Joint disorders

it is about the type of joint disorder i.e Rheumatoid arthritis its causes symptoms and treatment

1. JOINT DISORDERS Pooja Deori

2. INRODUCTION A JOINT is where two or more bones come together like knee, hip, elbow, shoulder etc. Joint can be damaged by nonsystematic non inflammatory disorder i.e. associated with Aging & Trauma In this there is ulceration of articular cartilage that leaves the underlined bone exposed

3. The treatment of joint disorder depend upon the cause E.g. If a person have any injury the treatment often begin with RICE (REST ICE COMPRESSION & ELEVATION)

4. DEFINITION JOINT DISORDER is defined as an abnormal condition that involve any aspect of joint caused by infection, inflammation, chronic repetitive injury, degeneration, congenital deformity, neoplasm etc.

5. TYPES OF JOINT DISORDER There are various disorders which affects the joints these are as follows -: RHEUMATOID ARTHRITIS OSTEOARTHRITIS GOUT BACTERIAL & SEPTIC ARTHRITIS SPONDYLOARTHROPATHIES BURSITIS TENDONITIS

6. OSTEOARTHRITIS (OA) Degenerative joint disease Most common joint disease Involves the entire synovial joint Preferentially affects weight bearing joints e.g. Hips, knees, spine (vertebrae) Prevalence increases with age

7. “Acute, monoarticular, inflammatory arthritis” Characterized by hyperuricemia Decreased excretion via kidneys or Overproduction of uric acid Primarily in joints, subcutaneous tissue, and kidneys E.g. toe, ankle, instep, knee, wrist, elbow, fingers Occurs primarily in middle age men GOUT

8. BACTERIAL & SEPTIC ARTHRITIS Description: joint inflammation as a result of an infection by bacteria, virus, parasites, or fungi; can damage tissue Symptoms: joint pain, redness, swelling, decreased ROM, weight loss, fatigue, fever/chills

9. SPONYDYLOARTHROPATIES It is a long term chronic disease of joint. these occur in children It involve attachment between your low back & pelvis. Affect areas around the joints where ligament & tendon attach to bone E.g. knee, foot, hip etc

10. BURSITIS ARTHRITIS Description: Swelling of the bursa (fluid pouch around joint) Symptoms: Swell/Pain when pressure applied, pain, stiffness

11. TENDONITIS Description: High concentration of urate crystals in blood Symptoms: inflammation/tenderness, pain, redness (usually in the foot)

12. RHEUMATOID ARTHRITIS DEFINITION It is defined as an auto immune disease in which the body immune system attacks the joints & cause inflammation & pain in & around the joints

13. ETIOLOGY CHRONIC SYSTEM INFLAMMATORY DISEASE GENETIC & FAMILIAL PREDISPOSITION OBESITY WEAK IMMUNE SYSTEM AGE SMOKING BACTERIA & VIRUS AIR POLLUTION INSECTICIDES MINERAL OIL

14. PATHOPHYSIOLOGY Due to Etiological factor Antigen –Antibody Response Transformation of IgG & IgM into rheumatoid factor Formation of immune complex into blood & synovial fluid Primarily involve the synovial joint

15. cont Inflammation stimulus in growth of vessels & proliferation of synovial cells Pannus develops covers the surface like articular sheet Cartilage destroyed & erode the underlying bone Joint become immobilized Undergoes osteoporosis & enclosing Chronic inflammatory joint disease

16. SKIN MENIFESTATION

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20. CARDIAC MENIFESTATION

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22. PULMONARY MENIFESTATION

23. NEUROLOGICAL MENIFESTATION

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25. DIAGNOSTIC EVALUATION HISTORY COLLECTION Past medical History Present medical history List of allergies PHYSICAL EXAMINATION check Inflammation around the joints Joint stiffness joint fluid & nodules Range of motion

26. Cont LABORATORY TEST Synovial fluid analysis liver enzyme monitoring X-ray MRI Bone scan Ultrasound Synovial Biopsy Rheumatoid factor normal range – 0-20µl CBC Uric Acid

27. MANAGEMENT Medical management -: Hydro collator packs Paraffin Baths Electric Heating pads MEDICATION- NSAIDS E.g. Ibuprofin, Naproxen Sodium corticosteroids e.g. prednisone Disease Modifying Antirheumatic Drug {DMARDS} E.g. methotrexate, Sulfasalazine Biological Agent E.g. Anakinra, Golimumab

28. SURGICAL MANAGEMENT ARTHROSCOPY SYNOVECTOMY OSTEOTOMY TENDON TRANSPLANTS ARTHRODESIS TOTAL JOINT REPLACEMENT

29. ARTHROSCOPY Arthroscopy examination into joint using arthroscope with fiber optic lens, most knee injuries are treated with arthroscopy.

30. SYNOVECTOMY

31. OSTEOTOMY

32. TENDON TRANSPLANT

33. ARTHRODESIS

34. TOTAL JOINT REPLACEMENT

35. NURSING MANAGEMENT NURSING DIAGNOSIS & INTERVENTIONS DIAGNOSIS CHRONIC PAIN related to swelling as evidenced by facial expression of the patient INTERVENTIONS Assess the condition of the patient Apply local heat or cold to affected joint for 15-20 min 3-4 times per day Encourage exercise consistent

36. Administer or teach self administration of pharmacological agent Encourage patient for using adjunctive pain control measures E.g. PROGRESSIVE MUSCLE RELAXATION MEDICATION Encourage patient for taking warm bath or shower to decrease morning stiffness

37. DIAGNOSIS 2. ACTIVITY INTOLERANCE related to musculoskeletal impairment evidenced by patient is semi dependent on others. INTERVENTIONS Encourage patient for gentle ROM exercises Use splints Refer physical therapy Use occupational therapy

38. DIAGNOSIS 3. RISK OF INJURY related to toxicity of drug INTERVENTIONS Review the drug information before administration to ensure baseline blood work such as CBC, LIVER FUNCTION Ensure that TUBERCULIN test has been done prior to starting biological agent Make sure that there is no liver vaccines should be administered in past 2-3 days before drug administration

39. Administer medication subcutaneously by rotating site of abdomen DIAGNOSIS 4. SELF CARE DEFICIT related to limitation secondary to disease process. INTERVENTIONS Provide pain relief drugs before self care activities. Conduct an environment for performing daily activities.

40. Schedule adequate rest period. Discuss importance of promoting the patient’s self care at appropriate level.

41. HEALTH EDUCATION Instruct patient & family in the nature of disease E.g. RA has no cure avoid MIRACLE cure. Educate patient about pharmacological agent. encourage patient for doing exercise. patient should be advised not to take heavy load. patient should be advised to quit smoking Patient should be educated regarding regular checkup

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