ncm 116 midterm ms gayatin part 2

Osteoarthritis

1. Cartilage: The slippery "cushion" on the ends of bones.

2. Synovial Fluid: The "oil" that keeps things moving smoothly.

3. Ligaments: The "rubber bands" holding the bones together.

What goes wrong? As we age or put too much stress on our joints (obesity/trauma), the cushion thins out, the oil dries up, and the rubber bands harden. Without that cushion, bone rubs on bone. This friction causes inflammation.

• Calor: Heat (The joint feels warm).

• Dolor: Pain (It hurts to move).

• Rubor: Redness (The skin looks angry).

• Tumor: Swelling (Fluid builds up).

• Functio Laesa: Loss of function (You can't use it properly).

Signs of Inflammation of osteoarthritis

• Pain, stiffness and muscle spasms, which are more pronounced after exercise, at night and in the early morning.

• Limited motion in affected joints

• Joint “grating” or “grinding” with movement (Crepitus)

• Deformity; Flexion contractures, primarily in the hip and knee

• Joint tenderness

• Heberden’s (distal) & Bouchard’s (proximal) nodes

• Bony growths “Bone Spur” (the response of the body if there is an injury is a scar formation)

CLINICAL MANIFESTATIONS OF OSTEOARTHRITIS

proximal (Middle joint)

Bouchard’s Nodes OSTEOARTHRITIS

Distal (Last joint near nail)

Heberden’s Nodes OSTEOARTHRITIS

Tool	Purpose	Key Indicator
Blood Test	Check Inflammation	High ESR
X-Ray	View Structure	Bone spurs/narrowing
Fluid Analysis	Check Lubrication	High Protein / Viscous
Arthroscopy	Diagnose & Treat	Visual repair of cracks

Diagnosis vs. Procedure osteoarthritis

Medication Type	Purpose/Function	Nursing Considerations
Basic Analgesics	Paracetamol, NSAIDs, COX2 Inhibitors	Gastric Irritants: Patients must eat before taking them. Check liver and kidney function.
Opioids / Narcotics	Severe pain relief	Safety: Monitor Respiratory Rate (RR) and neurological status. Use safety precautions due to drowsiness.
Cartilage Builders	Glucosamine & Chondroitin Sulfate	These are responsible for the build and repair of cartilage.
Injections	Steroids or Hyaluronates	Delivered "Intra-articularly" (directly into the joint space).

Drug Therapy & Nursing Priorities osteoarthritis

Viscosupplementation

• This involves injecting hyaluronates into the joint to improve lubrication. osteoarthritis

• The "Last Resort": If damage becomes extensive and nonsurgical methods fail, the patient will be suggested for hip replacement surgery.

Arthroscopy

OSTEOARTHRITIS SURGICAL PROCEDURE

Surgery done through small "spy holes" using a camera. Used to both diagnose and treat cracks in the joint.

Synovectomy

OSTEOARTHRITIS SURGICAL PROCEDURE

Removal of the enlarged synovial membrane.Done before major bone or cartilage destruction occurs.

Arthroplasty

OSTEOARTHRITIS SURGICAL PROCEDURE

Total joint replacement. Suggested when joint damage is extensive.

Arthrodesis

OSTEOARTHRITIS SURGICAL PROCEDURE

Surgical fusion (locking) of a joint.Performed when joint surfaces are severely damaged.

Reconstructive

OSTEOARTHRITIS SURGICAL PROCEDURE

Replacement of a joint with a prosthetic device.Used for badly damaged joints.

Procedure	Description	Timing / Purpose
Arthroscopy	Surgery done through small "spy holes" using a camera.	Used to both diagnose and treat cracks in the joint.
Synovectomy	Removal of the enlarged synovial membrane.	Done before major bone or cartilage destruction occurs.
Arthroplasty	Total joint replacement.	Suggested when joint damage is extensive.
Arthrodesis	Surgical fusion (locking) of a joint.	Performed when joint surfaces are severely damaged.
Reconstructive	Replacement of a joint with a prosthetic device.	Used for badly damaged joints.

Surgical Procedures Overview OSTEOARTHRITIS

GOUTY ARTHRITIS

is a metabolic disease marked by urate crystal deposits in joints throughout the body, causing local irritation and inflammatory responses.

• Commonly affects men older than age 30.

• Pathophysiology:

• Disorder in purine metabolism that leads to high levels of monosodium uric acid in the blood & the deposition of uric acid crystals (tophi) in tissues, especially joints; followed by an inflammatory response

Category	Specific Foods
Main Trigger	Red meat (very high in urate).
Seafood	Crustaceans like crab, shrimp, and lobsters.
Plant-Based	Beans and legumes.
Vegetables	Tomatoes.

Dietary Triggers in gouty arthritis

1. The "Attack" Profile

Gout doesn't usually linger at a low level; it hits hard and fast.

• Timing: Attacks are sudden and most often occur at night.

• The Pattern: Patients go through periods of remission (no pain) and exacerbations (flares).

• The Location: It is typically monoarticular, meaning it affects only one joint at a time.

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2. Classic Clinical Signs

If you see these symptoms in a clinical setting, think Gout:

• The Pain: Described as acute, crushing, and pulsating.

