ARTHRTITIS

 inflammation of one or more joints

 a joint disorder featuring inflammation
 A joint is an area of the body where two different bones meet. A joint functions to move
the body parts connected by its bones

Joint inflammation may result from:

a. An autoimmune disease (the body's immune system mistakenly attacks healthy tissue)
b. Broken bone
c. General "wear and tear" on joints
d. Infection, usually by bacteria or virus

Common Types
1. Osteoarthritis
2. Gout
3. Rheumatoid arthritis

GOUT
 results from an overload of uric acid in the body.
 Gout is considered a chronic and progressive disease.
 Uric acid is a breakdown product of purines that are part of many foods we eat.

STAGES OF GOUT DEVELOPMENT

A. ASYMPTOMATIC
 Serum urate rise but no symptoms. As the disease progress, may produce HTN and
nephrolithiasis with sevre back pain
B. ACUTE
 Strikes suddenly and peaks quickly
 Involves one or two joints but extremely painful
C. INTERCRITICAL
 Symtom free intervals between gout attacks
D. CHRONIC
 “tophaceous gout”
 Marked by persistent polyarthritis with large subcutaneous tophi in cartilage, synovial
membranes, tendons and soft tissue
 Clinical Manifestations:
 Pain in the involved joints
 Swelling and inflammation
 Tophi (yellowish-whitish, irregular deposits in the skin that break open and reveal a
gritty appearance)
 Fever & malaise
 Body weakness

Diagnostic Tests
 Arthrocentesis (joint aspiration)
 elevated levels of uric acid in the blood
 (+) urate crystals in the synovial fluid
 X-rays
 show tophi-crystal deposits and bone damage as a result of repeated bouts of
inflammation

Treatment
 Medical Management
o Allupurinol- taken with food
-rash signifies allergic reaction
o Colchicine- for acute attacks
o Probenecid- for uric acid excretion in the kidney
 Nursing Management
o Low purine diet
 Avoid organ meats and processed foods
o Increase fluid intake
o Avoid alcohol
o Bed rest during early attacks
o Anti-gout medications

OSTEOARTHRITIS
 most common form of degenerative joint disorder
 Chronic
 Non systemic
Risk Factors
 Increased age
 Obesity
 Repetitive use of joints with previous joint damage
 Anatomical deformity
 Genetic susceptibility

Clinical Manifestations
 Pain in the affected joint after repetitive use
 Swelling and warmth of the affected joint
 Stiffness of joint after long periods of inactivity
 Heberden’s node (enlargement of the small joints of the finger)

Diagnostic Tests
 X-rays
 loss of joint cartilage
 Narrowing of joint space between adjacent bones
 Arthrocentesis
 Arthroscopy

Treatment
 Medical Management
 Weight reduction
 Occupational and physical therapy
 Pharmacologic management

 Nursing Management
 Provide relief of pain
 Advise to reduce weight
 Administer medications
 Proper positioning

RHEUMATOID ARTHRITIS
 autoimmune disease that causes chronic inflammation of the joints
 Chronic in nature
Assessment Findings
 Fatigue
 Loss of energy
 Lack of appetite
 Muscle and joint aches
 Stiffness
 Diagnostic Tests
o X-ray
 Marked deformity, bone demineralization and soft tissue swelling
o Arthrocentesis
o CBC

Treatment
 Therapeutic dose of NSAIDS and aspirin to reduce inflammation
 Relieve pain and discomfort
 Increase patient mobility
 Provide diet therapy

CASTS
Functions
 Is a temporary immobilization
 to rigidly protect an injured bone or joint. It serves to hold the broken bone in proper
alignment to prevent it from moving while it heals.
 Casts may also be used to help rest a bone or joint to relieve pain that is caused by
moving it (such as when a severe sprain occurs, but no broken bones).

TYPES
PLASTER
 A plaster cast is made from rolls or pieces of dry muslin that have starch or
dextrose and calcium sulfate added.
 When the plaster gets wet, a chemical reaction happens (between the water and
the calcium sulfate) that produces heat and eventually causes the plaster to set,
or get hard, when it dries.
 Plaster casts are usually smooth and white.

FIBERGLASS
 Fiberglass casts are also applied starting from a roll that gets wet.
 After the roll gets wet, it is rolled on to form the cast. Fiberglass casts also get
warm and harden as they dry.
 Fiberglass casts are rough on the outside and look like a weave when they dry.
Some fiberglass casts may even be colored.
 Double Hip Spica Cast
 For fracture of hip and femur
Long Arm Circular Cast
 For fractured radius and ulna
Short Arm Circular Casts
 For wrists and fingers
Short Leg Circular Casts
 For ankle and foot fracture
Shoulder Spica
 For humerus and shoulder joint
Single Hip Spica
 For hip and one femur

CAST CARE
 Always keep the cast clean and dry.
 If the cast becomes very loose as the swelling goes down, call the doctor for an
appointment.
 Cover the cast with a plastic bag or wrap the cast to bathe (and check the bag for holes
before using the bag a second time).
 If a fiberglass cast gets damp, dry it (make sure it dries completely)..
 If the cast gets wet enough that the skin gets wet under the cast, contact the doctor.
 Sweating enough under the cast to make it damp may cause mold or mildew to develop.
 Do not lean on or push on the cast because it may break.
 Do not put anything inside the cast. Do not try to scratch the skin under the cast with
any sharp objects; it may break the skin under the cast. Do not put any powders or
lotions inside the cast.
 Do not trim the cast or break off any rough edges because this may weaken or break the
cast
 An arm sling may be needed for support if the cast is on the hand, wrist, arm, or elbow..
 If the cast is on the foot or leg, do not walk on or put any weight on the injured leg,
unless the doctor allows it.
 If the doctor allows walking on the cast, be sure to wear the cast boot (if given one by
the doctor). The boot is to keep the cast from wearing out on the bottom and has a
tread to keep people in casts from falling.
 Crutches may be needed to walk if a cast is on the foot, ankle, or leg. Make sure the
crutches have been adjusted properly before leaving the hospital or the doctor's office.