Wk. 14 - Arthritis & Total Joint Arthroplasty Flashcards

What are key clinical manifestations of osteoarthritis?

Joint pain that improves with rest early on, later occurs at rest; morning stiffness after inactivity; crepitus; limited ROM; mild joint swelling; Heberden’s and Bouchard’s nodes; difficulty with ADLs.

What nursing interventions help manage pain in osteoarthritis?

Administer acetaminophen or topical agents first line; NSAIDs if needed; apply moist heat, hot packs, paraffin dips; cold therapy for acute inflammation; use splints briefly; position joints in functional alignment.

What exercise recommendations should the nurse provide for a patient with OA?

Encourage low-impact aerobic exercise; active ROM; balance activity and rest; stop exercise if pain occurs; avoid exercise during severe inflammation.

Why is weight management important for patients with OA?

Maintaining a healthy weight decreases mechanical stress on weight-bearing joints, reducing pain and slowing joint degeneration.

When is arthroplasty indicated for osteoarthritis?

When conservative measures fail to control pain or functional impairment and OA significantly impacts quality of life.

What are hallmark clinical manifestations of rheumatoid arthritis?

Symmetric joint inflammation; morning stiffness > 30 minutes; warm, spongy joints; joint deformities; muscle atrophy; fatigue; low-grade fever; weight loss; anemia.

What are goals of nursing management in RA?

Preserve joint function, reduce inflammation, manage fatigue, prevent deformities, support ADLs, and promote balanced activity and rest.

What non-pharmacologic therapies help manage RA symptoms?

Heat therapy, cold for acute inflammation, paraffin baths, splints during flares, ROM exercises, strengthening, energy conservation, and assistive devices.

Why is fatigue management important in RA, and what should the nurse teach?

RA causes systemic inflammation and anemia, leading to fatigue. Teach pacing activities, prioritizing rest, and identifying fatigue triggers.

What surgical options exist for severe RA?

Synovectomy, arthrodesis (joint fusion), and joint replacement (arthroplasty).

What is the mechanism of action of NSAIDs in RA?

They inhibit prostaglandin synthesis by blocking COX enzymes, reducing inflammation and pain.

What are major side effects of NSAIDs the nurse should monitor for?

GI bleeding, ulcers, renal impairment, fluid retention, and increased cardiovascular risk (especially COX-2 inhibitors like celecoxib).

How do glucocorticoids help manage RA symptoms?

They suppress immune function and inflammatory processes, providing rapid relief during acute flare-ups.

What adverse effects are associated with long-term glucocorticoid use?

Hyperglycemia, osteoporosis, increased infection risk, weight gain, fluid retention, hypertension, and GI irritation.

What is the mechanism of action of methotrexate, the first-line DMARD for RA?

Inhibits folate metabolism, reducing immune system overactivity and slowing disease progression.

What side effects of methotrexate require monitoring?

Bone marrow suppression, hepatotoxicity, oral ulcers, teratogenicity; nurses must monitor CBC and LFTs.

What are important considerations for hydroxychloroquine therapy?

It can cause retinal damage; patients require baseline and annual eye exams.

What risks are associated with biologic DMARDs such as adalimumab and etanercept?

Increased risk of serious infections and TB reactivation, injection-site reactions, fatigue, rash, and possible increased malignancy risk.

What are priority preoperative nursing actions before hip or knee arthroplasty?

Assess mobility and home safety; review medications (stop anticoagulants as ordered); teach about postoperative precautions, walker use, pain control, and infection prevention.

What are essential postoperative nursing interventions following hip or knee arthroplasty?

Pain control and early mobilization with PT/OT. DVT prevention. Infection monitoring. Hip precautions: avoid flexion > 90°, no crossing legs, avoid internal rotation. Knee: use CPM if ordered, maintain alignment. Perform neurovascular checks (CMS) every 2–4 hours