness." Rationale: Acetaminophen therapy is continuous and is effective only if therapeutic blood levels are reached. It is not taken intermittently. The other statements are appropriate self-care measures when taking acetaminophen for osteoarthritis.

The nurse collects data from a client with suspected osteoarthritis. The nurse elicits information that will confirm which manifestations of osteoarthritis? 1. Elevated sedimentation rate 2. Pain and stiffness associated with prolonged inactivity 3. Elevated white blood cell count 4. Positive rheumatoid factor

2. Pain and stiffness associated with prolonged inactivity Rationale: Pain and stiffness associated with prolonged inactivity is characteristic of osteoarthritis. An elevated sedimentation rate and positive rheumatoid factor are characteristics of rheumatoid arthritis. There are no lab tests that diagnose osteoarthritis. An elevated white blood cell count is not characteristic of this disease.

What are the risk factors for the development osteoarthritis?

> 55 Hard labor (heavy lifting, bending, or repetitive motion) Obesity due to stress and wear on joints Malformed joints or defective cartilage; Diabetes, hypothyroid, gout, and Paget; or joint injuries from sports, accidents, or repetitive use.

Describe what arthroscopy is.

A small fiberoptic light source, magnifying lens, and camera is inserted into the joint to visualize the joint structures.