Republic of the Philippines
UNIVERSITY OF NORTHERN PHILIPPINES
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
JOINT DISORDERS
PRESENTED BY GROUP 3
BALINO, NATHANIEL B.
BARIAO, CRISTYL SHINE G.
BISTOYONG, ALYSSA MAE P.
CABAONG, RENDEL JOSHUA P.
CABJUAN, KATE GWYNETH A.
CALIBUSO, NIÑA GRACIA T.
CONTENT
1
Brief Background
2
Different Joint
3
Osteoarthritis
of the Joint Disorders
4 5
Carpal Tunnel
Gout
Syndrome
WHAT IS JOINT?
A joint, also known as an articulation or
articular surface, is a connection that occurs
between bones in the skeletal system. Joints
provide the means for movement. A joint is the
part of the body where two or more bones meet
to allow movement. The six types of freely
movable joint include ball and socket, saddle,
hinge, condyloid, pivot and gliding.
6 TYPES OF FREELY MOVABLE
JOINT
BALL AND SOCKET JOINT CONDYLOID JOINT
SADDLE JOINT PIVOT JOINT
HINGE JOINT GLIDING JOINT
DIFFERENT JOINT
DISORDERS
ARTHRITIS
Rheumatoid Arthritis
Osteoarthritis
Infectious Arthritis
Gouty Arthritis
Spondyloarthritis
Juvenile Idiopathic Arthritis
BURSITIS
CARPAL TUNNEL SYNDROME
DISLOCATED JOINTS
HINGE JOINT OF THE
KNEE
OSTEOARTHRITIS
WHAT IS OSTEOARTHRITIS?
• Osteoarthritis is a degenerative joint disease
that affects the cartilage.
• Inflammation or swelling of a joint caused by
the wear and tear of the cartilage of a bone.
• Osteoarthritis is the most common form of
arthritis.
• Osteoarthritis is most common in weight-
bearing joints.
ETIOLOGY
• Osteoarthritis occurs when the cartilage that cushions
the ends of bones in your joints gradually deteriorates.
• Cartilage wears down completely, bone will rub on bone.
RISK FACTORS
• Older age.
• Sex.
• Obesity.
• Joint injuries.
• Repeated stress on the joint.
• Genetics.
• Bone deformities.
• Certain metabolic diseases.
CLINICAL MANIFESTTAIONS
Osteoarthritis symptoms can usually be managed, although the damage to joints can't be reversed. Its
symptoms often develop slowly and worsen over time. Signs and symptoms of osteoarthritis include:
PAIN STIFFNESS TENDERNESS LOSS OF
FLEXIBILITY
GRAFTING
BONE SPURS SWELLING
SENSATION
COMPLICATIONS
CHRONIC PAIN
UNABLE TO PERFORM DAILY
TASKS.
DEPRESSION
SLEEP DISTURBANCES
DIAGNOSTIC PROCEDURES
During the physical exam, the doctor will check the affected joint for
tenderness, swelling, redness and flexibility.
IMAGING TESTS
To get pictures of the affected joint, the doctor might recommend:
X-rays. Cartilage doesn't show up on X-ray images, but cartilage loss is
revealed by a narrowing of the space between the bones in the joint.
Magnetic resonance imaging (MRI). An MRI uses radio waves and a
strong magnetic field to produce detailed images of bone and soft tissues,
including cartilage.
DIAGNOSTIC PROCEDURES
LAB TESTS
Analyzing blood or joint fluid can help confirm the diagnosis.
Blood tests. Although there's no blood test for osteoarthritis, certain tests can help rule
out other causes of joint pain, such as rheumatoid arthritis.
Rheumatoid arthritis, or RA, is an autoimmune and inflammatory disease, which
means that your immune system attacks healthy cells in your body by mistake, causing
inflammation (painful swelling) in the affected parts of the body. RA mainly attacks the joints,
usually many joints at once.
Joint fluid analysis. Your doctor might use a needle to draw fluid from an affected
joint. The fluid is then tested for inflammation and to determine whether your pain is caused by
gout or an infection rather than osteoarthritis.
TREATMENT
Osteoarthritis can't be reversed, but treatments can reduce pain and help you move better.
MEDICATIONS
Medications that can help relieve osteoarthritis symptoms, primarily pain, include:
Acetaminophen. Acetaminophen (Tylenol, others) has been shown to help some
people with osteoarthritis who have mild to moderate pain.
Nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter NSAIDs, such as
ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), taken at the
recommended doses, typically relieve osteoarthritis pain. Stronger NSAIDs are available by
prescription.
Duloxetine (Cymbalta). Normally used as an antidepressant, this medication is also
approved to treat chronic pain, including osteoarthritis pain.
TREATMENT
Osteoarthritis can't be reversed, but treatments can reduce pain and help you move better.
THERAPY
Physical therapy. A physical therapist can show you exercises to strengthen the
muscles around your joint, increase your flexibility and reduce pain.
Occupational therapy. An occupational therapist can help you discover ways to do
everyday tasks without putting extra stress on your already painful joint.
Transcutaneous electrical nerve stimulation (TENS). This uses a low-voltage
electrical current to relieve pain. It provides short-term relief for some people with
knee and hip osteoarthritis.
TREATMENT
Osteoarthritis can't be reversed, but treatments can reduce pain and help you move better.
SURGICAL AND OTHER PROCEDURES
If conservative treatments don't help, you might want to consider procedures such as:
Cortisone injections. Injections of a corticosteroid into the joint might relieve pain
for a few weeks. The doctor numbs the area around the joint, then places a needle
into the space within the joint and injects medication. The number of cortisone
injections a patient can receive each year is generally limited to three or four.
Lubrication injections. Injections of hyaluronic acid might relieve pain by
providing some cushioning in the knee, though some research suggests that these
injections offer no more relief than a placebo. Hyaluronic acid is similar to a
component normally found in your joint fluid.
TREATMENT
Osteoarthritis can't be reversed, but treatments can reduce pain and help you move better.
SURGICAL AND OTHER PROCEDURES
If conservative treatments don't help, you might want to consider procedures such as:
Realigning bones. If osteoarthritis
has damaged one side of your knee
more than the other, an osteotomy
might be helpful. In a knee
osteotomy, a surgeon cuts across
the bone either above or below the
knee, and then removes or adds a
wedge of bone.
TREATMENT
Osteoarthritis can't be reversed, but treatments can reduce pain and help you move better.
SURGICAL AND OTHER PROCEDURES
If conservative treatments don't help, you might want to consider procedures such as:
Joint replacement. In joint
replacement surgery, your surgeon
removes your damaged joint surfaces
and replaces them with plastic and
metal parts. Surgical risks include
infections and blood clots. Artificial
joints can wear out or come loose and
might eventually need to be replaced.
NURSING DIAGNOSIS
Acute Pain/Chronic Pain.
Impaired Physical Mobility.
Activity Intolerance.
NURSING INTERVENTIONS
Here are some nursing interventions that can be implemented
for patients with osteoarthritis:
Pain management
Exercise
Weight management
Assistive devices
Education
Emotional support
GOUT
WHAT IS GOUT?
Gout is a common form of inflammatory arthritis that is very
painful.
It usually affects one joint at a time (often the big toe joint).
There are times when symptoms get worse, known as flares, and
times when there are no symptoms, known as remission.
Repeated bouts of gout can lead to gouty arthritis, a worsening
form of arthritis.
WHAT CAUSES GOUT?
Gout occurs when urate crystals accumulate in your joint, causing the
inflammation and intense pain of a gout attack. Urate crystals can form
when you have high levels of uric acid in your blood.
Normally, uric acid dissolves in your blood and passes through your
kidneys into your urine. But sometimes either your body produces too
much uric acid or your kidneys excrete too little uric acid. When this
happens, uric acid can build up, forming sharp, needlelike urate crystals
in a joint or surrounding tissue that cause pain, inflammation and
swelling.
CLINICAL MANIFESTTAIONS
INTENSE PAIN
Gout usually affects the big toe, but it can occur in any joint. Other commonly affected joints include the
ankles, knees, elbows, wrists and fingers. The pain is likely to be most severe within the first four to 12 hours
after it begins.
LINGERING DISCOMFORT
After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. Later
attacks are likely to last longer and affect more joints.
INFLAMMATION & REDNESS
The affected joint or joints become swollen, tender, warm and red.
LIMITED RANGE OF MOTION
As gout progresses, you may not be able to move your joints normally.
WHO ARE AT RISK?
