OsteoarthritisHip ReplacementOsteoporosis

OSTEOARTHRITISDegenerative joint disease

Pathophysiology:Deterioration of the articular cartilage Cartilage becomes stiff and loses elasticityBone spurs joint deformity, pain, and disability

OSTEOARTHRITISDegenerative joint disease

Whos at risk?Obese - wt stress on the jointsRepetitive trauma bending, lifting, repetitive motionsAge incidence greatly increased after age 60, but it can develop in any ageGenetics

Nursing Assessment of the Patient with OA

Joint stiffness, aching pain in the joint, and limited movement - Worse upon arising in the morning or after inactivity

Nursing Interventions for Patients with Osteoarthritis

Weight reduction Aerobic exercise & flexibility routinesPharmacology:-Acetaminophen or Tylenol- NSAIDs - Opioids in severe casesOther options:- Use of braces - Oral glucosamine and chondroitin supplements- Capsaicin cream- Steroids - Acupuncture - Surgical procedures

TOTAL HIP REPLACEMENT

Pre-op Teaching - Isometric Exercises- Transferring: bed to the chair w/o flexing the hip < 90 degrees- Bedpan use- Use of wedge pillow- C&DBPre-op Prep: Lab results: CBC, WBC, PT, PTT, UA, CXRTempSkin prepPre-op prophylactic antibioticsAssess for risk of DVT

Post-operative Care for the Patient w/ a Hip Replacement General guidelines:Avoid hip flexionKeep legs in abduction prevents dislocationAnti-emboli measures - Sequential pneumatic stockings- IV Heparin or sub q Lovenox Coumadin- Exercises

Post-operative Care for the Patient w/ a Hip ReplacementMedicate for pain Check circulation of legsCheck incision (may be lateral or anterior) Check for dislocation Neuro assessment of legPrevent external rotation of the hip Prevent skin impairment

Position:- OOB to chair w/in 24 hrs- Turn to unaffected sideAdminister antibiotics

Post-operative Care for the Patient w/ a Hip ReplacementIf hemovac is usedInstructions to go home:- need toilet seat extension- NO crossing the legs sitting or standing

OSTEOPOROSIS

PathophysiologyThere is a in bone density due to an in bone reabsorption.Calcitonin and Estrogen promotes bone formationBoth w/age bone loss - Parathyroid hormone w/ age in serum Ca - As Ca is lost from the bone brittle & porous bones

OSTEOPOROSIS

Primary Osteoporosis:Postmenopausal womenDietaryLack of weight bearing exercisesOlder age

Actual Calcium need for adults

WomenMen25-50 yrs 1,000 mg25-65 yrs 1,000 mg50-65 yrs 1,000-1,500 mg> 65 yrs 1,500 mg> 65 yrs 1,500 mgPreg/lactating 1,200-1,500 mg

OSTEOPOROSIS

Secondary Osteoporosis:2nd to renal failure, liver failure2nd to medications affects the bodys use of calcium- corticosteroids, heparin, INH, diuretics2nd to ETOH abuse2nd to malignancy, DM2nd to immobility

OSTEOPOROSIS

Risk Factors:Small-framed, non-obese (< 127 lbs) Caucasian or Asian womenAge MenopauseFamily historyDiets low in Ca and Vit DSedentary lifestyleExcessive ETOH, caffeine, & tobacco use

Nursing Assessment for Osteoporosis

Asymptomatic for years Decreased radio-density on X-ray- Norm: bone mineral density (BMD) value w/in 1 stand dev- Osteopenia: - BMD value btw 1 & 2.5 SD below the mean BMD- Osteoporosis:- BMD value > 2.5 SD below the mean BMD

Nursing Assessment for OsteoporosisCurvature of the spine Kyphosis: dowagers hump urine Ca levelsFractures wrist, hip, pelvis, vertebral collapseLoss of height

Nursing Interventions for OsteoporosisPrevention!!!Diet Weight bearing exercisesResistance trainingMedications1. Stabilizes bone loss- Ca carbonate/ Ca citrate - Estrogen replacement therapy2. Build bone mass- Fosamax, Actonel - Evista: Selective Estrogen Receptor Modulators (SERMs)- Effective in preventing 40% of spinal fx only- Calcitonin- Forteo: parathyroid hormone