Arthritis...........................pptx

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1. SEPTIC ARTHRITIS Septic arthritis is also known as infectious arthritis or bacterial arthritis. Some inflammation of joints tendons and bursae is directly related to infection caused by bacterial, viral, fungal or parasite agents. Typically, septic arthritis affects one large joint in the body, such as the knee or hip. However, septic arthritis can also affect multiple joints if the infection rapidly spreads.

2. CAUSES OF SEPTIC ARTHRITIS Infectious organisms reach joints by direct penetration (eg. trauma, surgery arthrocentesis ,biteS) extension from an adjacent infection (eg, onteomyelitis,soft tissue abscess, an infected wounds or hematogenous spread from a remote site infection In adults and children, common bacteria that cause acute septic arthritis include Haemophilus influenza. Neisseria gonorrhoeae, staphylococcus and streptococcus. These foreign invaders enter the bloodstream and infect the joint, causing intlammation and pain. Other infections, such as those caused by viruses and fungi, can also cause arthritis Viruses include: hepatitis A, B. and C. parvovirus B19, herpes viruses. HIV (AIDS virus), HTLV-1. adenovirus, Coxsackie viruses, mumps and Ebola Fungi that can cause arthritis include histoplasma, coccidiomyces, and blastomyces. These infections are usually less severe and slower to develop than septic arthritis

3. RISK FACTORS OF SEPTIC ARTHRITIS Previous joint infection or damage (trauma or rheumatoid arthritis) Arthroscopic surgery, arthrocentesis and joint replacement surgery History of previous Immunosuppressive therapy, including corticosteroids drugs Immunodeficiency, including HIV Hemodialysis Hemophilia Chronic medical illness, diabetes, lung or liver disease, cancer Skin conditions such as psoriasis and eczema • Taking medications for rheumatoid arthritis Intravenous drug abuse

4. Due to etiological & risk factors Infection and Inflammation occurs and result in synovitis and joint effusion i nfecting organisms multiply in the synovial fluid and synovial lining

5. infecting organisms produce virulence factors (adhesins) Allow bacteria to penetrate, remain within and infect joint tissues f ormation of abscess in synovial tissue or bones, Destruction of affected joint SEPTIC ARTHRITIS

6. CLINICAL MANIFESTATIONS Symptoms of septic arthritis usually come on rapidly with intense pain, joint swelling and fever. Septic arthritis symptoms may include: Fever with chills Fatigue and generalized weakness Inability to move the limb with the infected joint (pseudoparalysis) Severe pain in the affected joint, especially with movement Swelling and tenderness of joint increased fluid within the joint) . Warmth (the joint is red and warm to touch because of increased blood flow) Decreased ROM

7. DIAGNOSTIC TEST Synovial fluid analysis - to detect the presence of inflammatory cells or crystals that may indicate either an infectious or non-infectious cause ljust as gout) for joint pain and symptom Blood culture- to determine if a microorganism is present in the blood • Complete blood count to determine the presence and number of red and white cells that would indicate action to an infection in order to help evaluate and monitor the condition. Culture of joint fluid - to detect the presence of bacteria, mycobacteria or yeast in the joint in order to determine the antimicrobials to which they are susceptible and to evaluate the effectiveness of treatment. Erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) - to detect inflammation useful in following response to therapy X-ray of joint to help evaluate joint damage: may not show abnormalities until significant damage exists CT scan ,bone scan and MRI

8. MEDICAL MANAGEMENT Treatment for septic arthritis in given to eliminate the infection, reduce inflammation & associated fluid pressure on the joint, minimize joint damage and maintain &/or recover joint mobility .prompt treatment is essential to prevent the destruction of joints which can occur within days or hours. The primary treatment is joint drainage and appropriate antimicrobial therapy, which may require intravenous antibiotics 1. Antibiotics are used to treat the infection. Broad spectrum IV antibiotics administered. Antibiotics are continued for 2 weeks even after symptoms subside, 2 .Fluid is usually aspirated from the affected joint to relieve pressure and to analyze in order to identify the specific microorganism causing the infection, In some cases surgery may be needed to drain the infected joint fluid 3 Severe cases may need surgery to drain the infected joint fluid .Arthrotomy or arthroscopy done to drain the exudate and removal of dead tissue. 4. Patients may also be treated for inflammation and pain with a nonsteroidal anti-inflammatory drug (NSAID), and physical therapy may be recommended

9. NURSING DIAGNOSIS 1 Acute pain related to joint inflammation, possibly evidenced by verbal/coded reports, guarding behavior, restlessness, and narrowed focus 2 Impaired physical mobility related to joint stiffness pain/discomfort, and reluctance to initiate movement, possibly evidenced by limited range of motion, slowed movement 3. Self Care Deficit related to musculoskeletal impairment, pain/discomfort, decreased strength, impaired coordination, possibly evidenced by inability to perform desired ADLs. 4 Risk for infection related to presence of infectious, chronic disease states,and invasive procedures

10. NURSING MANAGEMENT 1. Encourage frequent changes of position.Assist patient to move in bed, supporting affected joints above and below, avoiding jerky movement 2.Maintain bedrest/chair when indicated .Scheudule activities providing frequent rest periods and uninterrupted time sleep. 3. Provide variety of comfort measures eg. application of heat/cold; massage, position changes, rest, foam mattress ,supportive pillow, splints; relaxation techniques, diversional activities. 4.Administer anti-inflammatory, analgesic and antirheumatic medication as prescribed. 5.Advice patient to use pillows for elevation of joint. Splints may be used to immobilize joint.

11. 6. Teach pathophysiology of pain and rheumatic disease and assist patient to recognize that pain often leads to unproven treatment methods, 7. Assist in identification of pain that leads to use of proven methods of treatment. 8. Advice the patient to use and ambulatory aids safely.Advise the patient to do ROM exercises to preserve joint mobility. 9. Advice the patient to use aseptic technique while changing dressing.Good hand washing habits should be encouraged. 10. Allow patient sufficient time to complete tasks to fullest extent of ability. Captilize on individual strengths.