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Osteoarthritis (Degenerative Joint Disease, DJD)

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Osteoarthritis (Degenerative Joint Disease, DJD) Progressive degeneration of the joints as a result of wear & tear. Causes the formation of bony buidup & the loss of ... – PowerPoint PPT presentation

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Title: Osteoarthritis (Degenerative Joint Disease, DJD)


1
Osteoarthritis (Degenerative Joint Disease, DJD)
  • Progressive degeneration of the joints as a
    result of wear tear.
  • Causes the formation of bony buidup the loss of
    articular cartilage in peripheral axial joints.
  • Affects the weight-bearing joints joints that
    receive the greatest stress, such as the knees,
    toes, lower spine.
  • The cause is unknown but may be trauma,
    fractures, infections, or obesity.

2
Osteoarthritis (Degenerative Joint Disease, DJD)-
Assessment
  • Joint pain that early in the disease process
    diminishes after rest intensifies after
    activity
  • As the disease progresses, pain occurs with
    slight motion or even at rest.
  • Symptoms are aggravated by temperature change
    humidity.
  • Crepitus
  • Joint enlargement
  • Limited ROM
  • Difficulty getting up after prolonged setting
  • Skeletal muscle atrophy

3
Osteoarthritis (Degenerative Joint Disease, DJD)
  • Inability to perform activities of daily living
  • Compression of the spine as manifested by
    radiating pain, stiffness, muscle spasm in one
    or both extremities.
  • Presence of Heberdens nodes or Bouchards nodes

4
Osteoarthritis (Degenerative Joint Disease, DJD)
Implementation
  • Administer NSAIDs, salicylates, and muscle
    relaxants
  • Prepare for corticosteroid injections into joints
  • Place affected joint in functional position
  • Immobilize the affected joint with splint or
    brace
  • Avoid large pillows under the head or knees
  • Provide a foot cradle
  • Position the client prone twice a day

5
Osteoarthritis (Degenerative Joint Disease, DJD)
  • Position the client prone twice a day
  • Instruct the important of moist heat, hot packs
    or compresses paraffin dips
  • Apply cold applications when the joint is acutely
    inflamed.
  • Encourage adequate rest
  • Encourage a well-balanced diet
  • Encourage weight loss if necessary
  • Reinforce the exercise program the important of
    participating in the program.

6
Osteoarthritis (Degenerative Joint Disease, DJD)
  • Instruct to stop exercise if pain is increased
    with exercising
  • Instruct to decrease the number of of repetitions
    in an exercise when the inflammation is severe.
  • Surgical Management Osteotomy- the bone is cut
    to correct joint deformity promote realignment.
  • Total joint replacement performed when all
    measures of pain relief have failed. Hips knees
    are most commonly replaced. Contraindicated in
    the presence of infection, advanced osteoporosis,
    or severe inflammation.

7
Rheumatoid Arthritis (RA)
  • Chronic systemic inflammatory disease the
    etiology may be related to a combination of
    environmental genetic factors.
  • Leads to destruction of connective tissue and
    synovial membrane within the joints.
  • Weakens leads to dislocation of the joint
    permanent deformity.
  • Exacerbations are increased by physical or
    emotional stress
  • Risk factors include exposure to infectious
    agents fatigue stress can exacerbate the
    condition.

8
Rheumatoid Arthritis (RA)implementation
  • Inflammation, tenderness, stiffness of the joints
  • Moderate to severe pain AM stiffness lasting
    longer than 30 minutes
  • Joint deformities, muscle atrophy decreased ROM
  • Spongy, soft feeling in the joints
  • Low-grade temperature, fatigue, weakness
  • Anorexia, weight loss anemia
  • Elevated ESR positive RA
  • X-ray showing joint deterioration
  • Synovial tissue biopsy presents inflammation

9
Rheumatoid Arthritis (RA)
  • Pain-Salicylates (ASA). Monitor for side effects,
    including tinnitus, GI upset prolonged bleeding
    time. Administer with meals or a snack. Monitor
    for abnormal bleeding or bruising.
  • Nonsteroidal antiinflammatory drugs (NSAIDS)
  • May be prescribed in combination with
    salicylates if pain inflammation have not
    decreased within 6 to 12 weeks following
    salicylate therapy.
  • Corticosteroids Administer during exacerbations
    or when commonly used agents are ineffective.

