Osteoarthritis Treatment and Management Quiz

320 Exam 4 Study Guide (Adult Health Nursing)

• Ischemic Strokes:

  • Pathophysiology: Injury to a blood vessel leads to clot formation (thrombotic) or an embolus lodging in artery (embolic).
  • Signs and Symptoms: Most patients don't lose consciousness initially. Manifestations can progress over 72 hours. Embolic strokes often have rapid onset severe symptoms.
  • Diagnostic Tests: Non-contrast CT or MRI to distinguish ischemic from hemorrhagic, CTA for blood vessel visualization. Cardiac tests if embolus suspected.
  • Risk Factors: Hypertension, heart disease, diabetes, smoking, alcohol, illicit drug use, obesity, birth control pills (women), migraines (women), rheumatoid arthritis, sickle cell disease, factor V Leiden, and certain ethnicities (Blacks, Hispanics, Asians).
  • Complications: Permanent brain damage, permanent motor dysfunction, and death.
  • Medications and Treatments: Addressing hypertension, tPA (within 3-4.5 hours post-stroke onset) may be used for reestablishing blood flow.
  • RN Interventions and Patient Teaching: Assessment of symptom onset, duration, and changes. History of previous symptoms and current medications and risk factors, family history. Stroke scale assessment, and prevention of aspiration and atelectasis.

• Hemorrhagic Strokes:

  • Pathophysiology: Bleeding into brain tissue, subarachnoid space, or ventricles.
  • Signs and Symptoms: Severe headache, nausea and vomiting, weakness, slurred speech, hemiplegia (severe hemorrhage). Fixed and dilated pupils, abnormal body posturing, and coma (severe hemorrhage).
  • Diagnostic Tests: Non-contrast CT or MRI to distinguish from ischemic. Provides type, size, and location.
  • Risk Factors: Hypertension is the most common cause. Uncontrolled/undiagnosed hypertension is a major cause.
  • Complications: Poor prognosis, 30-80% mortality rate in 30 days, half of deaths occurring within 48 hours.
  • Medications and Treatments: Managing hypertension (oral or IV agents to maintain BP in normal range). Immediate evacuation of aneurysm-induced hematomas or cerebellar hematomas larger than 3 cm, insertion of a ventriculostomy for CSF reduction of ICP, coil aneurysm, and using hydrogel-coated platinum coil in aneurysm lumen (interventional neuroradiology).
  • RN Interventions and Patient Teaching: Assessment of symptoms onset, duration, and nature. History of similar symptoms, medications/illnesses, family history (stroke, aneurysm). Stroke scale assessment and prevention of aspiration and atelectasis.

• Headaches:

  • Types: Tension, migraine, cluster.
  • Signs and Symptoms: Tension: Bilateral, band-like, base of skull, constant squeezing and tightness, stiff neck, tenderness, common in women. Migraine: Unilateral (60%), often anterior, throbbing (with synchronous pulse). Aura, improved with sleep, common in women. Cluster: Unilateral, radiating in eye, severe, bone-crushing, nocturnal (awakens person), common in men.
  • Risk Factors: Gender (tension and migraine more common in women, cluster more common in men), alcohol (trigger for cluster pain).
  • Complications: Cluster: alcohol trigger, seizures.
  • Diagnostic Tests: Neurologic examination, inspection for local infection, palpation for tenderness, possible auscultation for bruits. CBC, electrolytes, urinalysis.
  • Medications and Treatments: NSAIDs, acetaminophen, aspirin, caffeine combinations, muscle relaxants, antidepressants (amitriptyline), antiseizure medications (topiramate), triptans (sumatriptan) first-line for moderate-to-severe migraine.
  • RN Interventions + Patient Teaching: Keeping a headache diary, avoidance of trigger foods, stress management, and regular exercise.

• Seizures:

  • Pathophysiology: Abnormal firing of neurons without clear cause.
  • General Onset Symptoms: Tonic-clonic (body stiffens, jerks), generalized onset may involve motor/sensory areas. Symptoms of focal seizures depend on area of brain involved.
  • Focal Onset Symptoms: Usually involve one side of the body/part of body. Patient can be awake.
  • Complications: Status epilepticus (continuous seizure activity despite treatment), refractory status epilepticus.
  • Diagnostic Tests: Usually history and physical, birth/developmental history, and significant illnesses/injuries. CBC, urinalysis, electrolytes; Creatinine, fasting blood glucose, LP for CSF (analysis), CT, MRI, MRA, MRS, SPECT, PET (rule out structural lesions, assess cerebral blood flow). EEG (if abnormal).
  • RN Interventions + Patient Teaching: Airway protection, injury prevention (pad side rails), monitor seizure (duration, body parts involved), vital signs, and assess for postictal state, pupil size, and memory for sleepiness following or before a seizure.

