Bone Tumors, Arthritis & Connective Tissue Diseases: Degenerative Disc Disease, Osteoporosis, Osteoarthritis, Rheumatoid Arthritis, Gout, and Systemic Lupus Erythematosus (SLE)

What is degenerative disc disease?

it is herniated discs that pinch the nerves that emerge through the intervertebral foramen

What are the common sites of degenerative disc disease?

• L4-5

• L5-S1

• C5-6

• C6-7

What are the signs and symptoms of degenerative disc disease?

• radiculopathy and radiating pain down spine

• numbness and tingling in spine

• decreased strength in spine

• limited range of motion in spine

What are the lab and diagnostic tests for degenerative disc disease?

• x-rays

• myelogram

• MRI

• CT

• Epidural venogram or discogram

• EMG

What is osteoporosis?

it is weak and brittle bones, increasing risk of fracture

What are the signs and symptoms of osteoporosis?

• asymptomatic 

• several fractures within a short time frame

What are the labs and diagnostic tests for osteoporosis?

• Hx & physical assessment

• x-rays

• bone mineral density tests (BMD)

What are some teachings for patients with osteoporosis?

• tell pt. to take calcium carbonate with food

• tell pt. to take calcium citrate on an empty stomach 

• tell pt. to take bisphosphonates with water, sit up for 30 minutes, take for at least 5 years, and wait at least 30 minutes before eating

• tell female pt. to take 1000 mg/day calcium (19 to 50 years)

• tell female pt. to take 1200 mg/day calcium (51 years and older)

• tell male pt. to take 1000 mg/day calcium (19 to 70 years)

• tell male pt. to take 1200 mg/day calcium (71 years and older)

• tell pt. to take 800 units of vitamin D daily

What is osteoarthritis?

it is a degenerative joint disease caused by wear and tear of articular cartilage 

What joints are affected by osteoarthritis?

• hips

• knees

• metatarsophalangeal (MTP)

• cervical vertebrae

• lumbar vertebrae

• distal interphalangeal (DIP)

• proximal interphalangeal (PIP)

• metacarpophalangeal (MCP)

What are the signs and symptoms of osteoarthritis?

• joint pain with movement or weight bearing

• stiff joints

• crepitus

• pain relief with rest

• enlargement of joints

• herberden’s nodes in distal joints

• bouchard’s nodes in hip joints

What are the labs and diagnostic tests for osteoarthritis?

• bone scans

• x-rays

• CT

• MRI

What are some surgical interventions for osteoarthritis?

• hip replacement

• knee replacement

What are some teachings for patients with osteoarthritis?

• tell pt. they can take 200mg ibuprofen up to 4 times a day for pain

• tell pt. they can take isopropyl to decrease GI side effects

• tell pt. they can get intraarticular corticosteroid injections  every 3 months

• tell pt. they can do alternative therapies such as acupuncture, massage, or Tai Chi

• tell pt. to take fish oil or ginger for inflammation

What is rheumatoid arthritis?

it is a chronic systemic inflammatory disease caused by antibodies from the bloodstream moving into the synovial lining of joints, causing joint swelling

What joints are affected by rheumatoid arthritis?

• wrists

• hands

• knees

• feet

What are some signs and symptoms of rheumatoid arthritis?

• morning stiffness in joints due to inflammation

• movement helps with joint stiffness 

• fever

• weight loss

• limited range of motion due to inflammation and pain

What are the labs and diagnostic tests for rheumatoid arthritis?

• antinuclear antibody (ANA)

• erythrocyte sedimentation rate (ERS)

• Gamma globulins

• x-rays

• Synovial fluid analysis

• Tissue biopsy

• bone scans

What are some surgical interventions for rheumatoid arthritis?

• Synovectomy

• Total joint replacement (arthroplasty)

What are some teachings for patients with rheumatoid arthritis?

• tell pt. that Methotrexate is used for early treatment 

• tell pt. that Sulfasalazine (Azulfidine) & hydroxychloroquine (Plaquenil) is used for mild to moderate rheumatoid arthritis  

• tell pt. if they are taking Sulfasalazine (Azulfidine) & hydroxychloroquine (Plaquenil), they need to have regular eye exams every 6-12 months 

• tell pt. Leflunomide (Arava) blocks immune cell overproduction 

• tell pt. they cannot have live vaccines of they are taking Biological Response Modifiers

What is gout?

 it is a buildup of uric acid crystals in the joints

What can cause gout?

• metabolic syndrome

• increased intake of high purine foods

• prolonged fasting

• excessive alcohol

What are some signs and symptoms of gout?

• acute onset of excruciating in joint

• redness around joint 

• nephrolithiasis (kidney stones)

What are the labs and diagnostic tests for gout?

• erythrocyte sedimentation rate (ESR)

• C-reactive protein (CRP)

• serum uric acid

• urinary uric acid

• Arthrocentesis

What are some nursing actions and interventions for gout?

• give oral colchicine when ordered

• administer NSAIDs when ordered

• administer corticosteroids when ordered 

• if pt. is taking Allopurinol, monitor liver levels

What are some teachings for patients with gout?

• tell pt. side effect of oral colchicine is diarrhea 

• tell pt. oral colchicine helps with inflammation

• tell pt. NSAIDs help with joint pain 

• tell pt. to not take colchicine or steroids when on NSAIDs

• tell pt. that aspirin does not work for pain due to gout 

• tell pt. to limit alcohol and food high in purine (beans, beer, red meats, fried foods, etc.)

What is systemic lupus erythematosus (SLE)?

it is a multisystemic inflammatory autoimmune disease that leads to necrosis & inflammation in blood vessel, lymph nodes, gastrointestinal tract and pleura

What are some signs and symptoms of systemic lupus erythematosus (SLE)?

• butterfly rash across nose and cheeks

• heart dysrhythmias

• dry, scaly skin

• joint pain

• light sensitivity

What are the labs and diagnostic tests for systemic lupus erythematosus (SLE)?

• antinuclear antibody (ANA)

• erythrocyte sedimentation rate (ERS)

• C-reactive protein (CRP)

What are some nursing actions and interventions for systemic lupus erythematosus (SLE)?

• administer NSAIDs for joint pain when ordered

• administer antimalarial drugs for fatigue and skin & joint problems 

• administer corticosteroids for inflammation when ordered

• taper off and give at lowest effective dose of corticosteroids

• administer immunosuppressive drugs when ordered

• assess ADLs

• monitor neurological function

What are some teachings for patients with systemic lupus erythematosus (SLE)?

• tell pt. there is not cure for SLE

• tell pt. to avoid crowded areas if taking immunosuppressive drugs 

• tell pt. they can apply topical immunomodulators for butterfly rash on face and discoid lesions

What picture depicts osteoarthritis?

What picture depicts rheumatoid arthritis?

What type of medications does the provider need to order for patients with rheumatoid arthritis?

disease modifying antirheumatic drugs