University of Kerbala / College of Nursing
Adult Nursing Department
Dr .Fatma Makee Mahmmod
Nursing management of patients with Musculoskeletal disorders
Arthritis
Arthritis
Arthritis occurs when the joints in the body are in
flamed or there is a breakdown of cartilage in the joints.
Joints are places in the body where two or more bones
meet, such as the hip or knee.
Cartilage is the cushions in the joints that protects them
from pressure and makes movements smooth. When
cartilage breaks down in a joint, the bones rub together.
This causes pain, swelling and stiffness
The most common type of arthritis is
1.osteoarthritis
. With this type of arthritis, the joints wear out over time
from use or as the person ages.
Injury to a joint may also lead to this type of arthritis.
Osteoarthritis occurs most often in the knees, hips and
hands. The joints begin to ache and thicken. At times, the
tissues around the joint become strained and cause more
pain.
Arthritis can also occur when the immune system, which
normally
protects the body from infection, attacks the body’s
tissues.
2.Rheumatoid arthritis
is the most common type of this kind of
arthritis.
It causes inflamed and painful joints and
may affect other parts of the
body, such as the heart, muscles, blood
vessels, nerves and eyes
3.Gout arthritis
Is the common and complex form of inflammatory
arthritis
More than 3 million Americans self-report the diagnosis
of gout . Men are three to four times more likely to
diagnosis with gout than women . but women
increasingly susceptible to gout after menopause .
The incidence of gout increases with age , body mass
index , alcohol consumption , hypertension and
diuretic use
Other type:
*Juvenile Rheumatoid Arthritis (Still’s
Disease):
Considered a major crippler of young
children. Usual onset is before 7 years of age.
*Ankylosing Spondylitis:
Affects the axial skeleton and large peripheral joints of the
body.
Most prevalent in males with the age of onset ranging
from 20 to 40 years of age. Common symptoms include
recurrent back pain and early morning stiffness
Signs of Arthritis
•Joint pain
•Joint is not stable or it feels like it will not support
you
•Joint enlarges or swells
•Stiffness, often in the morning
•Limited use of joint
•Warmth around joint
•Redness of the skin around joint and Recurrent
back pain.
Risk factors for arthritis include:
- Family history. Some types of arthritis run in families, so you
may be more likely to develop arthritis if your parents or siblings
have the disorder. Your genes can make you more susceptible to
environmental factors that may trigger arthritis.
- Age. The risk of many types of arthritis including
osteoarthritis, rheumatoid arthritis and gout _ increases with age.
- sex. Women are more likely than are men to develop
rheumatoid arthritis, while most of the people who have gout,
another type of arthritis, are men.
- Previous joint injury. People who have injured a joint,
perhaps while playing a sport, are more likely to eventually develop
arthritis in that joint.
- Obesity. Carrying excess pounds puts stress on joints,
particularly your knees, hips and spine. Obese people have a higher
risk of developing arthritis.
Nursing diagnosis
Acute and chronic pain related to inflammation
and increased disease activity ,tissue damage
,fatigue ,or lowered tolerance level
Impaired physical mobility related to decreased
range of motion ,muscle weakness ,pain in
movement
Readiness for enhanced self –care related to
contractures , fatigue ,loss of motion
Disturbed body image related to physical and
psychological change and dependency imposed by
chronic illness
Ineffective coping relayed to actual or
perceived lifestyle or role change
Fatigue related to increased disease
activity , pain , inadequate sleep \rest
,inadequate nutrition , and emotional
stress \depression
Tests and diagnosis
During the physical exam, the doctor will check your
joints for swelling, redness and warmth. to see how well
you can move your joints. Depending on the type of
arthritis suspected, your doctor may suggest some of the
following tests.
Laboratory tests
The analysis of different types of body fluids can help
pinpoint the type of arthritis you may have. Fluids
commonly analyzed include blood, urine and joint
fluid. To obtain a sample of your joint fluid, your doctor
will cleanse and numb the area before inserting a needle in
your joint space to withdraw some fluid (aspiration).