• Alzheimer's Disease:

  • Pathophysiology: Abnormal protein aggregation (amyloid plaques and neurofibrillary tangles), neuron loss, synaptic dysfunction.
  • Signs and Symptoms: Gradually developing, forgetfulness, short-term memory impairment (especially for new learning), loss of initiative, trouble organizing, planning, recognizing family, delusions/hallucinations, behavior problems.
  • Risk Factors: Age, family history, diabetes, head trauma.
  • Complications: Repetitiveness, delusions, hallucinations, agitation, aggression, sleep pattern alterations, wandering, hoarding, and resisting care.
  • Diagnostic Tests: Comprehensive neurologic assessment, Mini-Cog, Mini-Mental State Examination, brain imaging (CT, MRI, MRS, PET), CBC, ECG, serum glucose, creatinine, blood urea nitrogen, serum levels of vitamins, and thyroid function tests.
  • Medications and Treatments: Cholinesterase inhibitors (donepezil, rivastigmine, galantamine) slow progression (mild/moderate) . NMDA receptor antagonist (memantine) aids in moderating moderate-severe (stages).
  • RN Interventions + Patient Teaching: Maintaining functional ability as long as possible. Create a safe environment with minimum injuries, maintaining dignity, use orientation, redirection, and reassurance. Explore all options before using medications.

• Myasthenia Gravis:

  • Pathophysiology: Autoimmune disease affecting neuromuscular junction; antibodies attack ACh receptors.
  • Signs and Symptoms: Fluctuating weakness of skeletal muscles, initially mild, progressively worsens. Common in eyes and eyelids (drooping), chewing, swallowing, speaking, and breathing.
  • Risk Factors: Women <40, Men >60.
  • Complications: Myasthenic crisis (acute worsening of muscle weakness).
  • Diagnostic Tests: History, physical, EMG, and testing for anti-AChR antibodies.
  • RN Interventions + Patient Teaching: Instruction on the importance of taking the medication on time, to identify and address symptoms of the progressive disease.

• Multiple Sclerosis:

  • Pathophysiology: Chronic progressive nervous system disorder; inflammatory process, demyelination, and gliosis in CNS.
  • Signs and Symptoms: Gradual onset, vary between patients, blurred vision, red-green color distortion, extremity weakness, numbness, tingling, speech impairments, tremors and dizziness, cerebellar dysfunction, coordination difficulty, spastic bladder or retention, and sexual dysfunction.
  • Risk Factors: Genetic, infection, smoking, physical injury, emotional stress, excessive fatigue, pregnancy.
  • Complications: Exacerbations triggered by infection, trauma, emotional stress, pregnancy.
  • Diagnostic Tests: History and physical, MRI (brain and spinal cord to show plaques and possible inflammation). CSF analysis (increased immunoglobulin G and oligoclonal banding).
  • RN Interventions + Patient Teaching: Energy conservation, adequate fluid intake (2000 mL/day), bowel/bladder training, promoting independence, daily exercise. Understanding potential triggers for exacerbations, and emphasizing importance of adherence to treatment plan.

• Other Neurological Conditions:

  • Delirium: A state of confusion that develops over days to hours. May be caused by impairment of cerebral metabolism (less oxygen, problems using oxygen), or stress, surgery, sleep deprivation, or bacterial meningitis.
  • Signs and Symptoms: Sudden onset, disorientation, clouded sensorium, sleep disturbance, range of manifestations from hypoactivity, lethargy to hyperactivity, agitation, and hallucinations. In early stages, difficulty concentrating, disorganized thinking, irritability, and insomnia. In later stage, agitation and misinterpretations.
  • Risk Factors: Dementia, dehydration, electrolyte imbalances, emotional stress, lung, liver, heart, and kidney conditions, infection.
  • Complications: Delirium is a common serious surgical, medical, and critical care complication among older adults.
  • Diagnostic Tests: History and physical, labs (CBC, serum electrolytes, blood urea nitrogen, creatinine levels, liver and thyroid function tests), ECG, urinalysis, oxygen saturations, drug and alcohol levels, lumbar puncture, x-ray, CT scan, MRI (if head injury suspected.
  • RN Interventions + Patient Teaching: Protect from harm, maintain a calm, non-stimulating environment, use re-orientation techniques (clocks, calendars).

