Professional Documents
Culture Documents
Arthritis PPT For Class
Arthritis PPT For Class
Osteoarthritis
&
Systemic Lupus
Erythematosus
By Brianne ONeill And Lynn Bates
Objectives
Understand the pathophysiology of
RA,OA, & SLE.
Review signs and symptoms of RA,
OA, & SLE.
Understand how these conditions
affects a persons everyday life.
Understand the treatments available
for RA, OA, & SLE.
Arthritis
arthr = joint
itis = inflammation
Facts
(The Arthritis Society , 2012; Statistics Canada, 2012; Canadian Arthritis Network, 2007)
Myths
http://www.youtube.com/watch?
v=nCL-Xm7k_DE&feature=related
Articular/hyaline cartilage
-acts as a shock absorber
- allows for friction-free movement
- not innervated!
Synovial membrane/synovium
-secretes synovial fluid
-nourishes cartilage
-cushions the bones
Rheumatoid Arthritis
A chronic autoimmune disease characterized by the inflammation of the synovial joints
(The Arthritis Society, 2012; Gulanick & Myers, 2011; Firth, 2011)
Symptoms
Morning stiffness lasting
more than half an hour
Simultaneous symmetrical
joint swelling
Not relieved by rest
Fever
Weight loss
Fatigue
Anemia
Lymph node enlargement
Nodules
Raynauds phenomenon
(The Arthritis Society, 2012; Firth, 2011; Oliver, 2010; Day et al., 2010)
Nodules
(Arthritis Foundation, 2012; Day et al., 2010; American College of Rheumatology, 2009)
Diagnosis
No single test is specific to Rheumatoid Arthritis
CBC
Radiographs of involved joints
CT/MRI scans
Direct arthroscopy
Synovial/Fluid aspirate
Synovial membrane biopsy
Arthrocentesis
Increasing amount
suggests inflammation
Antibody Tests:
Rheumatoid Factor Test and
CCP
Other blood tests check for the presence of
antibodies that are not normally present in
the human body
Direct arthroscopy
Benefits
Minimally invasive
Less tissue damage
Fewer complications
Reduced pain
Quicker recovery time
Outpatient basis
(American Academy of Orthopaedic Surgeons, 2012; Day et al., 2010)
Synovial/Fluid aspirate
Synovial membrane biopsy
Arthrocentesis
Athrocentesis: synovial fluid is aspirated and analysed for inflammatory components
X-Ray
X-rays are an important diagnostic test for monitoring the disease progression
Arthography
A radiopaque substance or air is injected
into the joint, which outlines soft tissue
structures surrounding the joint
http://www.youtube.com/watch?
v=2YJsuDxxNJE&feature=related
CT/MRI scans
Used for better visualization of soft tissue
MRI is particularly sensitive for the early and subtle features of RA
Can detect changes of Rheumatoid Arthritis prior to an X-Ray
Newly Diagnosed
The major goal is to relieve pain and inflammation and prevent further joint damage
Medications
There are four types of medications used to treat
RA:
Non-steroidal anti-inflammatory drugs
(NSAIDs)
Disease-modifying anti-rheumatic
drugs(DMARDS).
Corticosteroids
Biologic Response Modifiers (Bioligics)
General
Use
Side Effects
Nursing
Consideration
s
Aspirin, ibuprofen,
naproxen, COX-2
inhibitors,
propionic acid,
phenylacetic acid
antiinflammator
y:
Used in the
managemen
t
inflammator
y conditions
Antipyretic:
used to
control fever
Analgesic:
Control mild
to moderate
pain
Nausea
Vomiting
Diarrhea
Constipation
Dizziness
Drowsiness
Edema
Kidney failure
Liver failure
Prolonged
bleeding
Ulcers
Use cautiously
in patients with
hx of bleeding
disorders
Encourage pt
to avoid
concurrent use
of alcohol
NSAIDs may
decrease
response to
diuretics or
antihypertensiv
e therapy
Corticosteroids
Examples
General
Use
Cortisone,
hydrocortisone,
prednisone,
betamethasone,d
exa-methasone
Used in
the
managemen
t
inflammator
y conditions
Side Effects
Increased
appetite
Weight gain
Water/salt
retention
Increased
blood pressure
When
Thinning of
NSAIDS may skin
be
Depression
contraindica Mood swings
ted
Muscle
Promptly
weakness
Osteoporosis
improve
symptoms
Delayed
of RA
wound healing
Onset/worseni
ng of diabetes
Nursing
Consideratio
ns
Take
medications as
directed
(adrenal
suppression)
Used with
caution in
diabetic
patients
Encourage
diet high in
protein,
calcium,
potassium and
low in sodium
and
carbohydrates
Discuss body
General Use
Side Effects
Nursing
Consideration
s
Methotrexate
(the gold
standard)
, gold salts,
cyclosporine,
sulfasalazine,
azathioprine
immunosuppres
sive activity
Reduce
inflammation of
rheumatoid
arthritis
Slows down joint
destruction
Preserves joint
function
Dizziness,
May take
drowsiness,
several weeks
headache
to months
Pulmonary
before they
fibrosis
become
Pneumonitis
effective
Anorexia
Discuss
Nausea
teratogenicity,
Hepatotoxicity should be taken
Stomatitis
off drug several
Infertility
months prior to
Alopecia
conception
Skin ulceration Discuss body
Aplastic
image
anemia
Thrombocytop
enia
Leukopenia
Nephropathy
(The Arthritis Society, 2011; Day et al., 2010)
General
Use
Side Effects
Nursing
Consideration
s
Etanercept,
anakinra,
abatacipt,
adalimumab,
Infliximab
(Remicade)
Used in the
managemen
t
inflammator
y conditions
When
NSAIDS may
be
contraindicat
ed
Promptly
improve
symptoms of
RA
Increased
appetite
Weight gain
Water/salt
retention
Increased
blood pressure
Thinning of
skin
Depression
Mood swings
Muscle
weakness
Osteoporosis
Delayed
wound healing
Onset/worseni
ng of diabetes
Take
medications as
directed
(adrenal
suppression)
Encourage diet
high in protein,
calcium,
potassium and
low in sodium
and
carbohydrates
Discuss body
image
Discuss risk for
infection
Alternative Medicine
Olive leaf extract
Aloe Vera
Green Tea
Omega 3
Ginger Root Extract
Cats Claw
Omega 3 interferes with blood clotting drugs!