Imaging
These types of tests can detect problems within your joint that may be causing your
symptoms. Examples include:
- X-rays. Using low levels of radiation to visualize bone, X-rays can show cartilage loss,
bone damage and bone spurs. X-rays may not reveal early arthritic damage, but they are
often used to track progression of the disease.
- Computerized tomography (CT). CT scanners take X-rays from many different angles
and combine the information to create cross-sectional views of internal structures. CTs can
visualize both bone and the surrounding soft tissues.
- Magnetic resonance imaging (MRI). Combining radio waves with a strong magnetic
field, MRI can produce more-detailed cross-sectional images of soft tissues such as
cartilage, tendons and ligaments.
- Ultrasound. This technology uses high-frequency sound waves to image soft tissues,
cartilage and fluid-containing structures such as bursae. Ultrasound also is used to
guide needle placement for joint aspirations and injections.
Arthroscopy
In some cases, your doctor may look for damage in your joint by inserting a small, flexible
tube called an arthroscope through an incision near your joint. The arthroscope transmits
images from inside the joint to a video screen.
Medications
The medications used to treat arthritis vary depending on the type of
arthritis. Commonly used arthritis medications include:
- Analgesics. These types of medications help reduce pain, but have
no effect on inflammation. Examples include acetaminophen,
tramadol and narcotics containing oxycodone or hydrocodone.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs reduce
both pain and inflammation. Over-the-counter NSAIDs include
ibuprofen and naproxen sodium. Some types of NSAIDs are
available only by prescription. Oral NSAIDs can cause stomach
irritation, and some may increase your risk of heart attack or stroke.
Some NSAIDs are also available as creams or gels, which can be
rubbed on joints.
.
- Counterirritants. Some varieties of creams and ointments
contain menthol or capsaicin, the ingredient that makes hot
peppers spicy. Rubbing these preparations on the skin over your
aching joint may interfere with the transmission of pain signals from
the joint itself.
- Disease-modifying antirheumatic drugs (DMARDs). Often
used to treat rheumatoid arthritis, DMARDs slow or stop your
immune system from attacking your joints. Examples include
methotrexate and hydroxychloroquine .
- Biologics. Typically used in conjunction with DMARDs,
biologic response modifiers are genetically engineered drugs that
target various protein molecules that are involved in the immune
response. Examples include etanercept and infliximab.
- Corticosteroids. This class of drug, which includes prednisone
and cortisone, reduces inflammation and suppresses the immune
system. Corticosteroids can be taken orally or be injected directly
into the painful joint.
Therapy
Physical therapy can be helpful for some types of arthritis. Exercises
can improve range of motion and strengthen the muscles
surrounding joints. In some cases, splints or braces may be
warranted.
Surgery
If conservative measures don't help, your doctor may suggest
surgery, such as:
- Joint replacement. This procedure removes your damaged joint
and replaces it with an artificial one. Joints most commonly replaced
are hips and knees.
- Joint fusion. This procedure is more often used for smaller
joints, such as those in the wrist, ankle and fingers. It removes the
ends of the two bones in the joint and then locks those ends
together until they heal into one rigid unit.
Treatment
Treatment of arthritis depends on:
•The cause
•Which joints are painful
•Amount of pain
•How the arthritis affects your daily activities
•Your age
•Your work or activity
As a part of your treatment, you may
need to:
•Exercise to improve movement and joint
strength. Good choices
include walking, swimming, bike riding,
strength training and gentle stretching
exercises.
•Use hot or cold treatments to control pain
and
swelling.
•Avoid positions or movements that put extra
stress
on your painful joints.
CONTRAINDICATED ACTIVITIES:
•Jumping activities (i.e., jumprope,
trampolines)
•Activities where falls might be more
frequent (i.e., roller skating, skiing,
gymnastics)
•Sitting for long periods of time
•Repeated hopping, leaping or movement
exploration activities in which the body
leaves the floor
•Contact sports, particularly football and
soccer