10
Rheumatoid Arthritis (RA)
  • Antineoplastic medications Administer in clients
    with life- threatening RA
  • Gold salts Administer in combination with
    salicylates NSAIDS to induce remission
    decrease pain inflammation.
  • Preserve joint function
  • Balance rest and activity
  • Prevent flexion contractures
  • Apply heat or cold therapy
  • Apply paraffin bath massage

11
Rheumatoid Arthritis (RA)
  • Exercise only to the point of pain
  • Avoid weight bearing on inflamed joints
  • Identify factors that may contribute to fatigue
  • Monitor for signs of anemia
  • Administer iron, folic acid Vitamin supplement
  • Monitor for drug-related blood loss by testing
    the stool for occult blood
  • Asses the clients reaction to the body change
  • Encourage to verbalize feelings

12
Rheumatoid Arthritis (RA)
  • Surgical intervention Synovectomy removal of
    the synovia to help maintain joint function.
  • Arthrodesis Bony fusion of a joint to regain
    some mobility.
  • Joint replacement (arthroplasty) removal of
    diseased joints with artificial joints performed
    to restore motion to a joint function to the
    muscles, ligaments other soft tissue structures
    that control a joint.

13
Gout
  • A systemic disease in which urate crystal deposit
    in joints other body tissues
  • Leads to abnormal amounts of uric acids in the
    body
  • Primary gouts results from a disorder of purine
    metabolism
  • Secondary gout involves excessive uric acid in
    the blood that is caused by another disease.

14
Gout (phases)
  • Asymptomatic No symptoms. Serum uric acid is
    elevated.
  • Acute Excruciating pain inflammation of one or
    more small joints, especially the great toe.
  • Intermittent Asymptomatic period between acute
    attacks
  • Chronic results from repeated episodes of acute
    gout. Deposits of urate crystal under the skin
    and within the major organ, especially the renal
    system.

15
Gout (assessment)
  • Excruciating pain in the involved joints
  • Swelling Inflammation of the joints
  • Tophi (hard, fairly large, irregularly shaped
    deposits in the skin) that may break open
    discharge a yellow gritty substance
  • Low-grade fever
  • Malaise headache
  • Pruritis
  • Presence of renal stones
  • Elevated uric acid levels

16
Gout (implementation)
  • Provide a low purine diet
  • Instruct to avoid foods, such as organ meats,
    wines, aged cheese
  • Encourage a high fluid intake of 2000 ml to
    prevent stone formation
  • Encourage weight-reduction diet
  • Instruct the client to avoid alcohol 7 starvation
    diets because they may precipate a gout attack.
  • Provide bedrest during the attack

17
Gout
  • Monitor the joint in mild flexion during acute
    attack.
  • Elevate the affected extremity
  • Protect the affected joint from excessive
    movement or direct contact with sheets or
    blankets
  • Provide heat or cold for local treatments to
    affected joints
  • Administer NSAIDs antigout medications.

18
Systemic Lupus Erythematosus (SLE)
  • A chronic progressive systemic inflammatory
    disease that can cause major organs systems to
    fail.
  • Connective tissue fibrin deposits in blood
    vessels, collagen fibers organs
  • Leads to necrosis / or inflammation of blood
    vessels, lymph nodes, GI tract, pleura.
  • There is no cure for the disease.
  • Cause is unknown although the disease is due to
    defect in the immunological mechanisms or to have
    a genetic origin

19
Systemic Lupus Erythematosus (SLE)
  • Precipitating factors include medications,
    stress, genetic factors, sunlight or ultraviolet
    light pregnancy.
  • Assessment Dry scaly raised rash on the face or
    upper body
  • Fever, weakness, malaise, fatgue
  • Anorexia, weight loss, photosensitivity
  • Joint pain, erythema of the palms, anemia
  • Positive antinuclear (ANA) LE prep.
  • Elevated ESR.

20
Systemic Lupus Erythematosus (SLE)
(Implementation)
  • Monitor skin integrity provide frequent oral
    care
  • Instruct to clean skin with mild soap, avoiding
    harsh perfumed substances
  • Assist with the use of ointments creams for
    rash
  • Instruct inmeasures to conserve energy, such as
    pacing activities balancing rest with exercise.

21
Systemic Lupus Erythematosus (SLE)
  • Administer topical or systemic corticosteroids,
    salicylates NSAIDs.
  • Administer hydroxychloroquine (Plaquenil) to
    decrease the inflammation.
  • Instruct to avoid exposure to sunlight
    ultraviolet light
  • Monitor for proteinuria red cell casts in the
    urine
  • Monitor for brusing, bleeding injury.

22
Systemic Lupus Erythematosus (SLE)
  • Assist with plasmapheresis to remove
    autoantibodies immune complexes from the blood
    before organ damage occurs.
  • Monitor for signs of organ involvement, such as
    pleuritis, nephritis, pericarditis, neuritis,
    anemia peritonitis.
  • Provide supportive therapy as major organs become
    affected.
  • Provide emotional support encourage to
    verbalize feelings.
  • Provide group information regarding support
    groups, encourage utilization of community
    resources.
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