Pain
Pain is subjective and influenced by multiple factors
Lack of
control
Helpless
Exercise
Being overweight strains joints and leads to further inflammation
Walking
Light jogging
Water aerobics
Cycling
Yoga
Tai chi
stretching
Nutrition
The most commonly observed vitamin and
mineral deficiencies in patients with RA are:
o folic acid
o vitamin C
o vitamin D
o vitamin B6
o vitamin B12
o vitamin E
o calcium
o magnesium
o zinc
o selenium
(Johns Hopkins Arthritis Center, 2012)
Synovectomy
Increases function of the joint
Decreases pain and inflammation
Beneficial as an early treatment option
Not a cure!
Braces/casts/splints
Support injured joints and weak muscles
Improve joint mobility and stability
Help to alleviate pain, swelling and muscle
spasm
May prevent further damage and deformity
Osteoarthritis
Most common form of arthritis
Over 3 million Canadians affected (1/10)
Osteoarthritis is defined as a degenerative joint disease characterized by destruction of the articular cartilage and overgrowth of bone
Pathophysiology
Age
Family History
Excess weight
Joint injury
Complications of other
types of arthritis
Diagnosis
A Complicated Process
(Day et al., 2010; National Institute of Arthritis & Musculoskeletal & Skin Diseases, 2010).
Clinical history
X-rays
Physical Assessment
MRIs
Joint Aspirate
Non-Pharmacological
Management
Exercise
Weight loss
Heat & Cold Therapy
Activity pacing
Maintaining proper joint alignment
Use of assistive devices
Relaxation Exercises
Pharmacological
Management
Acetaminophen
NSAIDs
Opioids
Corticosteroid injections
Topical analgesics
Glucosamine and chondroitin
(Day et al., 2010; Arthritis Society, 2011)
Surgical Management
Osteotomy
Arthrodesis
Arthroplasty
Total knee
replacement
Total hip replacement
Osteotomy
The surgical cutting of a bone
Displacement osteotomy: a
bone is redesigned surgically
to alter the alignment or
weight-bearing stress areas
Arthrodesis
Fusion of bones in a
joint
Bones are held
together by plates,
screws, pins, wires,
or rods
New bone begins to
grow
Limited joint motion
Pain reduction
Arthroplasty
Athro=joint
Plasty=remodelling
Nursing Considerations
Total Knee Replacement
Compression bandage & ice may
be applied
Active ROM of the foot q1h while
patient is awake.
Wound suction drain 200-400
mL in first 24 hours is considered
normal
Continuous passive motion (CPM)
device may be used
Nurse assists patients in
ambulating evening of or day after
surgery
Elevate knee while patient sits
(Day et al., 2010)
Nursing Considerations
Total Hip Replacement
Hip precautions
Monitor for dislodgement
Abduct leg
Keep HOB less than 60
degrees
Use of fracture bedpan
High-seat surfaces
Sleep on unaffected side
Avoid crossing legs
No bending at the waist
(Day et al., 2010)
Pre-op Care
Educating Patient
Discharge planning
Evaluating patient risks
(Walker, 2012)
Post-op Care
Monitor VS
Wound assessments
Neurovascular assessments
Monitor wound drainage
Pain relief
Infection/Osteomyelitis prevention
Promote early ambulation
Ensure physiotherapy is consulted
(Walker, 2012; Day et al., 2010)
LUPUS
A chronic disease, affecting
over 1/1000 Canadians
Affects 8x as many women
Auto-immune
Cause is unclear potential
hormonal or genetic link
When properly treated, most
individuals can survive for a
normal lifespan
(Lupus Society of Canada, 2012)
Types of Lupus
Systemic Lupus Erythematosus
(SLE) : The most common
type of lupus. Any tissue in
the body may be affected
including the kidneys, heart,
lungs, and brain.
