NCLEX/ ATI comp: Musculoskeletal (OA & RA)

Osteoarthritis (OA)

Progressive deterioration and loss of *cartilage* in one or more joints Cartilage destruction with bone spur growth at joint ends; *degenerative*

OA nursing interventions

- thermal applications: *heat* to alleviate pain and *ice* for acute inflammation -assistive devices to promote safety and independence, including an elevated toilet seat, shower bench, long-handled reacher, and shoe horn -daily schedule of activities that will promote independence

OA manifestations

-*pain* with *activity* improves with rest -localized inflammatory response -*overweight* -*asymmetrical* -*Heberdens node* (close to ends of fingers and toes) -*Bouchards node* (middle joints of fingers and toes)

RA manifestations

-*synovial mem.* inflammation -cartilage destruction & bone erosion--> inflammatory -*morning stiffness* -redness, swelling, warmth, pain at rest -all joints -*symmetrical* -*Sjögrens syndrome*n (dry eyes, dry mouth, dry vagina)

RA tests

-Anti-CCP antibodies - Positive -RF antibody -Erythrocyte sedimentation rate (ESR) - Elevated -C-reactive protein (may be done in place of ESR) - Positive -Elevated WBCs

OA tests

-Erythrocyte sedimentation rate (*ESR*) and high-sensitivity *C-reactive protein* may be *increased slightly* related to secondary synovitis. -*MRI* -*X-ray*

A nurse is providing information to a client who has osteoarthritis of the hip and knee. Which of the following information should the nurse include in the information? (Select all that apply.) A. Apply heat to joints to alleviate pain. B. Ice inflamed joints following activity. C. Install an elevated toilet seat. D. Take tub baths. E. Complete high-energy activities in the morning

A. CORRECT: Applying heat to joints can provide temporary relief of pain. B. CORRECT: Applying ice to inflamed joints following activity can decrease edema. C. CORRECT: Installing an elevated toilet seat can help decrease strain and pain of the affected joints. D. INCORRECT: Taking a tub bath places the client at risk for increased strain and pain on the affected joints when getting in and out of the tub and increases the risk for falls. E. CORRECT: Encouraging high-energy activity in the morning is recommended as part of a daily routine to promote independence.

A nurse is caring for a client who has rheumatoid arthritis. Which of the following laboratory tests are used to diagnose this disease? (Select all that apply.) A. Urinalysis B. Erythrocyte sedimentation rate (ESR) C. BUN D. Antinuclear antibody (ANA) titer E. WBC count

A. INCORRECT: A urinalysis is not a laboratory test used to diagnose rheumatoid arthritis. This test can used for detecting kidney failure. B. CORRECT: ESR is a laboratory test used to diagnose rheumatoid arthritis. This laboratory test will show an elevated result in clients who have rheumatoid arthritis. C. INCORRECT: A BUN is not a laboratory test used to diagnose rheumatoid arthritis. This test can be used for detecting kidney failure. D. CORRECT: ANA titer is a laboratory test used to diagnose rheumatoid arthritis. This laboratory test will show a positive result in clients who have rheumatoid arthritis. E. CORRECT: WBC count is a laboratory test used to diagnose rheumatoid arthritis. This laboratory test will show a decreased result in clients who have rheumatoid arthritis

OA meds

Acetaminophen - *max 4,000 mg/24h* NSAIDs Topical analgesics -Trolamine salicylate (Aspercreme) -Capsaicin *glucosamine* -rebuilds cartilage -caution with shellfish allergy

RA diagnostics

Arthrocentesis -Synovial fluid aspiration by needle -With RA, increased WBCs and RF are present in fluid. X-ray

Rheumatoid Arthritis (RA)

Chronic, progressive autoimmune connective tissue disorder primarily affecting *synovial joints*

RA meds

first line NSAIDs -admin w/ food or water/milk Corticosteroids -prednisone DMARDS -slow progression of RA and suppress immune sys. -*hydroxychloroquine* -*Leflunomide* (cytotoxic) -*Methotrexate* (cytotoxic) Biological response modulators (admin parenterally) -Etancercept (Enbrel) -Adalimumab (Humira)

RA nursing interventions

-Morning stiffness (hot shower) -Pain in hands/fingers (heated paraffin) -Edema (cold therapy) -Conserve energy (space out activities, take rest periods, ask for additional assistance when needed) -small frequent meals

A nurse working in an outpatient clinic is assessing a client who has rheumatoid arthritis (RA). The client reports increased joint tenderness and swelling. Which of the following findings should the nurse expect? (Select all that apply.) A. Recent influenza B. Decreased range of motion C. Hypersalivation D. Decreased blood pressure E. Pain at rest

A. CORRECT: Exacerbating factors, such as a recent illness, are indicative of RA. B. CORRECT: Decreased ange of motion is indicative of RA. C. INCORRECT: Xerostomia is indicative of RA. D. INCORRECT: Blood pressure changes are not indicative of RA. E. CORRECT: Pain at rest is characteristic of RA.

A nurse is assessing a client who has osteoarthritis of the knees and fingers. Which of the following clinical 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. CORRECT: Heberden's nodes are enlarged nodules on the distal interphalangeal joints of the hands and feet of a client who has osteoarthritis. B. INCORRECT: Swelling and pain of all joints is a manifestation of rheumatoid arthritis. A local inflammation of a joint is related to osteoarthritis. C. INCORRECT: A small body frame is a risk factor for rheumatoid arthritis. Obesity is a risk factor for osteoarthritis. D. CORRECT: A client may manifest enlarged joints due to bone hypertrophy. E. CORRECT: A client may manifest a limp when walking due to pain from inflammation in the localized joint.

A nurse is providing information to a client newly diagnosed with rheumatoid arthritis (RA). Which of the following statements by the nurse is appropriate? A. "You may experience morning stiffness when you get out bed." B. "You may experience abdominal pain." C. "You may experience weight gain." D. "You may experience low blood sugar

A. CORRECT: The client can experience stiffness in her joints upon rising. This is an appropriate statement for the nurse to give. B. INCORRECT: This is not an appropriate statement for the nurse to give. The client who has RA may experience pleuritic pain (upon inspiration). C. INCORRECT: This is not an appropriate statement for the nurse to give. The client who has RA may experience weight loss. D. INCORRECT: This is not an appropriate statement for the nurse to give. The client who has RA does not experience a low blood sugar.

A nurse is providing information about capsaicin (Capsin) 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 hr during the day.

A. INCORRECT: Capsaicin cream provides temporary relief of pain when applied up to four times a day. B. CORRECT: 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. C. INCORRECT: After capsaicin cream is applied, avoid covering the area with a tight bandage, which may cause increased skin irritation. D. INCORRECT: For maximum pain relief benefit, apply capsaicin cream up to four times a day

A nurse is providing educational information on glucosamine to a group of clients at a health fair. Which of the following should the nurse include in the teaching? A. It decreases the amount of synovial fluid produced in the joints. B. The medication aids in the rebuilding of cartilage. C. A prescription is required for this medication. D. This medication is injected into the joint to decrease joint pain.

A. INCORRECT: Glucosamine may increase the amount of synovial fluid produced in the joint and decrease inflammation. B. CORRECT: Glucosamine can aid in the rebuilding of cartilage and decrease joint pain. C. INCORRECT: Glucosamine is an over-the-counter dietary supplement used to decrease pain and build damaged cartilage. D. INCORRECT: Glucosamine is administered orally or topically to relieve joint pain.