Question

Draw a table to compare and contrast Osteoartritis, Rheumatoid artritis And septic Artritis ( Clinical manifestations, etiology, Nursing Managment)

Answer 1

Osteoarthritis	Rheumatoid arthritis	Septic arthritis
Clinical manifestations Pain. Inflamed synovium causes the pain, stretching of the joint capsule or ligaments, irritation of the nerve endings in periosteum over osteophytes, trabecular microfracture, intraosseous, hypertension, bursitis, tendinitis, and muscle spasm. Stiffness. Stiffness, which is mostly experienced in the morning or upon awakening, usually lasts less than 30 minutes and decreases with movement. Functional impairment. Functional impairment results from pain on movement and limited motion caused by structural changes in the joint	Symptoms Signs and symptoms of rheumatoid arthritis may include: Tender, warm, swollen joints Joint stiffness that is usually worse in the mornings and after inactivity Fatigue, fever and loss of appetite Early rheumatoid arthritis tends to affect your smaller joints first — particularly the joints that attach your fingers to your hands and your toes to your feet. As the disease progresses, symptoms often spread to the wrists, knees, ankles, elbows, hips and shoulders. In most cases, symptoms occur in the same joints on both sides of your body. About 40 percent of the people who have rheumatoid arthritis also experience signs and symptoms that don't involve the joints. Rheumatoid arthritis can affect many nonjoint structures, including: Skin Eyes Lungs Heart Kidneys Salivary glands Nerve tissue Bone marrow Blood vessels Rheumatoid arthritis signs and symptoms may vary in severity and may even come and go. Periods of increased disease activity, called flares, alternate with periods of relative remission — when the swelling and pain fade or disappear. Over time, rheumatoid arthritis can cause joints to deform and shift out of place.	Symptoms of Septic Arthritis Symptoms of septic arthritis usually come on rapidly with intense pain, joint swelling, and fever. Septic arthritis symptoms may include: Chills Fatigue and generalized weakness Fever Inability to move the limb with the infected joint Severe pain in the affected joint, especially with movement Swelling (increased fluid within the joint) Warmth (the joint is red and warm to touch because of increased blood flow)
Etilogy Knee osteoarthritis is classified as either primary (idiopathic) or secondary. Among the various structures making up the knee joint, the hyaline joint cartilage is the main target of the harmful influences that cause osteoarthritis and the structure in which the disease begins. 95% of hyaline cartilage consists of extracellular matrix. Otte et al. coined the term “organ of articulation” to emphasize the common functional purpose of all structures composing the joint , from its bony components covered with hyaline cartilage to its capsule, ligaments, and menisci, and the muscles that move it Etiologies of secondary osteoarthritis of the knee*1 Post-traumatic Congenital/malformation Malposition (varus/valgus) Postoperative Metabolic Rrickets Hemochromatosis Chondrocalcinosis Ochronosis Endocrine disorders Acromegaly Hyperparathyroidism Hyperuricemia Aseptic osteonecrosis	Rheumatoid arthritis is an autoimmune condition, which means it's caused by the immune system attacking healthy body tissue. However, it's not yet known what triggers this. Your immune system normally makes antibodies that attack bacteria and viruses, helping to fight infection.	ETIOLOGY: Septic arthritis, the invasion of the synovial membrane by microorganisms, usually with extension into the joint space, is generally secondary to infection elsewhere in the body. In young adults, the primary infection is generally a genital lesion caused by Neisseria gonorrhoeae. In all other age groups the most common agent is Staphylococcus aureus, which spreads from a cutaneous lesion. Several other agents may cause septic arthritis but their frequency of infection is low.
Nursing management Nursing management of the patient with osteoarthritis includes both nonpharmacologic and pharmacologic approaches. Nursing Assessment Nursing assessment for OA focuses mainly on history and physical assessment. Physical assessment. Assessment of the area over the affected joint may reveal tender and enlarged joints. Patient history. The nurse must take note of any past injury to the joints, as this is a risk factor for OA. Diagnosis Based on the assessment data, nursing diagnoses are: Acute pain related to inflammation of the synovium and irritation of the nerve endings. Activity intolerance related to joint pain. Impaired physical mobility related to joint stiffness. Nursing Care Planning and Goals Main Article: 4 Osteoarthritis Nursing Care Plans After successful management, a patient with osteoarthritis will: Identify negative factors affecting activity intolerance and eliminate or reduce their effects when possible. Use identified techniques to enhance activity intolerance. Report measurable increase in activity intolerance. Report pain is relieved or controlled. Follow prescribed pharmacologic regimen. Participate in ADLs and desired activities. Nursing Interventions The major goals of the nursing intervention are pain management and optimal functional ability. Weight loss. Weight loss is an important approach to pain and disability improvement. Assistive devices. Canes and other ambulatory devices are very helpful for ambulation. Exercise. Exercises such as walking should begin moderately and increase gradually. Analgesic. Adequate pain management is essential to the success of an exercise program. Physical therapy. A referral for physical therapy for people with similar problems can be very helpful.	