• Hyper-Sensitivity: A classic sign is intolerance to the weight of bed linens; even a light sheet touching the joint is unbearable.

• Tophi: These are deposits of uric acid that have hardened within the joints.

• Skin Changes: You may see joint edema (swelling), pruritus (itching), or even skin ulceration over the affected area.

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3. The Kidney Connection (Renal Involvement)

Uric acid is supposed to be flushed out by the kidneys. If the kidneys fail to do this, the acid builds up in the joints instead. In severe cases, look for:

• Oliguria: Low urine output.

• Low back pain: Potential sign of kidney stones or distress.

• Hypertension: High blood pressure related to renal strain.

ASSESSMENT GOUTY ARTHRITIS

The "P"s of Gout Assessment	What to look for
Pulsating Pain	Acute, crushing pain that feels like it's throbbing.
Precious Joint	So sensitive the patient won't even let a bedsheet touch it.
Particular	Usually hits just one joint (monoarticular).
Puritus	Itching or skin breakdown over the joint.
Pee Problems	Oliguria or back pain indicating the kidneys aren't clearing the acid.

ASSESSMENT GOUTY ARTHRITIS

Arthrocentesis (The Gold Standard): A needle is used to pull fluid out of the joint. Under a special microscope (Polarized light), they look for urate crystals. If you see crystals, it's Gout.

Gouty Arthritis The Gold Standard Test

Medication	When to give it?	What does it do?	Memory Trick
Allopurinol	Maintenance (Before an attack)	Stops the body from producing uric acid.	Allopurinol = Always. You take it daily to stay safe.
Colchicine	Acute Attack (During the pain)	Attacks the inflammation specifically during a flare-up.	Colchicine = Call the Fireman. Use it when the joint is "on fire."

Other Medications

• NSAIDs/COX2: For general pain and swelling.

• Glucosamine/Chondroitin: Helps repair the cartilage damaged by the crystals.

• Opioids: Used only for severe, "crushing" pain.

The "Big Two" Medications Gouty Arthritis

Dietary Education: Remind the patient to avoid the "Uric Acid Rich" foods: Red meat, shellfish (crustaceans), and beans.

Dietary Education Gouty Arthritis

The Good Guys (Alkaline)	The Bad Guys (Acid/Purine)
Fruits: Watermelon, Lemons, Oranges, Strawberries, Pineapple	Drinks: Soda, Alcohol (Wine)
Vegetables: Celery, Asparagus, Onion	Proteins: Organ meats, Shellfish, Beans, Shrimp
Nuts: Almonds (The only alkaline nut!)	Other: Corn, Plums, Tomatoes

Dietary Education Gouty Arthritis

• Positioning: During an acute stage, align the joints so they are slightly flexed.

Positioning Gouty Arthritis

our immune system (specifically your White Blood Cells and Antibodies) gets confused. It treats your joint linings and cartilage like a dangerous virus or bacteria and tries to destroy them.

• Autoimmune: The cause is technically "unknown," but we know the immune system is the culprit.

• Systemic: Unlike OA, which stays in the joint, is a body-wide problem. It can affect your heart, lungs, and other tissues.

• Synovitis: The attack starts in the synovium (the joint lining), causing it to become inflamed and angry.

• Ankylosis: This is the "scary" end-stage word. It means the joints become so damaged they actually fuse together or stiffen permanently.

Rheumatoid Arthritis

Feature	The Detail
Nature	Chronic & Systemic. It lasts a long time and affects the whole body.
Primary Target	Connective Tissue. Especially joints with cavities and moving surfaces.
The "Who"	Often associated with Systemic Lupus Erythematosus (SLE).
The Result	Destruction of cartilage and Ankylosis (joint fusion).

Key Characteristics Rheumatoid Arthritis

1. Morning Stiffness: Lasting more than 1 hour before getting better.

2. 3+ Joint Arthritis: Swelling in at least three joint areas observed by a doctor.

3. Symmetric Swelling: Both sides of the body are affected (e.g., both wrists).

4. Hand Involvement: Arthritis in the wrists, MCP, or PIP joints.

5. Rheumatoid Nodules: Bumps under the skin.

6. Rheumatoid Factor (RF): Positive blood test.

7. Radiographic Changes: X-rays showing erosions or bone thinning.

The "7-Point Checklist Rheumatoid Arthritis

• Elevated ESR & CRP: General markers that tell us "there is a fire (inflammation) in the body."

• Rheumatoid Factor (RF): A specific antibody often found in RA patients.

• Antinuclear Antibody (ANA): A positive test suggests the immune system is attacking the body's own cells.

Lab Work Rheumatoid Arthritis

Management Type	Specifics	Nursing Priority
Medications	Corticosteroids, NSAIDs, Immunosuppressants.	Infection Risk: Immunosuppressants leave the patient defenseless. Handwashing and avoiding crowds are vital.
Therapy	Physiotherapy & Paraffin (wax) dips.	Minimize deformities and use warm compresses to soothe joints.
Surgical	Hip or Joint Replacement.	Used when the joint reaches Stage 4 (Fusion/Ankylosis).

Critical Nursing Sign: A sore throat is the most common manifestation of an infection in a patient taking immunosuppressive drugs. Report this immediately!

Management Rheumatoid Arthritis