Health alterations class 5- Mobility

Important terms and concepts

What is osteoarthritis

Degenerative joint disease, slow and progressive deterioration of articulate cartilage

Where does osteoarthritis normally occur

In the hips and knees (weight bearing joints)

When do most patients start to experience symptoms of OA

Age 50-60

Risk factors for OA

1. Aging (not a normal part of aging but it does increase risk)

2. Known event or condition (injury)

3. Genetic traits (inflammatory condition)

4. Obesity

Signs and symptoms of OA

1. Pain

2. Stiffness in the morning that decreases with movement (difference from RA)

3. Tender joints (usually in hips and knees)

4. Deformity (late sign)

How does OA normally affect joints

Asymmetrically (1 side will be affected first, then if more weight is put on the other side to compensate that side will start to become affected)

Diagnosis of OA

1. Based on assessment findings (risk factors, meds, comorbidities, pain, swelling, abnormal posture etc)

2. Bone scan, CT, MRI

3. X-ray (looking for narrowing of joint spaces)

4. No lab abnormalities specific to OA, inflammation indicators may be present

Management of OA

1. Balance exercise and rest. (Low impact exercise)

2. Heat and cold

3. Weight management and exercise

4. Complementary and acupuncture therapy (acupuncture, cortisol injections etc)

5. Medications (start at lowest dose possible because OA is progressive)

6. Surgical therapy (joint replacement, when other options stop working)

Why are cortisone injections a temporary therapy for OA

Need space in-between the joints for the injection, as space narrows patient stops being a candidate

Nursing care of a latent with OA

1. Pain assessment

2. Musculoskeletal assessment

3. Psychosocial support

4. Home modifications

5. Education on health promotion and non pharmacological treatments

What is osteoporosis

A bone disorder resulting in low bone density, the rate of bone reabsorption exceeds the rate of new bone growth

Primary osteoporosis

No underlying cause, happens over time

Secondary osteoporosis

Caused by an underlying condition/cause (certain meds such as long term use of corticosteroids)

Groups that are at an increased risk of developing osteoporosis

1. Post menopausal women

2. Younger patients with unestablished bone health who are on meds that increase the risk

What bones are most affected by osteoporosis

The spine, hips and wrists

Why is osteoporosis often called a silent thief

People often don’t know they have it until something happens (fracture)

Signs and symptoms of osteoporosis

1. Loss of height (collapsed vertebrae)

2. Back pain

3. Restricted movement

4. Fractures (spontaneous and history)

5. Pain on palpation

Diagnosis of osteoporosis

1. History (fractures, meds etc)

2. Physical assessment

3. Bone mineral density scan (DEXA scan)- low energy x ray to evaluate bone density in the hip and spine

Why is a DEXA scan done in the hip and spine

Because they are good indicators of overall bone health

Nursing care of osteoporosis

1. Nutrition (dairy, spinach, sardines, almonds…)

2. Calcium supplement and vitamin D (needed to absorb calcium properly)

3. Exercise (normal stress and strain is important to build up bone health)

4. Medications

5. Educations

Patient education when taking phosomax (osteoporosis med)

1. Sit up afterwards (avoid reflux and damage to the esophagus)

2. Take in the morning on an empty stomach with a full glass of water

Clinical manifestations of a fracture

1. Pain

2. Loss of function

3. Deformity

4. Muscle spasms

5. Crepitus

6. Swelling and discolouration (neurovascular signs)

What does Closed reduction of a fracture mean

Non surgical intervention

What does open reduction of a fracture mean

Surgical intervention

Common complications of a fracture

1. Infection

2. Compartment syndrome

3. Venous thromboembolism (VTE)

4. Fat embolism

5. Impaired Elimination

What is osteomyelitis

Infection of bone

What should you monitor for related to osteomyelitis

1. Pain, edema, erythema

2. Fever

3. Elevated WBC and ESR

4. Blood cultures (bacteria in blood can indicate sepsis)

Osteomyelitis treatment

1. Long course IV antibiotics (6 weeks)

2. Surgical debridement

3. Analgesics

Compartment syndrome treatment

1. Loosen cast/dressing if possible

2. Relieve swelling (cold, elevation)

3. Pain meds if ordered

4. Call physician if symptoms don’t subside

5. Fasciotomy (last resort)

What fracture is a fat embolism most common with

Most common 24-48 hours after the fracture of a long bone (femur)

What is a fat embolism

Fat globules released from bone marrow into blood vessels (from a fracture)

Signs and symptoms of a fat embolism

1. Dyspnea, increased resp rate and decreased O2

2. Headache, confusion

3. Tachycardia, chest pain

4. Cutaneous petechiae (difference from pulmonary embolism)

Treatment of a fat embolism

Treat symptoms (O2, fluid replacement, pain meds etc), body eventually reabsorbs fat

Extra capsular hip fracture

Fracture that happens outside the joint capsule

Extra capsular hip fracture healing

Good blood supply, heals fast but has more soft tissue damage

Intra capsular hip fracture

Fracture that happens inside the joint capsule

Intra capsular hip fracture healing

Heals slower due to less blood supply, can get a vascular necrosis

Avascular necrosis

Blood flow is disrupted to a site, resulting in ischemia and bone necrosis

Avascular necrosis treatment

Replacement of the damaged bone

Clinical manifestations of a hip fracture

1. External rotation

2. Muscle spasms

3. Shortening of affected extremity

4. Severe pain and tenderness

Positioning with a hip fracture

1. No bending over 90 degrees

2. No crossing legs

3. Elevated seats/toilet seat

4. Can be tipped onto affected hip for a short time