DEGENERATIVE JOINT
DISEASE
1
Objectives
• Identify non-surgical and surgical
interventions for osteoarthritis.
• Discuss the common complications of
osteoarthritis.
• Identify three nursing interventions to
treat osteoarthritis.
2
Question #1
• Mrs. Tyler sees her NP for complaints of
soreness in both hands and swelling, soreness,
and pain in her left knee. Which of the
following diagnostic exams will most likely be
ordered to confirm a diagnosis of
osteoarthritis?
–
–
–
–
A.
B.
C.
D.
CRP, R/A factor, CBC with differential
CT of the left knee, X-rays of both hands
X-rays of affected extremities
MRI of the affected extremity
3
Answer #1
• C. X-ray of the affected extremities
4
Classification of Osteoarthritis
• Primary osteoarthritis - most common in
older age group due to degenerative
changes in joints
• Secondary osteoarthritis - results from a
previous process that damaged cartilage
such as trauma, or inflammatory
arthritis
5
Commonly Involved Joints
• Distal interphalangeal joints
• First carpometacarpal joint
• Weight bearing joints: spine, hips, knees
6
Epidemiology
•
•
•
•
•
Greatest factor: AGE
Genetic link
Hormonal Factors
Obesity
Others
7
Question #2
• Mrs. Tyler tells the nurse that she will try
alternative therapies for treatment of her
arthritis symptoms. The nurse:
A. Discourages the use of these therapies
B. Maintains a nonjudgmental attitude about
the therapies..
C. Reports the patient to the doctor.
D. Encourages utilization of any form of
alternative therapy
8
Answer #2
• B. The nurse should maintain a
nonjudgmental attitude toward the use of
alternative therapies
9
Pathophysiology
•
•
•
•
•
•
Cartilage erosion to bone
Cartilage digested
Nutritional deprivation
Osteophyte formation
Prostaglandin release
Secondary synovitis
10
Imaging
• Dx by plain films includes identification
of:
–
–
–
–
Asymmetric joint space narrowing
Osteophytes-bony spurs
Degenerative cysts
Sclerosis of subchondral bone
• CT or MRI are also useful on certain
occasions
11
OA of the Hip
OA of the Fingers
OA of the Knee
OA of the Spine
Diagnostic Tests
• Laboratory
– No specific test
– ESR might be elevated
– Synovial fluid is not specific; may have
calcium/crystals
16
Hallux Valgus
Assessment
• Pain - decreased with rest, localized, at
night in late stage
• Decreased ROM & am stiffness, limp,
joint instability
• Joint swelling/deformity - crepitus,
asymmetric, Heberden’s nodes (DIP),
Bouchard’s nodes (PIP), flexion
contractures, knee varus/valgus
18
Question #3
Mrs Tyler tells the nurse that she wants to
include Glucosamine in her daily
medications. The nurse knows this is
most effective when taken with:
A. SAM-E
B. Ginger
C. Boswellia
D. Chondroitin
19
Answer #3
• D. Glucosamine should be taken with
Chondroitin
20
Treatment Goals
• Decrease pain & inflammation
• Maintain or improve joint function
• Limit disability by preventing or
correcting deformity
• Optimal role function/independent self
care
• Avoidance of adverse drug events
21
Early Therapeutic Modalities
• Non-pharmacological
–
–
–
–
–
–
Exercise program & weight loss
Ice, heat, topical creams
Joint protection & energy conservation
Splints,braces, assistive devices
TENs Unit
Massage, biofeedback, relaxation
22
Question #4
•
Mrs. Tyler has been taking a prescribed
NSAID for several weeks for increasing pain
in her knee. She should report which of the
following:
– A. Bruising
– B. Itching
– C. Weight loss
– D. Fatigue
23
Answer #4
• A. NSAID’s can cause bleeding. Signs such as
tarry stools, bruising, petechia should be
reported to the health care provider
immediately.
24
Intermediate Therapeutic
Modalities
• Pharmacological
–
–
–
–
–
Acetaminophen
ASA
NSAIDS
Glucosamine/Chondroitin/MSM etc.
Joint injections
• Steroid, Hyaluronic Acid
– Long acting opiods
25
Complications
•
•
•
•
•
•
Pain - “aching”; severe in late stage
Decreased ROM
Decreased function
Decreased ADL status
Joint Contractures
Depression/isolation
26
Late Therapeutic Modalities
• Surgery
–
–
–
–
Osteotomy
Debridement
Arthrodesis
Arthroplasty (TKA, THA)
•
•
•
•
Cemented
Cementless
Hybrid
Minimally invasive
27
Question #5
• After total knee replacement, Mrs. Tyler
asks why she is has to wear the foot
pumps. The nurse explains that these are
used to prevent:
–
–
–
–
A.
B.
C.
D.
Infection
Bleeding
DVT
Muscle wasting
28
Answer #5
• C Foot pumps, LMWH, and sequential
compression devices are routinely utilized after
joint replacement to prevent DVT and PE.
29
Nursing Diagnoses
• Pain
• Sleep-Pattern
Disturbance
• Alterations in
Nutrition
• Impaired Physical
Mobility
• Self-Care Deficits
• Impaired Home
Maintenance
• Ineffective Coping
• Impaired
Adjustment
• Altered Sexuality
30
Question #6
• Which of the following is an indication
for antibiotic premedication in post TJR
patients receiving routine dental work?
A. Those with replacement within 2 years.
B. All joint replacement patients should
premedicate.
C. For invasive dentistry only.
D. At the dentist’s discretion
31
Answer #6
• A. Guidelines now recommend pre-medication
prior to routine dental work in patients who
have had joint replacement within the previous
two years, those patients who have had prior
joint infection, and patients who are immunosuppressed.
32
Nursing Interventions
•
•
•
•
•
•
•
Pain management, PCA Assistance
Constipation Management
Exercise Therapy: Joint Mobility
Fall Prevention
Positioning
Self-care Assistance
Wound care
33
Nursing Interventions
• Teaching
–
–
–
–
–
–
–
Wound Care
S/S infection
S/S complications
THA - Abduction, 90*
TKA - Neutral, Extension
WB status
Assistive Devices
34
35