CC Connective Tissue

  1. Name one noninflammatory and two inflammatory connective tissue diseases
    • Noninflammatory: OA
    • Inflammatory: RA, SLE
  2. Describe Osteoarthritis (OA)
    • Also called Degenerative Joint Disease (DJD)
    • Progressive deterioration and loss of cartilage (esp articulating cartilage)
    • Synovial fluid decreases (esp with age)
    • With the erosion of cartilage and decrease in synovial fluid, the joint space narrows and osteophytes (bone spurs) form
    • Deterioration of the joint occurs faster than the body can repair it
    • Eventually pieces of bone and cartilage break off and float in the joint space causing crepitis
  3. What are the s/s of osteoarthritis? What may be found upon assessment?
    • Joint pain- first with movement and then continuously
    • Joint stiffness- esp in morning, and then with any movement
    • Decreased mobility
    • Slowed Gait
  4. What is the etiology of primary and secondary OA?
    • Primary: aging (esp in hands), genetics, obesity, smoking
    • Secondary: heavy manual occupation (construction, carpet installer), sports, trauma
  5. What medications can be used for OA?
    • Acetaminophen (Tylenol)
    • Salicylic Acid (Aspirin)
    • Celecoxib (Celebrex)
    • Cyclobenzaprine (Flexeril)
    • Glucosamine
    • Cortisone
  6. Describe Acetaminophen (Tylenol) use for OA
    • Action: lowers the hypothalmic set point to reduce fever and activates the descending inhibitory seroteonergic pathways to produce analgesic effect
    • Classification: Antipyretic and analgesic
    • Anti-inflammatory effect is so small it is not clinically significant
    • AE: hepatotoxic
  7. Describe Salicylic Acid (Aspirin) use for OA
    • Actions: Inhibits platelet aggregation by inhibiting the generation of thromboxane. Blocks prostaglandin production and has analgesic effect
    • Classification: NSAID, analgesic, antipyretic, platelet inhibitor
    • SE: Monitor for toxicity (Acetylcysteine is the antidote, common sign is tinnitus), stomach upset or bleed, and always check for anticoag therapy prior to surgery
  8. Describe Celecoxib (Celebrex) use for OA
    • Action: celecoxib blocks the enzyme that makes prostaglandins resulting in a lower amount and decreased pain
    • Classification: cox-2 inhibitor, NSAID
    • AE: stomach bleed or perf, CVA, MI
  9. Describe Cyclobenzaprine (Flexeril) use for OA
    • Action: decreases firing of alpha motonneuron results in decreased muscle tone
    • Classification: muscle relaxant primarily acts on CNS
    • SE:HA, dry mouth, confusion, dizziness, anxiety, tachycardia, n/v/d, hallucinations, seizures, allergic reaction
    • Considerations: half life doubled over 65 y/o, higher dose needed
  10. Describe Glucosamine use for OA
    • Nutritional supplement taken for OA that may decrease inflammation
    • Made of glucose and amino acids, stimulates cartilage production and inhibits degradation of joint
    • Considerations: Do not take if you have HTN, are pregnant or BF,┬áMay increase BS if diabetic, bleeding precautions if taking with chondroitin or anticoag meds
    • SE: rash, diarrhea, drowsiness, HA
  11. Describe cortisone use for OA/RA
    • Actions: modulates the synthesis an release of a number of chemical mediators of inflammation, including prostaglandins and histamines
    • Classification: Steroid, anti-inflammatory
    • Considerations: may be injected directly into the joint
    • SE: muscle weakness, osteoporosis, CHF, n/v/d, peptic ulcers, HA, seizures, cushingoid symptoms, cataracts, hypokalemia
  12. What non-pharmaceutical treatments may be used for OA?
    • Rest, both of the joint and overall
    • Heat/Cold therapy (safety concern to prevent burns)
    • Use of cane on strongest side of body
  13. What surgical intervention may be done for OA? What is the indication and what is the main contraindication?
    • Total Joint Arthroplasty (TJA) or replacement (TJR)
    • Total Hip Arthroplasty (THA) or replacement (THR)
    • Total Knee Arthroplasty (TKA) or replacement (TKR)
    • Total Shoulder Arthroplasty (TSA)
    • Total Elbow Arthroplasty (TEA)
