Understand how these conditions affects a persons everyday life.
Understand the treatments available for RA, OA, & SLE.
Leading cause of disability in Canada
Leading cause of disability in Canada
Affects 1 in 6 individuals
Costs Canadians 33 billion each year
2/3 individuals with arthritis are women
One of the most prevalent chronic diseases of Aboriginal peoples
Skeletal remains from humans living 4500BC show signs of arthritis
By 2031 approximately 7 million people will be living with Arthritis
Has caused more deaths than melanoma, asthma, or HIV/AIDS
Only 1.3% of research is dedicated to arthritis.
# 1: Arthritis isn’t serious
# 1: Arthritis isn’t serious
#2: Arthritis is an old person’s disease
#3:Arthritis is a normal part of aging
#4: Not much can be done for those living with arthritis
#5: People with arthritis can’t exercise
CBC
CBC
Radiographs of involved joints
CT/MRI scans
Direct arthroscopy
Synovial/Fluid aspirate
Synovial membrane biopsy
Arthrocentesis
There are four types of medications used to treat RA:
Non-steroidal anti-inflammatory drugs (NSAIDs)
Disease-modifying anti-rheumatic drugs(DMARDS).
Corticosteroids
Biologic Response Modifiers (“Bioligics”)
Support injured joints and weak muscles
Support injured joints and weak muscles
Improve joint mobility and stability
Help to alleviate pain, swelling and muscle spasm
May prevent further damage and deformity
Osteoarthritis
Osteoarthritis
Most common form of arthritis
Over 3 million Canadians affected (1/10)
Osteoarthritis is defined as “a degenerative joint disease characterized by destruction of the articular cartilage and overgrowth of bone”
Normal Joint: Cartilage covers the end of bones to act as a shock absorber and to promote smooth movement of the joint.
Normal Joint: Cartilage covers the end of bones to act as a shock absorber and to promote smooth movement of the joint.
Osteoarthritis: Cartilage wears down over time. Patients may experience a painful bone-on-bone articulation.
Primary Osteoarthritis – no identifiable reason for arthritis development.
Primary Osteoarthritis – no identifiable reason for arthritis development.
Secondary Osteoarthritis – a likely cause for osteoarthritis exists (e.g. joint injury among professional athletes).
Age
Age
Family History
Excess weight
Joint injury
Complications of other
types of arthritis
MYTH – Normal wear and tear
Joint pain
Joint pain
Feeling joints “locking”
Joint “creaking”
Stiff joints in the morning
Joint swelling
Loss of joint flexibility or strength
Clinical history
X-rays
Physical Assessment
MRIs
Joint Aspirate
Exercise
Exercise
Weight loss
Heat & Cold Therapy
Activity pacing
Maintaining proper joint alignment
Use of assistive devices
Relaxation Exercises
Acetaminophen
Acetaminophen
NSAIDs
Opioids
Corticosteroid injections
Topical analgesics
Glucosamine and chondroitin
Osteotomy
Osteotomy
Arthrodesis
Arthroplasty
Total knee replacement
Total hip replacement
One of the most common surgeries for osteoarthritis
One of the most common surgeries for osteoarthritis
Displacement osteotomy: a bone is “redesigned surgically to alter the alignment or weight-bearing stress areas”
Hip replacements involve replacement of a damaged hip with an artificial acetabulum and femoral component.
Hip replacements involve replacement of a damaged hip with an artificial acetabulum and femoral component.
Often performed for patients with osteoarthritis or rheumatoid arthritis, femoral neck fractures, and problems related to congenital hip disease.
Hip precautions
Hip precautions
Monitor for dislodgement
Abduct leg
Keep HOB less than 60 degrees
Use of fracture bedpan
High-seat surfaces
Sleep on unaffected side
Avoid crossing legs
No bending at the waist
Educating Patient
Educating Patient
Discharge planning
Evaluating patient risks
Monitor VS
Monitor VS
Wound assessments
Neurovascular assessments
Monitor wound drainage
Pain relief
Infection/Osteomyelitis prevention
Promote early ambulation
Ensure physiotherapy is consulted
A chronic disease, affecting over 1/1000 Canadians
A chronic disease, affecting over 1/1000 Canadians
Affects 8x as many women
Auto-immune
Cause is unclear – potential hormonal or genetic link
When properly treated, most individuals can survive for a normal lifespan
Systemic Lupus Erythematosus (SLE) : The most common type of lupus. Any tissue in the body may be affected including the kidneys, heart, lungs, and brain.
Systemic Lupus Erythematosus (SLE) : The most common type of lupus. Any tissue in the body may be affected including the kidneys, heart, lungs, and brain.