YOU'RE MORE LIKELY TO DEVELOP GOUT IF YOU HAVE HIGH LEVELS OF URIC ACID IN
YOUR BODY. FACTORS THAT INCREASE THE URIC ACID LEVEL IN YOU BODY INCLUDE:
DIET
WEIGHT
MEDICAL CONDITIONS
CERTAIN MEDICATIONS
FAMILY HISTORY OF GOUT
AGE & SEX
RECENT SURGERY OR TRAUMA
COMPLICATIONS
RECURRENT ADVANCED KIDNEY
GOUT GOUT STONES
DIAGNOSTIC PROCEDURES
JOINT FLUID TEST
BLOOD TEST
X-RAY IMAGING
ULTRASOUND
DUAL - ENERGY COMPUTERIZED TOMOGRAPHY (DECT)
TREATMENT
GOUT MEDICATIONS ARE AVAILABLE IN TWO
TYPES AND FOCUS ON TWO DIFFERENT PROBLEMS.
The first type helps reduce the inflammation and
pain associated with gout attacks.
The second type works to prevent gout
complications by lowering the amount of uric acid
in your blood.
TREATMENT
DRUGS USED TO TREAT GOUT FLARES & PREVENT
FUTURE ATTACKS:
NONSTEROIDAL ANTI-INFLAMMATORY DRUGS
(NSAIDS)
COLCHICINE
CORTICOSTEROIDS
TREATMENT
MEDICATIONS TO PREVENT GOUT COMPLICATION:
MEDICATIONS THAT BLOCK URIC ACID
PRODUCTION.
ALLOPURINOL
FEBUXOSTAT
MEDICATIONS THAT IMPROVE URIC ACID
REMOVAL.
PROBENECID
NURSING DIAGNOSIS
Acute pain
Chronic pain
Impaired physical mobility
Activity intolerance
Bathing/hygiene self-care deficit
NURSING INTERVENTIONS
Promote measures to prevent exacerbations
Provide measure to promote comfort and reduce pain.
Administer prescribed medications, which may include
nonsteroidal anti-inflammatory drugs, uric acid synthesis
inhibitors, and uricosuric agents.
CARPAL TUNNEL
SYNDROME
WHAT WENT WRONG?
The median nerve that passes through the carpal tunnel in the
anterior wrist is compressed, resulting in pain and a numb
sensation in the thumb, index finger, middle finger, and lateral
aspect of the fourth finger in the hand. This is often the result of
repetitive hand motions and maybe work- or hobby-related.
Carpal tunnel syndrome tends to be more common in women.
Longterm presence of carpal tunnel syndrome can lead to
atrophy of muscles in the palm of the hand. Hand grip strength
may be affected. After treatment, carpal tunnel syndrome may
recur in the future.
CLINICAL MANIFESTTAIONS
Tingling, numbness, or burning sensation (paresthesia) in the
hand due to nerve compression.
Weakness in the hand.
Pain in the hand due to nerve compression.
Tapping over the carpal tunnel area will cause tingling, numbness, or
pain through the palm and affected fingers (Tunnel’s sign).
Pain, tingling, and burning sensation in the wrist and hand.
DIAGNOSTIC PROCEDURES
ELECTROMYOGRAPHY (EMG) OR NERVE CONDUCTION STUDIES
WILL SHOW NERVE DYSFUNCTION.
MAGNETIC RESONANCE IMAGING (MRI) WILL SHOW SWELLING
OF THE MEDIAN NERVE WITHIN THE CARPAL TUNNEL.
TREATMENT
Administer Surgery when
Administer corticosteroids decompression
Splint the NSAID of the carpal
to decrease
wrist for 2 (nonsteroidal tunnel is
inflammation:
weeks to keep anti- necessary to
Some are given
the wrist inflammatory orally. relieve pressure
Some may be
drugs) injected into the
on the median
carpal tunnel area. nerve.
NURSING DIAGNOSIS
Pain
Impaired mobility
Disturbed sensory perception: tactile
NURSING INTERVENTIONS
Assist the patient with hygiene if necessary before surgical
correction and with postoperative dressings after surgery.
Patients wearing wrist splints may need assistance with
certain activities of daily living (ADLs).
Assist the patient in exercising the hand;
Monitor the motion and sensation in the hand following
surgery.
NURSING INTERVENTIONS
Encourage movement of fingers after
surgery.
Monitor postoperative dressing for
drainage.
Explain to the patient: Use, interactions,
and side effects of anti-inflammatory
medications.
Proper use of wrist splints.
Encourage appropriate exercises.
Use of ergonomic devices, such as wrist
rests or keyboard trays for computer work.
