Osteoarthritis
What are two key symptoms of osteoarthritis, and how do they differ from rheumatoid arthritis?
OA features joint pain and stiffness that worsens with activity and improves with rest. RA has symmetrical joint swelling and prolonged morning stiffness lasting more than 30 minutes.
What is the hallmark difference in morning stiffness between OA and RA?
RA has prolonged stiffness >30 min; OA stiffness resolves quickly with movement.
Name the 5 Ps of neurovascular assessment.
Pain, Pulse, Pallor, Paresthesia, Paralysis.
List three signs of a possible hip dislocation post-surgery.
Shortened leg, external rotation, severe pain.
What is the first step in assessing pain for a non-verbal patient?
Use a faces scale or assess behavior/non-verbal cues.
Which joints are most commonly affected in OA, and why?
Weight-bearing joints like the knees, hips, and spine due to mechanical wear and tear.
Describe the systemic effects of RA and their implications for patient care.
Fatigue, anemia, weight loss, low-grade fever, potential lung/eye involvement—require holistic care.
What is the priority nursing action for suspected compartment syndrome?
Keep limb at heart level, notify provider, prepare for fasciotomy.
A post-op hip replacement patient tries to cross their legs. What do you do and why?
Educate to avoid crossing legs to prevent dislocation.
How can you tell pain management is working besides asking the patient?
Increased ROM, calm demeanor, improved sleep.
Explain why moderate exercise is recommended for OA patients and give an example.
It strengthens muscles around joints, improves mobility, and reduces pain. Example: Swimming.
A patient taking methotrexate reports mouth sores and fatigue. What should the nurse do?
Assess for signs of bone marrow suppression or liver toxicity. Notify provider and review labs.
A patient in Buck’s traction says their leg hurts more than before. What could be wrong?
Misalignment or traction not effective; assess alignment, neurovascular status.
How can nurses prevent DVTs in a hip fracture patient?
Early ambulation, anticoagulants, compression devices, hydration.
Name three nonpharmacological interventions for chronic joint pain.
Ice/heat, distraction, guided imagery.
A patient with OA reports worsening knee pain after gardening. What nursing advice should you offer?
Rest the joint, apply ice or heat, consider assistive devices, and modify activities to reduce strain.
What teaching is necessary for a female patient of childbearing age taking methotrexate?
Use effective contraception; stop at least 3 months before conception. Avoid during breastfeeding.
Compare internal vs external fixation in terms of nursing care priorities.
Internal: Monitor incision, prevent infection. External: Pin site care, prevent infection.
Differentiate between Buck’s traction and skeletal traction.
Buck's: skin traction, short-term. Skeletal: pin/wire inserted, long-term, more force.
What side effects should you monitor for in opioid use post-fracture?
Constipation, sedation, respiratory depression.
Compare OA to RA based on inflammation, symmetry, and systemic effects.
OA is non-inflammatory, asymmetrical, and localized. RA is inflammatory, symmetrical, and systemic (e.g., fatigue, fever)
A patient presents with ulnar deviation and fatigue. What labs might confirm RA?
Rheumatoid factor (RF), anti-CCP antibodies, ESR, and CRP.
A patient in skeletal traction reports pin site pain and drainage. What should the nurse assess next?
Check for signs of infection (redness, warmth, purulent drainage), document, notify provider.
A patient has delayed fracture healing. What comorbidities could contribute?
Diabetes, smoking, poor nutrition, OA.
How does identifying the type of pain (acute vs chronic) change the treatment approach?
Acute: opioids short-term. Chronic: non-pharm, non-opioid, multimodal approach.