Ortho

• Bones


  • 206 bones
  • Femur (largest bone)
  • Ossicles (smallest bones)
• Bones


  • Connective tissue
  • Matrix: minerals (calcium, phosphates) - hardness, collagen - resilience and tensile strength
  • Cells: osteogenic, osteoclasts, osteoblasts, osteocytes
• Osteoblast


  Bone formation
• Osteoclast

  Bone resorption, releases calcium back into the blood
• Estrogen


  Increases osteoblast activity
• Steroids (cortisol)


  Increases osteoclast activity
• Osteoarthritis


  Degenerative joint disease, osteoarthrosis (degeneration of the joint), hypertrophic arthritis, and degenerative arthritis
• Osteoporosis


  Brittle bone disease, irreversible, reduction in bone mass and minerals, porous bones
• Osteoarthritis


  • Characterized by chronic deterioration of the cartilage at the end of the bones
  • Cause: Unknown
• Risk Factors for Osteoarthritis

  • Female
  • Increasing age
  • Race
  • Genetic predisposition
  • Obesity
  • Joint injury
  • Occupation
  • Structural alignment
  • Muscle weakness
• Risk factors for osteoporosis

  • Age
  • Female
  • Nutrition
  • Physical exercise
  • Lifestyle
  • Medication
  • Genetics
• Classification of Osteoarthritis


  • Primary- Idiopathic- No prior event or disease related to OA
  • Secondary- From previous joint injury, inflammatory disease
• Menopause


  Leads to microarchitectural deterioration of bone tissue and bone mass, osteoporosis
• Bone remodeling


  Osteoclastic (bone resorption) activity > osteoblastic (bone building) activity, disruption leads to osteopenia and osteoporosis
• Osteoarthritis is the most common & frequently disabling of the joint disorders
• Osteoarthritis often begins during 30s and peaks between 50s & 60s
• Bone mineral density (BMD)


  Determines bone strength, peaks between 30-35 years, decreases rapidly in post-menopausal women as estrogen levels decrease
• Osteophyte


  • A-Sternum
  • B-Clavicle
  • C-Pelvic limb
  • D-Carpometacarpus
• Medications that can cause bone loss

  • Steroids
  • Breast cancer drugs
  • Prostate and prostate cancer drugs
  • PPI long term use
  • DEPO-PROVERA
  • Excessive thyroid hormone replacement
  • Antiseizure and mood-altering drugs
  • Diuretics
  • Aluminum containing antacids
  • Heparin long term use
• Signs and Symptoms of Osteoarthritis

  • Pain and Stiffness especially in the morning but will decrease with movement
  • Aching
  • Joint swelling
  • Inflammation
  • Heberden's Nodes - enlargement of the fingers at the end joints
  • Bouchard's Nodes - bony enlargements at the middle joints of the fingers
  • Crepitus, limping, limited range of motion
• Target Joints for Osteoarthritis

  • Finger joints
  • Feet
  • Hips
  • Knees
  • Lower spine or weight bearing joints
• Dual-energy X-ray absorptiometry (DXA/DEXA)


  Means of measuring bone mineral density, most definitive diagnostic test
• Diagnostics for Osteoarthritis


  • X-ray - Narrowing of the joint space, osteophyte formation
  • MRI
  • CT-scan
• Nursing diagnoses for osteoporosis

  • Pain
  • Impaired mobility
  • Risk for injury
  • Risk for fall
  • Disturbed body image
• Nursing interventions for osteoporosis

  • Provide safety
  • Use of assistive devices
  • Calcium and vitamin D rich diet
  • Avoid caffeine, soda, high sodium
  • Avoid smoking
  • Avoid steroids
  • Weight bearing exercise
  • Avoid high impact exercises
  • Rest in supine or side-lying position
  • Firm, non-sagging mattress
  • Intermittent local heat and back rubs
• Treatment Goal for Osteoarthritis

  Pain reduction/ Improve joint mobility
• Non-Pharmacological Treatments for Osteoarthritis

  • Exercise programs - Cardiovascular aerobic exercise and lower extremity strength training
  • Lose weight
  • Compression/stretch gloves and stockings
  • Adaptive/assistive equipment
• Osteomalacia


  Metabolic bone disease characterized by inadequate mineralization of bone, leading to softening and weakening of the skeleton
• Pharmacological Treatments for Osteoarthritis

  • Acetaminophen
  • NSAIDs
  • Nabumetone
  • COX-2 enzyme blocker
  • Intra-articular steroids
  • Gel-like hyaluronates (viscosupplement)
  • Topical analgesics - Capsaicin, Methylsalicylates
  • Glucosamine, Chondroitin
• Vitamin D


  Needed for calcium absorption, produced in the skin when exposed to sunlight, converted to active form in the liver and kidneys
• Diagnostic tests for osteomalacia

  • Serum parathyroid hormone
  • Alkaline phosphatase
  • Serum phosphorus
  • Arterial blood gases
  • Calcium (ionized)
  • ALP isoenzyme
  • Bone x-rays
• Surgical Treatments for Osteoarthritis


  • Osteotomy
  • Arthroplasty
  • Visco gel injection
  • Plasma rich protein injection
• Treatment for osteomalacia


  • Oral supplements of vitamin D, calcium, and phosphorus
  • Larger doses for intestinal malabsorption
  • Monitoring of blood levels
  • Regular daily supplements for simple vitamin D deficiency
  • Calciferol injection for intestinal problems
  • Extra calcium for bone healing
• Rheumatoid Arthritis (RA)


  An autoimmune and inflammatory disease, immune system attacks healthy cells in the body by mistake especially the synovium (lining that surrounds the joints), causing inflammation (painful swelling) in the affected parts of the body
• Nursing diagnoses for osteomalacia

  • Alteration in nutrition
  • Risk for injury
  • Impaired physical mobility
  • Pain
• Rheumatoid Arthritis


  • The resulting inflammation thickens the synovium, which can eventually destroy the cartilage and bone within the joint
  • Chronic inflammation of the joints, characterized by remission and exacerbation
  • Attacks the fingers, wrists, knees and spine
  • Primary cause: Unknown
• Risk Factors for Rheumatoid Arthritis

  • Female
  • Predisposing gene
  • Exposure to an infection
  • Advance age (70 up)
  • Environmental - Cigarette smoking
• Nursing management for osteomalacia

  • Assessment of dietary intake
  • Management of client responses
  • Vitamin D sources
  • Awareness of potential for toxicity
  • Fall prevention
• Signs and Symptoms of Rheumatoid Arthritis

  • Malaise, Fatigue, pain, swelling
  • Symmetrical patterns of joint inflammation, stiffness
  • Gelling (joint stiffs after rest)
• Paget's disease of the bone

  Localized rapid bone turnover, increased osteoclast and osteoblast activity, resulting in weak, highly vascularized, mosaic pattern bones