Transcript Nursing Management: Osteoarthritis and Rheumatoid Arthritis

Nursing Management:
Osteoarthritis and Rheumatoid Arthritis
What is it?
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
Arthritis
Over 100 different types

Prevalence
52.5 million adults, 1 in 5 (CDC)
Disability
 Osteoarthritis and Rheumatoid Arthritis
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Etiology
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Osteoarthritis

Idiopathic
Unknown

Secondary
Cartilage damage or
joint instability
Rheumatoid Arthritis
Unknown
 Autoimmune (?)

Osteoarthritis
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Rheumatoid Arthritis
Age at onset
Usually > 40
Young to middle age
Gender
F to M ratio is 3:1
Before 50, M>F
After 50, F>M
Systemic (Y/N) No
Yes
Pain
AM stiffness > 1 hr,
may  with use
AM stiffness < 30 min,
 with use,  with rest
Clinical Manifestations
Osteoarthritis
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Rheumatoid Arthritis
Affected Joints Often asymmetric, weightbearing joints first
Usually symmetrical, small
joints first
Deformity
Heberden’s (DIP) and
Bouchard’s (PIP) nodes
Ulnar drift, swan neck,
Boutonnière, subluxation
Disease
Localized disease with
variable, progressive
course
Systemic disease with
exacerbations and remission
Clinical Manifestations
Typical deformities of rheumatoid arthritis.
A, Ulnar drift. B, Boutonnière deformity.
C, Hallux valgus. D, Swan neck deformity.
Musculoskeletal Complaint
Use initial assessment to determine:
1.Is it intra- or extra-articular?
2.Is it acute or chronic?
3.Is inflammation present?
4.How many/which joints are involved?
5.Is involvement symmetric?
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Assessment: Subjective
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History of present illness: Symptoms
Past Medical History: Medical & Surgical Hx, trauma,
medication hx, menopause
Social History: Diet, exercise, repetitive physical
activity (sports and/or occupation)
Family History: Genetic factors (RA)
Assessment: Objective
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General: VS, appearance, demeanor, affect
MSK: Symmetry, surrounding tissues, ROM, muscle strength,
swelling, warmth, tenderness, redness
Integument: Keratoconjunctivitis, subcutaneous rheumatoid
nodules, skin ulcers
Sjögren’s syndrome:  lacrimal and salivary secretion
GI: Splenomegaly (Felty syndrome)
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Labs: Rheumatoid Factor,
Anti-CCP, ESR, CRP
Imaging: X-ray, bone scan,
CT, or MRI
Other tests: Synovial fluid
analysis
By Bernd Brägelmann Braegel with Dr. Martin Steinhoff (Own work) [GFDL or CC BY 3.0], via Wikimedia Commons
Labs & Diagnostics
Physiological: ABCD
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Acute or chronic pain
 Impaired physical mobility
 Self-care deficit
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Psychological
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Chronic low self-esteem
 Disturbed body image
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Interventions
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Monitor: Pain, ROM, participation in ADLs
Administer:
Medications: NSAIDS, DMARDS
Pain-relieving measures: therapeutic heat/cold, rest,
relaxation techniques, biofeedback, TENS, splints,
psychologic support
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Support & Educate:
 Use of assistive devices
 Joint protection and
energy conservation
 Therapeutic exercise
 Nutrition and weight
management
National Institute of Arthritis and Musculoskeletal and Skin Diseases, Public Domain
Interventions
Evaluation: Desired Outcomes
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Maintenance or improvement in joint function
 Effective use of joint protective measures
 Management of pain through the use of both
pharmacologic and non-pharmacologic strategies

Evaluation: Desired Outcomes
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Achievement of maximal amount of independence
with ADLs
 Maintenance of a
positive self-image