Nursing Management Nursing care of the patient with RA should follow a basic plan of care. Nursing Assessment The assessment of a patient with RA can contribute to its diagnosis. History and physical exam. The history and physical examination address manifestations such as bilateral and symmetric stiffness, tenderness, swelling, and temperature changes in the joints. Extra-articular changes. The patient is also assessed for extra-articular changes and these include weight loss, sensory changes, lymph node enlargement, and fatigue. Nursing Diagnosis Bases on the assessment data, the major nursing diagnoses appropriate for the patient are: Acute and chronic pain related to inflammation and increased disease activity, tissue damage, fatigue, or lowered tolerance level. Fatigue related to increased disease activity, pain, inadequate sleep/rest, deconditioning, inadequate nutrition, and emotional stress/depression Impaired physical mobility related to decreased range of motion, muscle weakness, pain on movement, limited endurance, lack or improper use of ambulatory devices. Self-care deficit related to contractures, fatigue, or loss of motion. Disturbed body image related to physical and psychological changes and dependency imposed by chronic illness. Ineffective coping related to actual or perceived lifestyle or role changes. Nursing Care Planning & Goals The major goals for a patient with RA are: Improvement in comfort level. Incorporation of pain management techniques into daily life. Incorporation of strategies necessary to modify fatigue as part of the daily activities. Attain and maintain optimal functional mobility. Adapt to physical and psychological changes imposed by the rheumatic disease. Use of effective coping behaviors for dealing with actual or perceived limitations and role changes. Nursing Interventions The patient with RA needs information about the disease to make self-management decisions and to cope with having a chronic disease. Relieving Pain and Discomfort Provide a variety of comfort measures (eg, application of heat or cold; massage, position changes, rest; foam mattress, supportive pillow, splints; relaxation techniques, diversional activities). Administer anti-inflammatory, analgesic, and slow-acting antirheumatic medications as prescribed. Individualize medication schedule to meet patient’s need for pain management. Encourage verbalization of feelings about pain and chronicity of disease. Teach pathophysiology of pain and rheumatic disease, and assist patient to recognize that pain often leads to unproven treatment methods. Assist in identification of pain that leads to use of unproven methods of treatment. Assess for subjective changes in pain. Reducing Fatigue Provide instruction about fatigue: Describe relationship of disease activity to fatigue; describe comfort measures while providing them; develop and encourage a sleep routine (warm bath and relaxation techniques that promote sleep); explain importance of rest for relieving systematic, articular, and emotional stress. Explain how to use energy conservation techniques (pacing, delegating, setting priorities). Identify physical and emotional factors that can cause fatigue. Facilitate development of appropriate activity/rest schedule. Encourage adherence to the treatment program. Refer to and encourage a conditioning program. Encourage adequate nutrition, including source of iron from food and supplements. Increasing Mobility Encourage verbalization regarding limitations in mobility. Assess need for occupational or physical therapy consultation: Emphasize range of motion of affected joints; promote use of assistive ambulatory devices; explain use of safe footwear; use individual appropriate positioning/posture. Assist to identify environmental barriers. Encourage independence in mobility and assist as needed: Allow ample time for activity; provide rest period after activity; reinforce principles of joint protection and work simplification. Initiate referral to community health agency. Facilitating Self Care Assist patient to identify self-caredeficits and factors that interfere with ability to perform self-care activities. Develop a plan based on the patient’s perceptions and priorities on how to establish and achieve goals to meet self-care needs, incorporating joint protection, energy conservation, and work simplification concepts: Provide appropriate assistive devices; reinforce correct and safe use of assistive devices; allow patient to control timing of self-care activities; explore with the patient different ways to perform difficult tasks or ways to enlist the help of someone else. Consult with community health care agencies when individuals have attained a maximum level ofself-care yet still have some deficits, especially regarding safety. Improving Body Image and Coping Skills Help patient identify elements of control over disease symptoms and treatment. Encourage patient’s verbalization of feelings, perceptions, and fears. Identify areas of life affected by disease. Answer questions and dispel possible myths. Develop plan for managing symptoms and enlisting support of family and friends to promote daily function. Monitoring and Managing Potential Complications Help patient recognize and deal with side effects from medications. Monitor for medication side effects, including GI tract bleeding or irritation, bone marrow suppression, kidneyor liver toxicity, increased incidence of infection, mouth sores, rashes, and changes in vision. Other signs and symptoms include bruising, breathing problems, dizziness, jaundice, dark urine, black or bloody stools, diarrhea, nausea and vomiting, and headaches. Monitor closely for systemic and local infections, which often can be masked by high doses of corticosteroids.	The nursing care plan for clients with sepsis involves eliminating infection, maintaining adequate tissue perfusion or circulatory volume, preventing complications, and providing information about disease process, prognosis, and treatment needs. Here are six (6) nursing care plans (NCP) and nursing diagnosis for patients with sepsis and septicemia: Risk For Infection Risk For Shock Risk For Impaired Gas Exchange Risk For Deficient Fluid Volume Hyperthermia Deficient Knowledge regarding self management Compromised immune system. Failure to recognize or treat infection and/or exercise proper preventive measuresI Interventions Teach the client about infection prevention measures Ask the client to take water more Ask the client to report the physician if temperature high Wear infection control measures when going to outside Take immunity increasing food items Follow medications Take follow up care Give emotional support Give health education regarding self management