what part of the hand is spared by rheumatoid arthritis
distal interphalangeal joints (close to fingernail)
which age group is affected by rheumatoid arthritis
35-45 years old
which age group is affected by osteoarthritis
60 and older
what condition affects weight bearing joints, hands and the spine
osteoarthritis
what part of the hand is spared from osteoarthritis
metacarpophalangeal joints (the knuckles)
bone and cartilage floating in the joint space is associated with which condition
osteoarthritis
what are primary causes of osteoarthritis
aging, genetic factors, weight bearing/overuse
what are secondary causes of osteoarthritis
joint injury, joint overuse, obesity, other joint diseases (rheumatoid arthritis)
heberden nodules is located on which part of the hand
distal interphalangeal joint (DIP)
bouchard nodules is located on which part of the hand
proximal interphalangeal joints (PIP)
persistent joint pain, stiffness and crepitus is associated with which condition
osteoarthritis
what happens when a patient with osteoarthritis is inactive
stiffness follows inactivity for less than 30 minutes
what is a telltale sign of osteoarthritis
swelling in the hands from herberden and bouchard nodules
what is the first line drug for persistent pain for osteoarthritis
acetaminophen
who is more at risk of liver damage while taking acetaminophen
a patient who is an alcoholic or liver disease
what would you teach a patient in regards to taking acetaminophen
teach them to read OTCD to see if acetaminophen is an ingredient
what is the next first line drug after acetaminophen
lidocaine 5% patch
how many patches of lidocaine can you apply to a painful joint at one time
3 patches
what will you teach the patient about lidocaine patch
apply to clean intact skin 12hrs/day
lidocaine 5% patch is contraindicated in which patient?
a patient taking antidysrhythmic drugs
second line drugs for persistent pain in osteoarthritis
celecoxib and diclofenac patch
what are the side effects of the diclofenac patch
it can cause cardiovascular and GI effects
celecoxib is contraindicated in a patient with
hypertension, kidney disease or CVD
with long term use of celecoxib what effect can happen
bleeding and acute kidney injury
vasoconstriction and platelet clumbing by the use of celecoxib can cause which conditions
hypertension and MI
what will you have the patient report if using celecoxib
dark tarry stools, SOB, edema, dyspepsia, hematesis, change in UO
if first and second line of drugs do not work for a patient with osteoarthritis you would administer what next?
tramadol (opioid)
tramadol can cause what in an older adult?
confusion
the nurse will teach the patient what when using tramadol?
do not drive or operate heavy machinery
patients may turn to OTC drugs and supplements for their pain such as
topical capsaicin, glucosamine, chondroitin
patient teaching for the use of topical capsaicin is
the med can cause burning sensation, use gloves and wash hands
if you want to strengthen cartilage using OTC/supplement you will use which drug?
chondroitin
if you want to decrease inflammation using OTC/supplement you will use which drug?
glucosamine
what will you teach the patients about nonpharmacological pain management
don't sleep with pillows under the knees, insoles in shoes, proper posture when sitting/standing
contraindications for surgical management is
progressive inflammation or infection anywhere in the body
what two things will you control preoperatively before THA/TKA
BP and glucose
decreased soft tissue damage, decreased blood loss and decreased post op pain and length of hospital stay is because the surgeon used which surgical technique?
minimally invasive surgery
after surgery for THA the nurse will conduct what post op
neurovascular assessment
to prevent dislocation after THA the nurse will have the patient use a
abduction pillow
the patient undergone a THA, the patient cannot communicate but is showing signs of agitation the nurse should recognize this as a possible?
hip dislocaiton
what are signs of hip dislocation?
pain, shortening leg, affected leg rotation
which patients are allowed immediate total weight bearing as tolerated?
those with cemented implants
which patients are told minimal weight bearing until bony ingrowth is shown on an xray?
those with non cemented implants
when can a patient transition to a single crutch or cane?