    • Indicated when pain/mobility are uncontrolled
    • Contraindicated if any infection is present
  14. What is the difference between a primary and revision arthroplasty?
    • Primary is the initial surgery
    • Revision is surgery done for loosened component or fixation around component
  15. What is the preop nursing care for someone receiving joint replacement?
    • CBC & UA Labs and assessment for any infection, which contraindicates the procedure
    • D/C all anticoag therapy, incl aspirin, 1-2 wks prior to procedure
    • Type and cross match, autologous blood is banked, H/H
    • Chest Xray
    • Pt teaching prior to surgery
    • Preop vital signs, allergies, site marking
    • Cephazolin (Ancef) antibiotics given IV 1 hr prior to cut time
  16. What is the intraoperative nursing care for a patient receiving joint replacement?
    • General or spinal anesthesia
    • Foley catheter with sterile insertion, most likely after the patient is under
    • Autologous blood admin
    • Maintain sterility to prevent infection
    • Maintain contact with family
    • Maintain safety of machinery- saws, drills, irrigation, cautery
  17. Describe the different access points and components used for a THA
    • Anterolateral approach- used for obese patients due to the low risk of dislocation
    • Anterior approach- primary only, decreased muscle damage
    • Acetabular cup is screwed or cemented in
    • Femoral head is friction fit to shaft or in one piece with fem shaft
    • Bone grows into the trochanteric area of femoral shaft
    • Cement called methyl methacrylate sets in 7 minutes and a main SE is hypotension
  18. What post-op nursing care should be done for a client receiving THA?
    • Prevent dislocation/subluxation by preventing 90 degree angles of hips (no knees above hips)
    • Abductor pillow and raised toilet seat used
    • No crossing of legs
    • Assess for dislocation with external rotation and leg shortening
    • Neuro checks should be done distal to the incision site
    • Always check for DVTs and FE (always applicable when long bones are involved)
  19. What are some ways to prevent infection during a joint replacement?
    • Use sterile techniques for all dressing changes and drain care
    • Maintain hemovac vaccuum
    • Proper hand washing for personal and client
    • Assess incision sites for q8hr
    • CBC labs for WBC differential (elderly may not get feverish with infection)
  20. How can thromboembolisms be prevents after a joint replacement?
    • Low Molecular Weight Heparin
    • Compression devices on legs
    • Early ambulation
    • TED hose
    • Leg exercises
  21. What risk factors put a person at risk of needing a TKA?
    • Obesity
    • OA, reduced joint space
    • Pain, esp with stairs
    • Crepitus
    • Decreased mobilities and ADLs
  22. What special intraoperative and post operative care should be taken for a TKA?
    • IV antibiotics 1 hr prior to cut time
    • Components are usually friction fit with cement
    • Continuous passive motion (CPM) may be used to keep prosthetic in motion
    • Ice packs to the knee first 24 hrs, then as comfortable
    • No special positioning, CMS checks distal to site
  23. What is RA?
    • Chronic, progressive, systemic inflammatory autoimmune disease that affects synovial joints
    • Affects primarily european americans
    • Fluid accumulates in the joint space, articular cartilage is eroded, calcification forms
    • Permanent joint damage occurs (Can be prevented or reduced if diagnosed early)
    • Remissions and exacerbations occur
  24. What are the early vs. late S/S of RA?
    • Early S/S:
    • Morning joint stiffness (gel phenomenon)
    • Edema
    • Pain
    • Late S/S:
    • Nodular joint deformity
    • Late S/S (systemic):
    • fatigue
    • weakness
    • anorexia
    • low-grade fever
    • Cardiac and pulmonary involvement
  25. How is RA diagnosed and treated?
    • Diagnosed with x-ray, Rheumatoid factor (Serum) and ESR lab
    • May be treated with a Total joint replacement (TJR)
    • Medications include NSAIDS, corticosteroids (prednisone),┬áDisease-modifying antirheumatic drugs (DMARDs) (methotrexate), Biologics (humira)
  26. Describe the differences and similarities between TKA and THA
  27. Describe the differences and similarities between OA and RA
Card Set
CC Connective Tissue
For Gordon's Exam 1