DEGENERATIVE JOINT

DISEASE

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 Objectives
Identify non-surgical and surgical
interventions for osteoarthritis.
Discuss the common complications of
osteoarthritis.
Identify three nursing interventions to
treat osteoarthritis.

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 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. CRP, R/A factor, CBC with differential
B. CT of the left knee, X-rays of both hands
C. X-rays of affected extremities
D. MRI of the affected extremity
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 Answer #1
C. X-ray of the affected extremities

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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
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Commonly Involved Joints
Distal interphalangeal joints
First carpometacarpal joint
Weight bearing joints: spine, hips, knees

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Epidemiology
Greatest factor: AGE
Genetic link
Hormonal Factors
Obesity
Others

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 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

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 Pathophysiology
Cartilage erosion to bone
Cartilage digested
Nutritional deprivation
Osteophyte formation
Prostaglandin release
Secondary synovitis

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 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
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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

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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, Heberdens nodes (DIP),
Bouchards nodes (PIP), flexion
contractures, knee varus/valgus

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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
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Answer #3
D. Glucosamine should be taken with
Chondroitin

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 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
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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

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 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

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 Answer #4
A. NSAIDs can cause bleeding. Signs such as
tarry stools, bruising, petechia should be
reported to the health care provider
immediately.

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 Intermediate Therapeutic
Modalities
Pharmacological
Acetaminophen
ASA
NSAIDS
Glucosamine/Chondroitin/MSM etc.
Joint injections
Steroid, Hyaluronic Acid
Long acting opiods

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 Complications
Pain - aching; severe in late stage
Decreased ROM
Decreased function
Decreased ADL status
Joint Contractures
Depression/isolation

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Late Therapeutic Modalities
Surgery
Osteotomy
Debridement
Arthrodesis
Arthroplasty (TKA, THA)
Cemented
Cementless
Hybrid
Minimally invasive
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 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. Infection
B. Bleeding
C. DVT
D. Muscle wasting
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 Answer #5
C Foot pumps, LMWH, and sequential
compression devices are routinely utilized after
joint replacement to prevent DVT and PE.

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 Nursing Diagnoses
Pain Impaired Home
Sleep-Pattern Maintenance
Disturbance Ineffective Coping
Alterations in Impaired
Nutrition Adjustment
Impaired Physical Altered Sexuality
Mobility
Self-Care Deficits

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 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 dentists discretion
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 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 immuno-
suppressed.

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Nursing Interventions
Pain management, PCA Assistance
Constipation Management
Exercise Therapy: Joint Mobility
Fall Prevention
Positioning
Self-care Assistance
Wound care

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Nursing Interventions
Teaching
Wound Care
S/S infection
S/S complications
THA - Abduction, 90*
TKA - Neutral, Extension
WB status
Assistive Devices

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