Osteoporosis, Osteoarthritis, Rheumatoid Arthritis, Gout, Fractures

Osteoporosis

• Osteoporosis leads to vertebral compression fractures.
• Loss of height and kyphosis (Dowager's hump) are hallmark signs of osteoporosis.
• The primary pathophysiological process is an imbalance where bone resorption exceeds bone formation, leading to reduced bone density
• A dual-energy X-ray absorptiometry (DEXA) scan is the gold standard diagnostic test.
• Alendronate, a bisphosphonate, is commonly prescribed to inhibit bone resorption by slowing osteoclast activity.

Osteoarthritis

• Osteoarthritis is a degenerative joint disease influenced by mechanical wear and tear, obesity, and aging.
• Obesity and aging are key risk factors for osteoarthritis.
• The primary pathological change is the erosion of articular cartilage and subsequent bone remodeling.
• Total knee replacement (TKR) and total hip replacement (THR) are common surgical treatments for severe osteoarthritis.

Rheumatoid Arthritis (RA)

• Rheumatoid arthritis is an autoimmune disorder affecting synovial joints, leading to inflammation and deformities.
• RA primarily affects diarthrodial joints.
• Methotrexate is a first-line disease-modifying antirheumatic drug (DMARD) used in RA, which slows its progression by suppressing immune function.

Fractures

• Fat embolism syndrome is suspected in patients with a femur fracture who suddenly develop dyspnea, petechiae, and confusion; this occurs when fat globules enter circulation, leading to respiratory distress and neurologic symptoms.
• For a patient with a newly applied cast, the priority nursing intervention is to elevate the extremity and assess neurovascular status to reduce swelling and prevent complications like compartment syndrome.
• Use sterile technique for pin care and monitor for signs of infection for patients with an external fixation device; cleaning with prescribed solutions should be done regularly.
• When assessing a patient with a suspected hip fracture, the priority action is to check neurovascular status.
• A fat embolism syndrome presents with respiratory distress, neurological symptoms, and petechiae on the chest or axilla in a patient with a long bone fracture.

Back Problems and Laminectomy

• Monitoring for urinary retention and CSF leakage (clear fluid at the incision site) is a post-operative priority after a laminectomy.
• CSF leakage (clear drainage at the incision site) and neurological deficits require immediate intervention after a lumbar laminectomy.
• After a spinal surgery, a new loss of motor function (inability to move toes) should be reported immediately as it could indicate spinal cord compression or nerve damage.
• Side-lying with a pillow between the knees is the best sleeping position after lumbar laminectomy to maintain spinal alignment and reduce strain.
• After a laminectomy, avoid bending, twisting, or heavy lifting to promote healing by reducing pressure on the spine.

Amputations

• Peripheral vascular disease (PVD), often caused by diabetes, is the most common cause of non-traumatic lower extremity amputations.
• Mirror therapy helps reduce phantom limb pain by providing visual feedback.
• After a below-knee amputation, lying prone several times a day helps stretch the hip flexors and prevents contractures.
• Administering prescribed gabapentin is the most appropriate intervention for a patient with an above-knee amputation reporting phantom limb pain; gabapentin is commonly used for neuropathic pain.
• In the immediate post-op period for an above-knee amputation, monitor for excessive bleeding, which is the most immediate risk.
• Upper body strengthening exercises should be encouraged for a patient with a below-knee amputation, as this helps with mobility and the use of assistive devices.

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.
• Gout typically affects the first metatarsophalangeal joint (big toe) with sudden severe pain and inflammation.
• During dietary changes teaching for gout, avoid organ meats, they are high in purines, which increase uric acid levels and worsen gout.
• Allopurinol reduces uric acid production and is most likely prescribed for chronic gout.
• Reduce alcohol consumption can prevent recurrent gout attacks, as alcohol increases uric acid levels.
• For acute gout attack, immobilize and elevate the joint, as resting and elevating the joint reduces inflammation and pain.

General Mobility-Related Questions

• A patient who had a total hip replacement should avoid crossing their legs, which increases the risk of hip dislocation post-THR.
• Sudden pain and shortening of the affected leg is a symptom of hip dislocation after total hip replacement caused by dislocation of the prosthetic hip.
• The first sign of osteoarthritis is typically pain that worsens with activity.
• Encourage weight-bearing exercise to help reduce the risk of falls for patients with osteoporisis; weight-bearing exercise helps maintain bone density.
• A patient taking alendronate for osteoporosis should remain upright for 30 minutes after taking it to avoid esophageal irritation.
• Inserting objects inside a cast can lead to skin breakdown and infection.
• Alendronate can cause esophageal irritation, so the patient should stay upright after taking it Severe pain unrelieved by medication is a hallmark sign of compartment syndrome and the nurse should assess suspect compartment syndrome.
• Open fractures increase the risk of infection, including osteomyelitis, due to exposure to bacteria. A patient with an open fracture is at risk for osteomyelitis.
• Regular weight-bearing exercise exercise should be included in a teaching plan for patients with osteoarthritis because exercise helps strengthen muscles around joints, improving function and reducing stiffness.
• Vitamin D helps the body absorb calcium, essential for bone health, and is essential for calcium absorption in osteoporosis prevention.
• Corticosteroids increase bone resorption, leading to osteoporosis. Patient taking long-term corticosteroids are at risk of osteoporosis.
• Encourage daily weight-bearing exercise to stimulate bone formation and reduce fracture risk for a patient with osteoporosis that is looking for ways to prevent fractures.
• Assess pain levels both before and after an intervention to effectively evaluate pain management in a patient with osteoarthritis, this will help determine how effective pain management strategies are.
• Prevent joint destruction and maintain function is the primary goal of treatment for rheumatoid arthritis because RA is a chronic condition with no cure, so treatment focuses on slowing progression and preserving function.
• Warm compresses and gentle exercises is the best intervention for managing stiffness in rheumatoid arthritis because heat therapy and movement help improve circulation and reduce stiffness.
• Crossing legs can cause knee dislocation after TKR, avoid crossing the legs.

This lesson covers the key differences between osteoporosis, osteoarthritis, and rheumatoid arthritis including causes, risk factors, and treatments. Osteoporosis is characterized by reduced bone density and vertebral fractures. Osteoarthritis features cartilage erosion, while rheumatoid arthritis is an autoimmune disorder.