4. OA
• Unilateral
• Called: osteoarthrosis or DJD
• Progressive deterioration
• Loss of cartilage in joint (hyaline cartilage)
• Synovial fluid declines
12. OA: CAM
• Glucosamine
• Don’t take if you have hypertension
• Don’t take if pregnant or breast-feeding
• Monitor for bleeding w/chondroitin
• Monitor glucose level (hyperglycemia)
• Be aware of: rash, GI effects diarrhea, drowsiness, headache
• Take dosage based on wt.
13. OA: Management
• Total joint arthroplasty (TJA)
• Total joint replacement (TJR)
• Total hip arthroplasty (THA)
• Arthroscopy
• Osteotomy
• Other Arthroplasties: TSA, hemiarthroplasty, TEA
14. OA: THA
• Have dental procedure prior
• Tell future HCP of THA
• VTE: assess clotting: (obesity, smoking, bleeding)
• NSAID’s, Vit C & E, HRT d/c 1 week prior
• Epoetin (Epogen) may be given prior
• Take shower with antiseptic soap noc b4
• Wear clean nightwear after shower
• IV antibioticsL cefazolin (Ancef) @ least 1 hr b4
• General or neuroaxial anesthesia
15. OA: THA Postop
• Hip dislocation: partial or total
• ↑ hip pain
• Shortening of affected leg
• Leg rotation
• VTE: SCD, warfarin, factor Xa inhibitors, LMWH, early ambulation (stand on same side of affected leg),
plantar/dorsiflexion, SLR
• Infection
• Anemia
• Pain: Percocet, Toradol, Motrin, guided imagery
• Neurovascular compromise: ck. color, temp. distal pulses, cap refill, movement, sensation
16. OA: TKA
• TKR
• Continuous Passive Motion machine (CPM)
• Xray, CT scan, MRI
• Antiseptic soap noc b4
• Wear clean nightwear & sleep on clean linen
• Take meds with small amts. Of H2O prevent aspiration/vomit
• General or neuroaxial anesthesia
• IV cephalosporin shortly b4
• Osteotomies
• CAM: intraop Adlea (refined capsaicin) cause C fiber & extra Ca+ enter nerve cells
17. OA: TKA Postop
• Neurovascular assessments
• CPM: 20-30 degree flexion & full extension (0 degrees) @ 2 cycle/min; if not in use let
knee rest flat on be or 1 pillow under lower calf & foot
• Ice packs
• Pain: similar to THA, peripheral nerve blockade (PNB), continuous femoral nerve blockade
(CFNB)
• Systemic Anesthetic reaction: metallic taste, tinnitus, dysarthia, ↓ HR, ↓ BP, ↓ RR
• Dislocation is rare
• Keep in neutral position not rotated inter/externally
18. OA
• Exercises:
• Do on both “good & bad” days
• Consistency
• Respect Pain: if it increases, stop report to HCP
• Use active rather than active-assist or passive
• Reduce # of repetition wn inflammation severe or more pain
• Don’t substitute nl activities or household tasks 4 prescribed exercises
• Avoid resistive exercises wn inflammed
19. OA
• Joint Protection:
• Use large joint
• Don’t turn doorknob clockwise
• Avoid twisting arm & promoting ulnar deviation
• Avoid twisting or wringing hands
• Use 2 hand for holding objects
• Sit in high-back straight chair
• Don’t push off finger getting out of bed: use palms
• Don’t bend @ waist; bend @ knees back straight
• Use assistive/adaptive devices
• Don’t use pillow except small under head
27. RA
• Heat paraffin dips
• Hot packs
• Plasmapheresis
• Energy conservation (pacing activities, rest periods, assistive devices)
• CAM: hypnosis, acupuncture, music, imagery, stress mngment
• Calcium supplement
• Cold water fish or fish oil
• Gamma-linolenic acid (GLA) (omega-6 fatty acid)
28. RA: Education
• Balance activity w/rest
• Pace yourself; don’t plan too muck 4 one day
• Set priorities: determine those most important, do first
• Delegate responsibilities & task: family and/or friends
• Plan ahead: prevents last-minute rushing & stress
• Learn your own activity tolerance