Discoid Lupus Erythematosus (DLE): Affects the skin; skin
develops lesions and scales.
Cutaneous Lupus Erythematosus : May be chronic or acute.
This type may only involve the skin or progress to involve
other body systems.
Manifestations of SLE
Pharmacological Therapy
Acetaminophen
NSAIDs
Corticosteroids
Cytotoxic or Immunosuppressive drugs
Antimalarial drugs
Healthy Lifestyle
(Arthritis Society, 2010)
Nursing Considerations
Educate patient on lupus.
Help patient identify factors
that precipitate flare-ups.
Assess patients medication
knowledge.
Provide adequate symptom
management.
MedicAlert bracelet
Provide emotional and
psychological support.. A big
one!
(Mosby, 2009; Lupus Society of Canada, 2007)
Case Study
Mrs. Sour Hip is a 66 year old female who has
suffered from lupus for the past 30 years. Mrs.
Sour Hip experiences many joint-related lupus
symptoms, particularly in her right hip. She
will be undergoing a right hip replacement
surgery next week. Her medical history
includes systemic lupus erythematosus, HTN,
a. fib, pneumonia in winter 2010, and a history
of pernicious anemia for which she receives
Vitamin B12 s/c q2months. Her medications
include long-term corticosteroid therapy to
help manage her lupus.
Questions?
References
American Academy of Orthopaedic Surgeons. (2012) . Arthritis. Retrieved from
http://orthoinfo.aaos.org/menus/arthritis.cfm
Arthritis Foundation. (2012). Common Myths. Retrieved from
http://www.arthritis.org/aam-common-myths.php
Arthritis Society. (2010). Lupus. Retrieved from
http://http://www.arthritis.ca/document.doc?id=327
Arthritis Society. (2011). Osteoarthritis: Know Your Options. Retrieved from
http://www.arthritis.ca/document.doc?id=328
Arthritis Society. (2012). About Arthritis. Retrieved from
http://www.arthritis.ca/aboutarthritis
Canadian Arthritis Network. (2007). Arthritis Facts and Figures. Retrieved from
http://www.arthritisnetwork.ca/home/Facts_and_Figures_2010.pdf
Cartilage Health. (2008). What is articular cartilage? Retrieved from
http://www.cartilagehealth.com/acr.html
Canadian Psychological Association. (2012). Arthritis. Retrieved From
http://www.cpa.ca/psychologyfactsheets/arthritis/
Day, R. A., Paul, P., Williams, B., Smeltzer, S. & Bare, B. (2007). Canadian
textbook of medical surgical Nursing (1st Canadian Ed.). Philadelphia:
Lippincott Williams & Watkins.
Firth, J. (2011). Rheumatoid arthritis: diagnosis and multidisciplinary
management.
Nursing, 20(18), 1179-80.
References cont.
Firth, J. (2011). Rheumatoid arthritis: diagnosis and multidisciplinary management.
Nursing, 20(18), 1179-80.
Gulanick, M. & Myers, J. (2011). Nursing Care Plans: Diagnoses, Interventions, and Outcomes
(7th ed.). St.Louis, MO: Elsevier Mosby.
John Hopkins Arthritis Center. (2012). Nutrition and Rheumatoid Arthritis. Retrieved from
http://www.hopkinsarthritis.org/patient-corner/disease-management/rheumatoid-arthrtisnutrition/
Lupus Society of Canada. (2007). Lupus Fact Sheet: Takling About Lupus. Retrieved from
http://www.lupuscanada.org/pdfs/factsheets/Talk-Online.pdf
Lupus Society of Canada. (2012). Living with Lupus: Lupus Overview. Retrieved from
http://www.lupuscanada.org/english/living/lupus-overview.html
Mosby. (2009). Mosbys Dictionary of Medicine, Nursing, & Health Professions (8th ed.). St.
Louis, MO: Author.
Myers, J., Gulanick, M. (2011). Nursing Care Plans (7th ed.). Elsevier
National Institute of Arthritis & Musculoskeletal & Skin Diseases. (2010). Handout on Health:
Osteoarthritis. Retrieved from
http://www.niams.nih.gov/Health_Info/Osteoarthritis/default.asp
Oliver, S. (2011). The role of the clinical nurse specialist in the assessment and management
of biologic therapies. Musculoskeletal Care Journal. 9, 54-62.
Sung-Jae, K., Kwang-Am, J. (2007). Arthroscopic Synovectomy in Rheumatoid Arthritis of
Wrist. Clinical Medical Research, 5(4), 244-250.
Walker, J. (2012). Care of patients undergoing joint replacements, Nursing Older People, 24(1),
14-20.
Walker, J. (2011). Management of osteoarthritis. Nursing Older People, 23(9), 14-19.