Diseases/Disorders of the Bone

Common Foot Disorders Hallux valgus Hallux valgus Hammertoe Hammertoe

Hallux Valgus Bunion Bunion Enlargement and lateral displacement of great toe Enlargement and lateral displacement of great toe Due to chronic pressure against the great toe Due to chronic pressure against the great toe Heredity Heredity Pointed-toe shoes or high heels Pointed-toe shoes or high heels Metatarsophalangeal (MTP) joint enlarged Metatarsophalangeal (MTP) joint enlarged Callus develops Callus develops

Hammertoe Flexion of the proximal interphalangeal joint with hyperextension of the MTP and distal interphalangeal joints Flexion of the proximal interphalangeal joint with hyperextension of the MTP and distal interphalangeal joints Affects any toe Affects any toe Causes painful corns to develop Causes painful corns to develop

Foot Disorders Corrective shoes and orthotic devices Corrective shoes and orthotic devices Analgesics and corticosteroids Analgesics and corticosteroids Surgery Surgery Nursing Care Nursing Care Pain Pain Risk for Infection Risk for Infection

Osteomalacia Adult rickets Adult rickets Inadequate mineralization of bone Inadequate mineralization of bone Insufficient amounts of calcium or phosphate Insufficient amounts of calcium or phosphate No mineralization of bone matrix No mineralization of bone matrix Bone unable to bear weight Bone unable to bear weight Results in deformities and pathologic fractures Results in deformities and pathologic fractures Cause is lack of vitamin D Cause is lack of vitamin D

Paget’s Disease Increase of osteoclasts Increase of osteoclasts Osteoblasts are stimulated but produce soft and poorly mineralized bone Osteoblasts are stimulated but produce soft and poorly mineralized bone Prone to fracture Prone to fracture Cause unknown Cause unknown

Osteomalacia/Paget’s Disease Replace vitamin D Replace vitamin D Calcium and phosphate supplements Calcium and phosphate supplements Biphosphonates and calcitonin drugs Biphosphonates and calcitonin drugs

Osteoporosis “Porous Bones” “Porous Bones” Fragile bones with risk of fractures Fragile bones with risk of fractures 80% are women over the age of 60 80% are women over the age of 60 Cause unclear Cause unclear

Osteoporosis – Risk Factors Cannot be Changed Age Age Female Female Family history Family history Endocrine disorders Endocrine disorders Can be Changed Calcium deficiency Calcium deficiency Estrogen deficiency Estrogen deficiency Smoking Smoking Excess alcohol Excess alcohol Sedentary lifestyle Sedentary lifestyle Medications Medications

Osteoporosis Reduced bone mass Reduced bone mass Imbalance of bone growth and maintenance Imbalance of bone growth and maintenance Peak bone mass at age 35 Peak bone mass at age 35 Formation does not keep pace with resorption, resulting in loss of bone mass Formation does not keep pace with resorption, resulting in loss of bone mass

Osteoporosis Type I Type I Postmenopausal women ages 51–75 Postmenopausal women ages 51–75 Caused by estrogen deficiency Caused by estrogen deficiency Type II Type II Men and women over age 70 Men and women over age 70 Slow development Slow development Calcium deficiency Calcium deficiency

Osteoporosis Focus is on stopping or slowing process Focus is on stopping or slowing process Relieving symptoms Relieving symptoms Preventing complications Preventing complications Bone density measurement Bone density measurement

Osteoporosis Calcium Calcium Vital in prevention Vital in prevention Adequate intake may slow process Adequate intake may slow process Calcium needs change over lifetime Calcium needs change over lifetime NIH calcium intake recommendations NIH calcium intake recommendations

NIH Recommended Daily Calcium Intake.

Osteoporosis Medications Medications Calcium supplements Calcium supplements Hormone replacement Hormone replacement Other drugs Other drugs

Osteoporosis – Nursing Care Risk for Injury Risk for Injury Imbalanced Nutrition: Less than Body Requirements Imbalanced Nutrition: Less than Body Requirements Pain Pain

Osteoporosis Teaching Teaching Prevention Prevention Calcium intake in diet Calcium intake in diet Physical activity Physical activity Hormone replacement therapy Hormone replacement therapy Smoking Smoking Fall prevention Fall prevention

Arthritis Inflammation of a joint Inflammation of a joint Localized Localized Osteoarthritis Osteoarthritis Systemic Systemic Rheumatoid arthritis Rheumatoid arthritis Systemic lupus erythematosus Systemic lupus erythematosus

Osteoarthritis Degenerative joint disease with progressive loss of joint cartilage Degenerative joint disease with progressive loss of joint cartilage Most common type Most common type Leading cause of disability in older adults Leading cause of disability in older adults Equal in men and women Equal in men and women

Osteoarthritis Risk factors Risk factors Age Age Repetitive joint use and trauma Repetitive joint use and trauma Heredity Heredity Obesity Obesity Congenital and acquired defects Congenital and acquired defects

Osteoarthritis Entire joint affected Entire joint affected Cartilage loses strength and elasticity and erodes and ulcerates Cartilage loses strength and elasticity and erodes and ulcerates Underlying bone exposed Underlying bone exposed Cartilage-coated osteophytes (bony outgrowths) Cartilage-coated osteophytes (bony outgrowths)

Osteoarthritis Manifestations and complications Manifestations and complications Inflammation in the joint Inflammation in the joint Pain Pain Decrease in joint range of motion Decrease in joint range of motion Enlarged joints Enlarged joints Herniated disk Herniated disk

Osteoarthritis History History Physical and x-ray examination Physical and x-ray examination Weight reduction and exercise Weight reduction and exercise Heat for local pain relief Heat for local pain relief Medications Medications Surgery Surgery Arthroscopy Arthroscopy

Arthroplasty Reconstruction or replacement of the joint Reconstruction or replacement of the joint Total joint replacement Total joint replacement Hip, knee, shoulder, elbow, ankle, wrist, joints of finger and toes Hip, knee, shoulder, elbow, ankle, wrist, joints of finger and toes Infection is major problem Infection is major problem

Total hip replacement.

