Osteoporosis and Osteoarthritis

Osteoporosis

• Osteoporosis is characterized by excessive bone resorption, leading to fragile bones
• Decreased bone mass and deterioration of bone tissue are characteristic features of osteoporosis
• Dual-energy X-ray absorptiometry (DEXA) measures bone mineral density and is the best tool for diagnosing osteoporosis
• Risk factors include hormonal changes, inactivity, smoking, and corticosteroid use
• Alendronate is a bisphosphonate that reduces bone resorption and is commonly prescribed for osteoporosis treatment

Osteoarthritis (OA)

• Pain that worsens with activity and improves with rest is most characteristic of osteoarthritis
• Osteoarthritis is degenerative, unlike rheumatoid arthritis which involves systemic inflammation
• Heberden's nodes, Bouchard's nodes, and crepitus are expected findings in a patient with osteoarthritis
• The primary goal of total knee arthroplasty (TKA) is to relieve pain and restore joint function
• TKA replaces damaged joints to restore mobility and reduce pain

Rheumatoid Arthritis (RA)

• The presence of systemic inflammation differentiates RA from OA
• RA is autoimmune and affects multiple joints systemically
• Methotrexate, NSAIDs, corticosteroids, and hydroxychloroquine are medications used to treat RA
• These drugs help manage inflammation and disease progression
• Warm, swollen joints with morning stiffness are early symptoms of RA
• These early signs differentiate RA from other joint disorders

Fractures

• Capillary refill and pulses are the priority assessment in a patient with a femur fracture
• Neurovascular checks ensure blood supply is intact
• Fat embolism is the most concerning complication with a long bone fracture
• Fat embolism syndrome can be fatal and occurs in long bone fractures
• Severe pain unrelieved by medication, pallor, pulselessness, and decreased sensation are signs of compartment syndrome
• These signs are the classic “6 P’s” of compartment syndrome
• Logrolling the patient is an essential intervention after a laminectomy
• Logrolling maintains spinal alignment and prevents injury
• The primary goal of laminectomy surgery is to relieve pressure on spinal nerves
• Laminectomy decompresses the spinal cord to relieve pain

Amputations

• Phantom limb pain is a major post-amputation complication and is a common post-amputation experience
• Teaching proper skincare is an important nursing intervention for a patient with a new prosthesis
• This intervention prevents infection and irritation at the prosthesis site

Gout

• Increased uric acid levels are the primary cause of gout
• Uric acid crystal deposits in joints trigger inflammation
• A patient with gout should avoid red meat
• Purine-rich foods (red meat, alcohol) increase uric acid
• Red, swollen joints and pain in the big toe are clinical signs of acute gout
• Gout commonly affects the big toe and causes swelling and joint damage

Fractures (Continued)

• Ensure the weights hang freely is the nurse’s priority action for a patient with a closed femur fracture placed in traction
• Traction must remain in place and uninterrupted to maintain bone alignment
• Notify the healthcare provider immediately is the nurse’s next action when a patient with a cast reports severe pain unrelieved by medication
• Severe pain unrelieved by medication is a sign of compartment syndrome, a medical emergency
• Perform frequent pin care is essential for a patient with an external fixation device
• Proper pin care prevents infection at the insertion site
• Fat embolism, osteomyelitis, and compartment syndrome are complications of fractures
• Fractures can lead to fat embolism, bone infection (osteomyelitis), and compartment syndrome

Pre-Operative Care

• Maintain proper alignment of the leg is the priority nursing intervention preoperatively for a patient with a hip fracture
• Proper alignment prevents further injury before surgery

Post Op: Care Total Knee & Hip Replacement

• Hip flexion greater than 90 degrees should be avoided in a patient post-op from a total hip replacement (THR)
• Excessive hip flexion can cause dislocation post-surgery
• The use of a continuous passive motion (CPM) machine, early ambulation, and regular use of anticoagulants are essential post-op interventions for a total knee replacement (TKR)
• CPM machines improve mobility, early ambulation prevents complications, and anticoagulants reduce clot risk
• Deep vein thrombosis is a complication the nurse should monitor for in a post-op total hip replacement patient
• Immobility increases the risk of clot formation post-op
• Sequential compression devices (SCDs) helps prevent blood clots for TKR patients
• SCDs promote venous return and reduce the risk of DVTs

Back Problems & Laminectomy

• The patient statement indicating a need for further teaching after a laminectomy is, "I can drive myself home tomorrow."
• Driving should be avoided immediately post-surgery
• Notify the healthcare provider is the nurse's priority action when a patient post-laminectomy reports new onset numbness in their leg
• Numbness may indicate nerve compression or damage
• Monitoring for urinary retention, logrolling the patient when repositioning, and assessing for signs of infection are interventions important for a post-op laminectomy patient
• Urinary retention, spinal misalignment, and infection are key post-op concerns

Amputations & Prosthesis Care

• The statement by a patient post-amputation requiring further teaching is, "I should elevate my stump continuously to prevent swelling."
• Continuous elevation can cause contractures
• Gradual weight-bearing, inspecting the residual limb daily, avoiding lotion on the residual limb, and wearing a prosthetic sock are interventions that should be included in the care of a patient with a new lower limb prosthesis
• Proper skin care and gradual adaptation to the prosthesis are important

Gout Management

• A patient with gout should limit purine-rich foods in their diet
• Purine-rich foods increase uric acid levels, worsening gout
• Colchicine and NSAIDs are medications used for acute gout attacks
• These medications reduce inflammation during acute attacks
• “I will drink plenty of fluids to help eliminate uric acid,” indicates an understanding of gout management
• Hydration prevents uric acid crystal formation

Final Questions: General Musculoskeletal Concepts

• Increased intake of calcium and Vitamin D helps prevent osteoporosis
• Calcium and Vitamin D maintain bone health
• Reducing joint pain and improve function is the primary treatment goal for osteoarthritis
• Osteoarthritis management focuses on symptom control

Fracture Complications & Post-Operative Care

• A 30-year-old patient with a femur fracture is at highest risk for developing a fat embolism
• Fat embolism syndrome is most commonly associated with long bone fractures, particularly the femur
• Sudden confusion and petechiae on the chest indicates a fat embolism
• Fat embolism syndrome can cause neurological impairment, petechiae, and respiratory distress

Osteoarthritis & Rheumatoid Arthritis

• Using heat therapy to relax stiff joints and applying cold packs before exercise can provide non-pharmacologic pain relief for clients with osteoarthritis
• Heat therapy can improve blood flow and relieve joint stiffness in OA
• Applying cold packs before exercise can help reduce inflammation and numb pain
• The patient statement indicating a need for more teaching is, "I should take my methotrexate only when I feel symptoms."
• Methotrexate should be taken regularly, even when symptoms improve, to prevent disease progression

Gout & Amputation Care

• Joint deformities and kidney stones are complications to assess for in a patient diagnosed with chronic tophaceous gout
• Tophaceous gout leads to joint damage and increases the risk of kidney stones due to uric acid accumulation
• Administering prescribed gabapentin is most appropriate for a patient with a below-knee amputation experiencing phantom limb pain
• Gabapentin (Neurontin) is effective in treating neuropathic pain, including phantom limb pain

Overview of osteoporosis and osteoarthritis (OA). Osteoporosis involves excessive bone resorption, leading to fragile bones. Osteoarthritis is a degenerative condition characterized by pain that worsens with activity and improves with rest.