Arthritis, Osteoporosis and Fractures

Osteoporosis

• A hallmark sign is loss of height and kyphosis, resulting from vertebral compression fractures.
• The primary pathophysiological process involves an imbalance where bone resorption exceeds bone formation.
• The gold standard diagnostic test is a DEXA scan (Dual-energy X-ray absorptiometry).
• Alendronate is commonly prescribed to inhibit bone resorption by slowing osteoclast activity and is a bisphosphonate.

Osteoarthritis

• Key risk factors include obesity and aging.
• The primary pathological change is erosion of articular cartilage.
• Total knee replacement (TKR) and total hip replacement (THR) are common surgical treatments for severe cases.

Rheumatoid Arthritis (RA)

• Primarily affects diarthrodial (synovial) joints, leading to inflammation and deformities.
• Methotrexate is a first-line DMARD (disease-modifying antirheumatic drug) that slows RA progression by suppressing immune function.

Fractures

• Fat embolism syndrome should be suspected in a patient with a femur fracture who develops dyspnea, petechiae, and confusion, due to fat globules entering circulation and causing respiratory and neurologic symptoms.
• Elevating the extremity and assessing neurovascular status is the priority nursing intervention for a patient with a newly applied cast to reduce swelling and prevent complications like compartment syndrome.
• Use sterile technique for pin care and monitor for signs of infection, sterile cleaning with prescribed solutions should be done regularly, for patients with an external fixation device.

Hip Fracture

• Checking neurovascular status is the priority action when assessing a patient with a suspected hip fracture to prevent complications of neurovascular compromise.

Fat Embolism

• Dyspnea, petechiae, and confusion are symptoms that may indicate a fat embolism in a patient with a long bone fracture.

Back Problems and Laminectomy

• Post-operative priorities after a laminectomy include monitoring for urinary retention and CSF leakage (clear fluid at the incision site) as these require immediate intervention.
• CSF leakage and neurological deficits require immediate intervention after lumbar laminectomy.
• Post-laminectomy patients are advised to avoid bending, twisting, or heavy lifting, as these movements increase pressure on the spine and inhibit healing.
• Side-lying with a pillow between the knees is the best sleeping position after a lumbar laminectomy as it maintains spinal alignment and reduces strain.
• Inability to move toes after spinal surgery should be reported immediately, as it may indicate spinal cord compression or nerve damage.

Amputations

• Peripheral vascular disease (PVD), often caused by diabetes, is the most common cause of non-traumatic lower limb amputations.
• Mirror therapy helps reduce phantom limb pain by providing visual feedback.
• Patients should lie prone several times a day to prevent hip flexor contractures after a below-knee amputation.
• Gabapentin is commonly used for neuropathic pain, including phantom limb pain in patients with above-knee amputation.
• Monitor for excessive bleeding, the most immediate risk after amputation for a above-knee amputation.
• Strengthening the upper body helps with mobility and the use of assertive devices after a below-knee amputation.

Gout

• Elevated uric acid levels are expected in a patient with gout due to hyperuricemia, leading to crystal deposits in joints.
• Colchicine reduces inflammation in acute gout attacks, while allopurinol is used for prevention.
• Organ meats, high in purines, should be avoided in the diet, as they elevate uric acid levels and worsen gout.
• Allopurinol reduces uric acid production and is likely to be prescribed to patients with chronic gout.
• A common symptom of acute gout is severe joint pain in the big toe.
• Reduce alcohol consumption as a major lifestyle modification to prevent recurrent gout attacks, because alcohol increases uric acid levels.
• Allopurinol prevents uric acid buildup and is used for chronic gout management.
• Immobilizing and elevating the joint is the best non-pharmacologic intervention for a acute gout attack.

General Mobility-Related Questions

• Crossing legs increases the risk of hip dislocation post-THR (total hip replacement) and should be avoided.
• Sudden pain and shortening of the affected leg is a symptom of hip dislocation after total hip replacement.
• Osteoarthritis pain increases with joint use and improves with rest.
• Weight-bearing exercise helps maintain bone density and reduces fall risk for elderly patients with osteoporosis.
• A patient taking alendronate for osteoporosis should remain upright for 30 minutes after taking it to prevent esophageal irritation.
• Compartment syndrome should be suspected in a patient in skeletal traction complaining of severe pain unrelieved by medication.
• Osteomyelitis is a risk for patients with open fractures due to exposure to bacteria.
• "I can insert a small object to scratch inside the cast if it itches" indicates a need for further teaching the patient.
• The first sign of osteoarthritis is typically pain that worsens with activity.
• Regular weight-bearing exercise can help maintain joint function in patients with osteoarthritis.
• Assessing pain levels before and after intervention is the best way to evaluate effective pain management in a patient with osteoarthritis.
• Vitamin D helps the body absorb calcium and is essential for bone health.
• Patients taking long-term corticosteroids are at risk for osteoporosis.
• Crossing legs should be avoided after a total knee replacement (TKR), as it can cause knee dislocation.
• Daily weight-bearing exercise stimulates bone formation, and reduces fracture risk.
• The primary goal of treatment for rheumatoid arthritis is to prevent joint destruction and maintain function.
• Rheumatoid arthritis is a chronic condition with no cure, so treatment focuses on slowing progression and preserving function.
• Applying warm compresses and gentle exercises is best for managing stiffness in rheumatoid arthritis, movement and heat therapy improve circulation and reduce stiffness.

Explore osteoporosis, osteoarthritis, rheumatoid arthritis and fractures. Osteoporosis involves bone resorption, diagnosed by DEXA scans, and treated with medications like alendronate. Osteoarthritis relates to cartilage erosion, while rheumatoid arthritis affects synovial joints and is treated with methotrexate.