Educate patient on lupus.
Educate patient on lupus.
Help patient identify factors that precipitate flare-ups.
Assess patient’s medication knowledge.
Provide adequate symptom management.
MedicAlert bracelet
Provide emotional and psychological support.. A big one!
Mrs. Sour Hip is a 66 year old female who has suffered from lupus for the past 30 years. Mrs. Sour Hip experiences many joint-related lupus symptoms, particularly in her right hip. She will be undergoing a right hip replacement surgery next week. Her medical history includes systemic lupus erythematosus, HTN, a. fib, pneumonia in winter 2010, and a history of pernicious anemia for which she receives Vitamin B12 s/c q2months. Her medications include long-term corticosteroid therapy to help manage her lupus.
Mrs. Sour Hip is a 66 year old female who has suffered from lupus for the past 30 years. Mrs. Sour Hip experiences many joint-related lupus symptoms, particularly in her right hip. She will be undergoing a right hip replacement surgery next week. Her medical history includes systemic lupus erythematosus, HTN, a. fib, pneumonia in winter 2010, and a history of pernicious anemia for which she receives Vitamin B12 s/c q2months. Her medications include long-term corticosteroid therapy to help manage her lupus.
American Academy of Orthopaedic Surgeons. (2012) . Arthritis. Retrieved from http://orthoinfo.aaos.org/menus/arthritis.cfm
Arthritis Foundation. (2012). Common Myths. Retrieved from http://www.arthritis.org/aam-common-myths.php
Arthritis Society. (2010). Lupus. Retrieved from http://http://www.arthritis.ca/document.doc?id=327
Arthritis Society. (2011). Osteoarthritis: Know Your Options. Retrieved from
http://www.arthritis.ca/document.doc?id=328
Arthritis Society. (2012). About Arthritis. Retrieved from http://www.arthritis.ca/aboutarthritis
Canadian Arthritis Network. (2007). Arthritis Facts and Figures. Retrieved from http://www.arthritisnetwork.ca/home/Facts_and_Figures_2010.pdf
Cartilage Health. (2008). What is articular cartilage? Retrieved from http://www.cartilagehealth.com/acr.html
Canadian Psychological Association. (2012). Arthritis. Retrieved From http://www.cpa.ca/psychologyfactsheets/arthritis/
Day, R. A., Paul, P., Williams, B., Smeltzer, S. & Bare, B. (2007). Canadian textbook of medical surgical Nursing (1st Canadian Ed.). Philadelphia: Lippincott Williams & Watkins.
Firth, J. (2011). Rheumatoid arthritis: diagnosis and multidisciplinary management.
Nursing, 20(18), 1179-80.
Firth, J. (2011). Rheumatoid arthritis: diagnosis and multidisciplinary management.
Firth, J. (2011). Rheumatoid arthritis: diagnosis and multidisciplinary management.
Nursing, 20(18), 1179-80.
Gulanick, M. & Myers, J. (2011). Nursing Care Plans: Diagnoses, Interventions, and Outcomes (7th ed.). St.Louis, MO: Elsevier Mosby.
John Hopkins Arthritis Center. (2012). Nutrition and Rheumatoid Arthritis. Retrieved from http://www.hopkinsarthritis.org/patient-corner/disease-management/rheumatoid-arthrtis-nutrition/
Lupus Society of Canada. (2007). Lupus Fact Sheet: Takling About Lupus. Retrieved from http://www.lupuscanada.org/pdfs/factsheets/Talk-Online.pdf
Lupus Society of Canada. (2012). Living with Lupus: Lupus Overview. Retrieved from http://www.lupuscanada.org/english/living/lupus-overview.html
Mosby. (2009). Mosby’s Dictionary of Medicine, Nursing, & Health Professions (8th ed.). St. Louis, MO: Author.
Myers, J., Gulanick, M. (2011). Nursing Care Plans (7th ed.). Elsevier
National Institute of Arthritis & Musculoskeletal & Skin Diseases. (2010). Handout on Health: Osteoarthritis. Retrieved from http://www.niams.nih.gov/Health_Info/Osteoarthritis/default.asp
Oliver, S. (2011). The role of the clinical nurse specialist in the assessment and management of biologic therapies. Musculoskeletal Care Journal. 9, 54-62.
Sung-Jae, K., Kwang-Am, J. (2007). Arthroscopic Synovectomy in Rheumatoid Arthritis of Wrist. Clinical Medical Research, 5(4), 244-250.
Walker, J. (2012). Care of patients undergoing joint replacements, Nursing Older People, 24(1), 14-20.
Walker, J. (2011). Management of osteoarthritis. Nursing Older People, 23(9), 14-19.
