Osteoarthritis (Degenerative Joint Disease, DJD)

1
Osteoarthritis (Degenerative Joint Disease, DJD)

• Progressive degeneration of the joints as a
  result of wear tear.
• Causes the formation of bony buidup the loss of
  articular cartilage in peripheral axial joints.
• Affects the weight-bearing joints joints that
  receive the greatest stress, such as the knees,
  toes, lower spine.
• The cause is unknown but may be trauma,
  fractures, infections, or obesity.

2
Osteoarthritis (Degenerative Joint Disease, DJD)-
Assessment

• Joint pain that early in the disease process
  diminishes after rest intensifies after
  activity
• As the disease progresses, pain occurs with
  slight motion or even at rest.
• Symptoms are aggravated by temperature change
  humidity.
• Crepitus
• Joint enlargement
• Limited ROM
• Difficulty getting up after prolonged setting
• Skeletal muscle atrophy

3
Osteoarthritis (Degenerative Joint Disease, DJD)

• Inability to perform activities of daily living
• Compression of the spine as manifested by
  radiating pain, stiffness, muscle spasm in one
  or both extremities.
• Presence of Heberdens nodes or Bouchards nodes

4
Osteoarthritis (Degenerative Joint Disease, DJD)
Implementation

• Administer NSAIDs, salicylates, and muscle
  relaxants
• Prepare for corticosteroid injections into joints
• Place affected joint in functional position
• Immobilize the affected joint with splint or
  brace
• Avoid large pillows under the head or knees
• Provide a foot cradle
• Position the client prone twice a day

5
Osteoarthritis (Degenerative Joint Disease, DJD)

• Position the client prone twice a day
• Instruct the important of moist heat, hot packs
  or compresses paraffin dips
• Apply cold applications when the joint is acutely
  inflamed.
• Encourage adequate rest
• Encourage a well-balanced diet
• Encourage weight loss if necessary
• Reinforce the exercise program the important of
  participating in the program.

6
Osteoarthritis (Degenerative Joint Disease, DJD)

• Instruct to stop exercise if pain is increased
  with exercising
• Instruct to decrease the number of of repetitions
  in an exercise when the inflammation is severe.
• Surgical Management Osteotomy- the bone is cut
  to correct joint deformity promote realignment.
• Total joint replacement performed when all
  measures of pain relief have failed. Hips knees
  are most commonly replaced. Contraindicated in
  the presence of infection, advanced osteoporosis,
  or severe inflammation.

7
Rheumatoid Arthritis (RA)

• Chronic systemic inflammatory disease the
  etiology may be related to a combination of
  environmental genetic factors.
• Leads to destruction of connective tissue and
  synovial membrane within the joints.
• Weakens leads to dislocation of the joint
  permanent deformity.
• Exacerbations are increased by physical or
  emotional stress
• Risk factors include exposure to infectious
  agents fatigue stress can exacerbate the
  condition.

8
Rheumatoid Arthritis (RA)implementation

• Inflammation, tenderness, stiffness of the joints
• Moderate to severe pain AM stiffness lasting
  longer than 30 minutes
• Joint deformities, muscle atrophy decreased ROM
• Spongy, soft feeling in the joints
• Low-grade temperature, fatigue, weakness
• Anorexia, weight loss anemia
• Elevated ESR positive RA
• X-ray showing joint deterioration
• Synovial tissue biopsy presents inflammation

9
Rheumatoid Arthritis (RA)

• Pain-Salicylates (ASA). Monitor for side effects,
  including tinnitus, GI upset prolonged bleeding
  time. Administer with meals or a snack. Monitor
  for abnormal bleeding or bruising.
• Nonsteroidal antiinflammatory drugs (NSAIDS)
• May be prescribed in combination with
  salicylates if pain inflammation have not
  decreased within 6 to 12 weeks following
  salicylate therapy.
• Corticosteroids Administer during exacerbations
  or when commonly used agents are ineffective.