4-6 weeks post op if no severe limp
you teach your patient to call 911 when what happens?
hip dislocation, acute chest pain or SOB
patients with a total knee replacement will receive what pre operately?
nasal mupirocin daily x1 week
what is a normal finding after a TKA
swollen discolored knee
for young patients undergoing surgery which drug can be effective in treating their pain?
IV acetaminophen
what is not a complication of TKA?
dislocation
a patient has restricted joint motion and decreased functional ability due to which condition after their TKA?
arthrofibrosis
what exercises should you avoid in osteoarthritis when severely inflamed?
resistive exercises
what forms in the joint space of rheumatoid arthritis?
pannus
a patient has developed vasculitis, the nurse knows the patient is at risk for what?
organ damage
your patient has lost some weight, complains of feeling weak and very fatigued. you check their temperature and they have a low grade fever and they tell you they occasionally wake up stiff in the morning. the nurse knows these are signs of?
early rheumatoid arthritis
a patient comes in with brown spots around their nail bed, the nurse knows this is a sign of?
vasculitis
your patient has osteoporosis, severe fatigue and pain, joint deformities and rheumatoid nodules. these sx are consistent with
advanced rheumatoid arthritis
in advanced rheumatoid arthritis what does the joints of your patient feel like?
soft and puffy
which nodules can appear and disappear?
rheumatoid nodules
life threatening condition that can happen with RA is?
subluxation
what will you expect to see with the synovial fluid after an arthrocentesis is performed if the patient has RA?
cloudy increased volume, with increased WBC
you wont give celecoxib to which patient?
one who had open heart surgery
celecoxib has a high risk for what?
GI bleeding
for a patient with RA taking NSAIDs for their chronic inflammation and persistent pain, they must take their NSAIDs with?
H2 blocker (famotidine)
the patient has been prescribed methotrexate and been on it for 2 weeks. they claim they still have not seen an improvement. the nurse should make which statement?
this drug takes 4-6 weeks to impact joint inflammation
a patient taking methotrexate, what should a nurse look our for with this patient?
signs of infection
a patient comes in with bruising and bleeding, labs show they have low platelets. the nurse knows this is because they are taking?
methotrexate which causes thrombocytopenia
a woman is taking methotrexate, you teach her to have another contraception method because?
methotrexate can cause birth defects
how many months should a women stop taking methotrexate before trying for pregnancy?
3 months
you can lessen the side effects of methotrexate if it taking with what?
folate
a patient comes in with pneumonitis, they have dyspnea and are complaining about sores in their mouth. labs came back and shows LFT and creatinine elevations. the nurse knows these are sx of which drug?
methotrexate
hair loss, diarrhea, birth defects, leukocytopenia, and thrombocytopenia are adverse effects of which drug?
leflunomide
how long does is take to get the max benefit of leflunomide?
4-6 weeks up to 3 months
light headedness, stomach discomfort and headaches are consistent with which drug?
hydroxychloroquine
hydroxychloroquine is contraindicated in which patients?
those with cardiac diseases and dysrhythmias
a patient comes into the clinic complaining of blurred vision, and a headache. the nurse knows this is a serious side effect of?
retinal damage caused by hydroxychloroquine use
a nurse is teaching a patient about side effects of sulfasalazine, the nurse tells the patient it can cause
nausea, vomiting and a skin rash
abatacept, etanercept, infliximab, rituximab can cause a patient to be high risk for what?
impaired immunity
due to the impaired immunity from abatacept the patient should be informed to refrain from getting what?
live vaccinations
abatacept or infliximab is contraindicated in patients with which conditions?
infections, MS or pos PPD
teaching for a patient taking infliximab would be?
avoid large crows and ppl with infections
glucocorticoids like prednisone and cortisone can cause which conditions?
diabetes, HTN, osteoporosis, glaucoma, adrenal insufficiency and F&E imbalace
the patient undergone a procedure that cleaned their plasma of antibodies from their blood and got it reinfused into their body. this procedure is called?
plasmapheresis