Osteoporosis �Porous Bones�
Loss of bone mass Increased risk of fracture
Most associated with aging 80% are women
Risk Factors for Osteoporosis
Nonmodifiable
Age Family history Small frame
Gender Race
Modifiable
Alcohol Use Corticosteroid Use Calcium
Low Estrogen Low (Menopause) Smoking
Sedentary Lifestyle
Low estrogen
Generalized progressive reduction of bone density, causing weakness
of skeletal strength
crush fractures especially at T-* and below, hip and colles
fractures most common
Slender, female, Caucasian, alcohol users, smokers and steroid
users, are highest at risk
Osteoporosis, a �Silent Disease�
Kyphosis (dowager�s hump)
Loss of height
1-1.5inches shorter or c/o �back pain�
Fractures of forearm, spine, or hip
Diagnosis
Bone density tests Dual-energy x-ray
absorptiometry Ultrasound of heel CT
Prevention and Treatment for Osteoporosis
Weight bearing exercise
Calcium and vitamin D
Biphosphonates inhibit bone reabsporption
Alendronate sodium (Fosamax)
Estrogen Replacement
Calcitonin Salmon Nose spray-post menopausal
Nursing Diagnosis
Risk for injury related to effects of change in bone
structure secondary to osteoporosis
Chronic pain secondary to osteoporosis m/b c/o �back
pain 8 on scale 0 to 10�.
Imbalanced nutrition; less than body requirements
related to inadequate intake of calcium
Knowledge deficit related to medication for
prevention worsening osteoporosis
Nursing Interventions for Patients with Osteoporosis
Patient teaching
Prevention and to slow progress of osteoporosis: Health
Promotion Nutrition Healthy Behaviors
Exercise-weight bearing
Medication administration
Fall Precautions
At home In hospital
Osteoarthritis (OA)
Characterized by progressive loss of joint cartilage, synovitis,
joint pain, stiffness, & loss of joint movement
Most common form of arthritis Degenerative
Cause for chronic pain and mobility problems
Risk Factors for OA
Age Genetics Excessive weight
Inactivity Repetitive joint use
Manifestations
Gradual onset and progressive Pain & stiffness in
affected joints that may be accompanied by paresthesia
Enlarged joints from bony overgrowth that are hard and cool to
palpation Risk of flexion contractures Disease
progresses faster in young adults
Nursing Diagnosis
Chronic Pain related to muscle spasm, cartilage
deterioration secondary to osteoarthritis m/b complaint of �knee pain
7 on scale 0 to 10�.
Impaired Physical mobility related to pain and muscle
atrophy secondary to osteoarthritis m/b unsteady gait
Nursing/Collaborative Interventions
NSAIDS Opiods Glucosamine, chondroitin
Weight Control ROM exercises Muscle
strengthening exercises, low-impact aerobic exercises Heat
& Ice Braces Use of ambulatory assistive
devices
Surgery
Joint Arthroplasty (Joint Replacement)
Hip Arthroplasty
Most often due to instability and pain secondary to
osteoarthritis Most frequently replaced joint Last
10-15 years
3 Approaches to Total Hip Replacement
Posterior Lateral Anterior
Positioning Patients After Hip Arthroplasty
Abduction pillow or wedge post-op Turn from back to
unaffected side post-op Pivot on unaffected side when
transferring from bed to chair
Post �Hip Arthroplasty Precautions (to prevent dislocation)
No leg crossing No inward turning of toes No
bending 90 degrees
Total Knee Arthroplasty
Joint replaced due to complaints of pain and instability often
related to osteoarthritis Second most commonly replaced
joint Vigorous rehab needed
Multidisciplinary Care
Nurse-driven variables that reduce length of stay and improve
outcomes for total knee replacement:
Comprehensive preoperative patient education
Physical therapy on the day of surgery
Pain control using multimodal analgesic
regimens
Proactive discharge planning
Determinants of outcomes
Preoperative pain & function
Environment
Lower socioeconomic
Preop anxiety/depression
Nursing Care After Hip and Knee Replacements
Post-operative nursing responsibilities
CPM to promote joint mobility(knee) Monitor for
hemorrhage, s/s infection Pain medication Transfer
with pivot on non-operative lower extremity Use of assist
device for ambulation (walker, cane) Check color, warmth,
pulses, sensation, movement distal to operative site
Musculoskeletal Impairments and Pain
Chronic Pain with osteoarthritis
Prolonged pain Associated symptoms may be depression
and insomnia --Decrease in serotonin (neurotransmitter) and
endorphins Nociceptive pain --Stimulation of
peripheral pain receptors
Musculoskeletal Surgeries and Pain
Acute Pain post-op hip and knee replacements
Sudden onset, localized, self-limited Results from
tissue injury with surgery Fear and Anxiety may result
May cause decreased mobility
Drug Therapy for Pain
NSAIDS
Mild to Moderate pain Anti-inflammatory
Risks vs. Benefit Pt. teaching
Opiod Analgesics
Moderate to Severe pain Risks vs. Benefit
Pt. teaching
Alternative interventions for Pain
Relaxation Techniques:
Deep breathing exercises Guided Imagery
Activity
Physical therapy
Early Ambulation
Nursing Diagnosis for Joint Replacement Surgery Patient
Impaired physical mobility Self-care deficits
Readiness for enhanced self care Knowledge deficit
related to post-op positioning Risk for neurovascular
dysfunction related to Anxiety r/t surgery and post
operative Fear Ineffective Coping as r/t
Depression
Rehabilitation
Process of learning to live to one�s maximum
potential with a chronic impairment and its resultant
functional disability.
Impairment: disturbance in structure or
function
Disability: degree of observable and measurable
impairment
Sites for Rehabilitation
Acute In-patient hospital Rehabilitation hospital
Outpatient Rehabilitation Facility Skilled Nursing
Facility Home
Rehabilitation Team
Physician Nurse Physical Therapist
Occupational Therapist Social Worker