10
Rheumatoid Arthritis (RA)

• Antineoplastic medications Administer in clients
  with life- threatening RA
• Gold salts Administer in combination with
  salicylates NSAIDS to induce remission
  decrease pain inflammation.
• Preserve joint function
• Balance rest and activity
• Prevent flexion contractures
• Apply heat or cold therapy
• Apply paraffin bath massage

11
Rheumatoid Arthritis (RA)

• Exercise only to the point of pain
• Avoid weight bearing on inflamed joints
• Identify factors that may contribute to fatigue
• Monitor for signs of anemia
• Administer iron, folic acid Vitamin supplement
• Monitor for drug-related blood loss by testing
  the stool for occult blood
• Asses the clients reaction to the body change
• Encourage to verbalize feelings

12
Rheumatoid Arthritis (RA)

• Surgical intervention Synovectomy removal of
  the synovia to help maintain joint function.
• Arthrodesis Bony fusion of a joint to regain
  some mobility.
• Joint replacement (arthroplasty) removal of
  diseased joints with artificial joints performed
  to restore motion to a joint function to the
  muscles, ligaments other soft tissue structures
  that control a joint.

13
Gout

• A systemic disease in which urate crystal deposit
  in joints other body tissues
• Leads to abnormal amounts of uric acids in the
  body
• Primary gouts results from a disorder of purine
  metabolism
• Secondary gout involves excessive uric acid in
  the blood that is caused by another disease.

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Gout (phases)

• Asymptomatic No symptoms. Serum uric acid is
  elevated.
• Acute Excruciating pain inflammation of one or
  more small joints, especially the great toe.
• Intermittent Asymptomatic period between acute
  attacks
• Chronic results from repeated episodes of acute
  gout. Deposits of urate crystal under the skin
  and within the major organ, especially the renal
  system.

15
Gout (assessment)

• Excruciating pain in the involved joints
• Swelling Inflammation of the joints
• Tophi (hard, fairly large, irregularly shaped
  deposits in the skin) that may break open
  discharge a yellow gritty substance
• Low-grade fever
• Malaise headache
• Pruritis
• Presence of renal stones
• Elevated uric acid levels

16
Gout (implementation)

• Provide a low purine diet
• Instruct to avoid foods, such as organ meats,
  wines, aged cheese
• Encourage a high fluid intake of 2000 ml to
  prevent stone formation
• Encourage weight-reduction diet
• Instruct the client to avoid alcohol 7 starvation
  diets because they may precipate a gout attack.
• Provide bedrest during the attack

17
Gout

• Monitor the joint in mild flexion during acute
  attack.
• Elevate the affected extremity
• Protect the affected joint from excessive
  movement or direct contact with sheets or
  blankets
• Provide heat or cold for local treatments to
  affected joints
• Administer NSAIDs antigout medications.

18
Systemic Lupus Erythematosus (SLE)

• A chronic progressive systemic inflammatory
  disease that can cause major organs systems to
  fail.
• Connective tissue fibrin deposits in blood
  vessels, collagen fibers organs
• Leads to necrosis / or inflammation of blood
  vessels, lymph nodes, GI tract, pleura.
• There is no cure for the disease.
• Cause is unknown although the disease is due to
  defect in the immunological mechanisms or to have
  a genetic origin

19
Systemic Lupus Erythematosus (SLE)

• Precipitating factors include medications,
  stress, genetic factors, sunlight or ultraviolet
  light pregnancy.
• Assessment Dry scaly raised rash on the face or
  upper body
• Fever, weakness, malaise, fatgue
• Anorexia, weight loss, photosensitivity
• Joint pain, erythema of the palms, anemia
• Positive antinuclear (ANA) LE prep.
• Elevated ESR.

20
Systemic Lupus Erythematosus (SLE)
(Implementation)

• Monitor skin integrity provide frequent oral
  care
• Instruct to clean skin with mild soap, avoiding
  harsh perfumed substances
• Assist with the use of ointments creams for
  rash
• Instruct inmeasures to conserve energy, such as
  pacing activities balancing rest with exercise.

21
Systemic Lupus Erythematosus (SLE)

• Administer topical or systemic corticosteroids,
  salicylates NSAIDs.
• Administer hydroxychloroquine (Plaquenil) to
  decrease the inflammation.
• Instruct to avoid exposure to sunlight
  ultraviolet light
• Monitor for proteinuria red cell casts in the
  urine
• Monitor for brusing, bleeding injury.

22
Systemic Lupus Erythematosus (SLE)

• Assist with plasmapheresis to remove
  autoantibodies immune complexes from the blood
  before organ damage occurs.
• Monitor for signs of organ involvement, such as
  pleuritis, nephritis, pericarditis, neuritis,
  anemia peritonitis.
• Provide supportive therapy as major organs become
  affected.
• Provide emotional support encourage to
  verbalize feelings.
• Provide group information regarding support
  groups, encourage utilization of community
  resources.