Total knee replacement.

Osteoarthritis – Nursing Care Assessment focuses on effects of the disease and ADLs Assessment focuses on effects of the disease and ADLs Nursing diagnosis Nursing diagnosis Chronic Pain Chronic Pain Impaired Physical Mobility Impaired Physical Mobility Self-Care Deficit Self-Care Deficit

Osteoarthritis – Nursing Care Teaching Teaching Environmental safety Environmental safety Use of assistive devices to maintain independence Use of assistive devices to maintain independence Medications Medications Activity and weight bearing Activity and weight bearing Signs and symptoms of infection Signs and symptoms of infection

Rheumatoid Arthritis Chronic systemic inflammatory disorder of the joints Chronic systemic inflammatory disorder of the joints More women than men More women than men Ages 30–50 Ages 30–50 Multiple joints Multiple joints Remission and exacerbations Remission and exacerbations

Rheumatoid Arthritis Autoimmune response Autoimmune response Autoantibodies (rheumatoid factors) bind with IgG to form immune complexes Autoantibodies (rheumatoid factors) bind with IgG to form immune complexes Complement activated and WBCs attracted to the area Complement activated and WBCs attracted to the area Cells phagocytize immune complexes and also destroy the joint Cells phagocytize immune complexes and also destroy the joint

Joint inflammation and destruction in rheumatoid arthritis. Joint inflammation and destruction in rheumatoid arthritis.

Rheumatoid Arthritis Systemic symptoms Systemic symptoms Fatigue Fatigue Anorexia Anorexia Weight loss Weight loss Aching and stiffness Aching and stiffness Destruction of joints and immobility Destruction of joints and immobility

Typical hand deformities associated with rheumatoid arthritis. (Source: Custom Medical Stock Photos, Inc.)

Rheumatoid Arthritis Diagnosis Diagnosis History and physical exam History and physical exam Rheumatoid factors Rheumatoid factors Erythrocyte sedimentation rate Erythrocyte sedimentation rate Synovial fluid aspirate Synovial fluid aspirate X-rays X-rays Rest and exercise Rest and exercise

Rheumatoid Arthritis - Treatment Medications Medications Aspirin and NSAIDs Aspirin and NSAIDs Steroids Steroids Drugs to modify the autoimmune response Drugs to modify the autoimmune response Surgery Surgery Relieve pain and repair or replace joints Relieve pain and repair or replace joints Arthrodesis (joint fusion) Arthrodesis (joint fusion)

Rheumatoid Arthritis - Treatment Plasmapheresis Plasmapheresis Total lympoid radiation Total lympoid radiation

Rheumatoid Arthritis – Nursing Care Assessment focuses on progress of disease and effect on functional abilities Assessment focuses on progress of disease and effect on functional abilities Nursing diagnoses Nursing diagnoses Pain Pain Fatigue Fatigue Ineffective Role Performance Ineffective Role Performance Disturbed Body Image Disturbed Body Image

Rheumatoid Arthritis – Nursing Care Teaching Teaching Disease and systemic effects Disease and systemic effects Rest and exercise Rest and exercise Medications Medications Assistive devices Assistive devices Safety Safety

Osteomyelitis Infection in the bone Infection in the bone Staphylococcus aureus Staphylococcus aureus Any age Any age Older adults at risk Older adults at risk Pathogens enter the bone from an open wound Pathogens enter the bone from an open wound Spread to the bone from local tissue Spread to the bone from local tissue

Osteomyelitis Pathogens lodge and multiply Pathogens lodge and multiply Cause inflammatory and immune system response Cause inflammatory and immune system response Phagocytes attempt to contain the infection, but release enzymes that destroy bone tissue Phagocytes attempt to contain the infection, but release enzymes that destroy bone tissue Canals in the marrow cavity of the bone allow the infection to spread Canals in the marrow cavity of the bone allow the infection to spread Spreads along the surface Spreads along the surface Disruption of blood supply leads to necrosis Disruption of blood supply leads to necrosis

Osteomyelitis

Osteomyelitis

Osteomyelitis Early diagnosis and antibiotic therapy Early diagnosis and antibiotic therapy WBC WBC Blood and tissue cultures Blood and tissue cultures MRI MRI Bone scan Bone scan Medications intravenously Medications intravenously Surgery Surgery Cultures Cultures Debridement Debridement

Osteomyelitis – Nursing Care Pain Pain Hyperthermia Hyperthermia Impaired Physical Mobility Impaired Physical Mobility Teaching Teaching Medications and wound management Medications and wound management Rest and limited weight bearing Rest and limited weight bearing Good nutrition Good nutrition