Mobility Lecture Exam 3

Osteoarthritis

• most common arthritis

• Progressive deterioration and loss of cartilage in one or more joints

• Primarily weight bearing joints

• can be primary (idiopathic) or secondary (trauma)

Osteoarthritis Etiology & Risk

Triggered by

• aging

• genetic changes

• obesity

• smoking

• trauma

Osteoarthritis Assessment

Joint pain & Stiffness

• worsens after activity

• improves with rest

Atrophy

Crepitus

Heberden’s (bony enlargement on finger joints) DIP

Bowchard’s nodes (PIP Joint)

OA Conservative Management

• Tylenol, topical lidocaine

• NSAIDs, COX-2 inhibitors

• Steroid or hyaluronic acid injections

• Heat therapy

• PT, Weight loss , diet changes

OA Surgical Management

Arthroplasty when:

• pain uncontrolled

• Loss of ADLs

Contraindicated in:

• infection

• Severe Osteoporosis

• Rapidly progressive inflammation

Rheumatoid Arthritis

• systemic autoimmune inflammatory disease

• affects joints symmetrically

• chronic, progressive, destructive

RA etiology

• autoimmune (IgG abnormal/IgM)

• Genetic (HLA-DR4)

• Metabolic & biochemical abnormalities

RA Pathophysiology

1. Joint Swelling

2. Pannus formation (excessive cartilage loss)

3. Fibrous ankylosis (joint invaded by fibrous connective tissue)

4. Bony Ankylosis (bones fused)

RA Clinical Manifestations

• bilateral joint inflammation

• pain, edema, warmth

• morning stiffness >30 mins

• activity improves pain

RA early symptoms

• Low-grade fever

• fatigue

• weakness

• anorexia

• paresthesias

RA Late symptoms

• joint deformity

• severe pain

• osteoporosis

• anemia

• weight loss, severe fatigue

• vasculitis

• cardiac/renal involvement

• subcutaneous nodules

Sjogren’s Syndrome

dry eyes & dry mouth

RA Diagnostic Test

Lab Assessment

• Rheumatoid Factor (RF)

• Antinuclear antibody (ANA) titer

• Serum Complement (C3 & C4)

• High sensitivity to C-reactive protein

• Erythrocyte Sedimentation rate (ESR)

CT Scan/ or MRI

X-ray

Arthrocentesis

RA Medications

• NSAIDs

• Salicylates

• Methotrexate (delays joint destruction, reduce inflammation)

• Steroids (Prednisone)

• Biological Response Modifiers

  • Enbrel

  • Remicade

  • Humira

  • Orencia

Gout Pathophysiology

• uric acid crystal deposits ——> severe inflammation

• “disease of kings

Primary Gout

inherited purine metabolism issue (90%, middle-aged men)

Secondary Gout

Renal disease, diuretics, crash diets, chemo

Gout Stages

• Asymptomatic

• Acute gouty arthritis: severe pain, great toe (podagra)

• Chronic gout: tophi, renal stones

Gout Assessment & Diagnosis

• Uric acid >6.8mg/dL

• ESR increase

• WBC increase

• Physical exam (joint pain)

Gout Treatment

Acute:

• Colchicine + NSAIDs

Chronic:

• Allopurinol + Febuxostat

Weight loss

Low-purine diet

Nursing Assessment Fractures

Check alignment, deformity

Airway, bleeding, circulation

• Ecchymosis

• SQ Emphysema

• Neurovascular compromise

6 Ps of Neurovascular compromise:

• pain

• pressure

• pallor

• paresthesia

• paralysis

• pulselessness

Fractures Diagnostic Testing

• x-ray

• CT scan

• MRI

Nonsurgical Management Goals Fractures

Pain control

• NSAIDs, acetaminophen, opioids

Stabilization

• Casts, splints, braces

Prevent complications

Restore strength and mobility

Psychosocial support

Nursing care Fractures

• Frequent Neurovascular checks

• Elevate 24-48 hours

• keep skin clean/dry

• avoid dependent positioning

• report sensation/motor changes immediately

Complications of Fractures

• Acute Compartment Syndrome

• Crush syndrome

• Hypovolemic shock

• Fat embolism

• DVT

• Local infection/osteomyelitis

Compartment Syndrome

increased pressure —→ decreased blood flow

occurs within 4-6 hours

requires emergency fasciotomy

External Fixation

• early ambulation

• less blood loss

• high infection risk —→ pin care essential

Hip Fracture Assessment

• shortened limb

• external rotation

• severe hip pain

Hip Fractures Treatment

• ORIF

• Hemiarthroplasty

• Total arthroplasty

Hip & Knee Arthoplasty Pre-Op

• pain control

• autologous donation

• PT/OT

• Fall precautions

Hip & Knee Arthroplasty Post-Op

PCA or Oral pain meds

CPM for knee only

Monitor for:

• Dislocation

• Infection

• Hypotension

• Blood loss

• DVT

Preventing Hip Dislocation

• Abduction pillow

• No crossing legs

• No low chairs

• No internal rotation

DVT Prevention

• Compression Stockings

• Anticoagulants (Heparin, Lovenox, Coumadin)

• ROM of unaffected leg

• Early ambulation

Pulmonary Embolism

• Sudden chest pain

• Dyspnea

• Tachycardia/tachypnea

• Anxiety, diaphoresis

Fat Embolism

• Same as PE + Petechiae

• Fever >39 Celsius

• AMS changes