• Osteoporosis/Osteopenia:

  • Pathophysiology: Bone loss due to decreased bone density.
  • Signs and Symptoms: Early= Back pain, spontaneous fractures, kyphosis.
  • Risk Factors: Women (low estrogen, calcium), age (65+), low body weight, smoking, ethnicity, family history, corticosteroids.
  • Complications: Fractures (spine, hips, wrist).
  • Diagnostic Tests: Bone Density Test (DEXA), serum calcium.,
  • Medications and Treatments: Calcium and vitamin D supplementation, bisphosphonates (e.g., alendronate), selective estrogen receptor modulators (SERMs like raloxifene).
  • RN Interventions + Patient Teaching: Ensuring adequate calcium and vitamin D intake; promoting weight-bearing exercise; educating on fall prevention strategies; and monitoring for side effects of medications.

• Bell's Palsy:

  • Pathophysiology: Inflammation and dysfunction of facial nerve (CN VII).
  • Signs and Symptoms: Sudden onset unilateral facial weakness/paralysis, drooping of one side of the face, inability to close one eye, decreased muscle movement for chewing, diminished sensation on the face, pain behind the ear, numbness of the face/ear/tongue, tinnitus, and headache.
  • Complications: Psychological withdrawal (changes in appearance), malnutrition, and dehydration.
  • Diagnostic Tests: History and physical examination, observation of symptoms progression. MRI and/or CT scan to eliminate other potential causes of facial drooping.
  • RN Interventions + Patient Teaching: Provide analgesics, protect face from sensitivities, teach eye protection/shield methods, facial massage and exercises, frequent mouth care, and avoidance of hot foods.

• Fractures:

  • Pathophysiology: A break in the continuity/structure of the bone. Can be open or closed.
  • Signs and Symptoms: Immediate localized pain. Decreased function, inability to bear weight/move. Obvious bone deformity, guarding/protective behavior.
  • Complications: Delayed union, malunion, nonunion, infection, and venous thromboembolism.
  • Diagnostic Tests: History and physical, X-ray, CT scan, and MRI.
  • RN Interventions + Patient Teaching: Maintain extremity position, assess for pain, edema, pulses, and sensation.

• Sprains/Strains:

  • Pathophysiology: Sprain: injury to ligaments surrounding joint. Strain: injury to muscle or tendon.
  • Signs and Symptoms: Pain, bruising, soft tissue swelling, decreased/limited movement and function, difficulty bearing weight.
  • Complications: Persistent pain, stiffness, difficulty with ADLs.
  • Diagnostic Tests: History, physical examination, assessing mobility and range of motion. Possible x-ray or imaging tests.
  • RN Interventions + Patient Teaching: RICE (Rest, Ice, Compression, Elevation) protocol, NSAIDs, using heat or cold appropriately. Instructed on avoiding any activity that worsens pain or increases instability in the injury area.

• Rheumatoid Arthritis:

  • Pathophysiology: Chronic systemic autoimmune disease; inflamed synovial membrane.
  • Signs and Symptoms: Fatigue, anorexia, weight loss, morning stiffness, swollen/tender joints, commonly affecting PIPs and MCPs, subcutaneous nodules, and possible joint deformity.
  • Diagnostic Tests: Comprehensive history, physical, possibly rheumatoid factor and/or anti-CCP antibody test; X-rays (not diagnostic, for assessment of initial or baseline stage).
  • Risk Factors: Genetic (HLA), external environmental factors.
  • Complications: Loss of independence, depression, joint deformities, muscle atrophy, tendon destruction, potentially impacting functional ADLs and ability for self-care.

• Systemic Lupus Erythematosus (SLE):

  • Pathophysiology: Multi-system inflammatory autoimmune disease; marked by unpredictable course and alternating periods of remission and exacerbation.
  • Signs and Symptoms: May include fatigue, anorexia, weight loss, joint pain, and excessive fatigue. Arthralgia (many joints) and polyarthralgia, often presenting with morning stiffness.
  • Diagnostic Tests: History, physical examination (assessing for any inflammation), possible lab tests.
  • Risk Factors: Genetic (HLA) and environmental triggers.
  • Complications: Polyarthralgia (swollen joints in multiple areas.) Deformities: (e.g., swan neck, ulnar deviation, & joint laxity), increasing risk for bone loss and possible fracture.

• Additional Information

  • Information on specific medications and treatments, diagnostics, and interventions for specific diseases was included as it pertained to the content areas.
  • Abbreviations and other definitions of specific terms are not included in these study notes.
  • Specific examples of specific diseases were not included.
  • Focus was to include relevant information while maintaining succinctness.

Test your knowledge on the treatment and management of osteoarthritis, including medication options, surgical interventions, and common symptoms. This quiz covers crucial aspects of osteoarthritis and its effects on patients, providing insights into effective strategies for care.