CHAPTER 36 – PART 2 Light exercises Rest + Light activity
(walking)
Osteoarthritis Rheumatoid Arthritis Assistive devices (e.g. COMPLICATIONS
Happens when the The immune system is crutches, canes, Joint deformity
cartilage and other attacking the synovial walkers) Organ involvement
tissues within the joint membrane of joints (heart, kidney, lungs)
break down or have a leading to joint damage COMPLICATIONS
change in their and different systemic Joint deformity
structure. manifestations. Disability of joint
DEGENERATIVE AUTOIMMUNE Decrease quality of life
Known as “WEAR and Symmetrical
TEAR” affectations of joints Osteoporosis Osteomalacia
Weight-bearing joints (e.g. wrists, fingers, Systemic skeletal A metabolic bone
are most commonly elbow, shoulder) disorder characterized disorder commonly
affected (e.g. ankles, by low bone mass, known as "SOFT
knees, hips, joints of RISK FACTORS micro-architectural BONE DISEASE"
the feet, pelvis, low Genetic – Because it is deterioration of bone results from inadequate
back and spine) an autoimmune tissue leading to more mineralization of bone
disease BRITTLE / POROUS tissue due to
RISK FACTORS Environmental bone, and increase in deficiencies in vitamin
Older Adults – factors – Highlanders fracture risk. D, calcium, or
Increases with age due who have lived in urban Variable prognosis – phosphate.
to loss of joint cartilage areas may be at hindi malala, hindi rin Good prognosis – hindi
and bone density. increased risk of RA sobrang lala malala
Sex – More common in through
females overexpression of HIF RISK FACTORS RISK FACTORS
Athletes – Due to joint Immune Caucasian or Asian Low intake of calcium,
overuse dysregulation Female vitamin D, or
Joint injuries – Older Adults phosphate
Injuries, such as those PATHOPHYSIOLOGY Hormonal imbalances Malabsorption disorder
that occur when playing (↓Estrogen, or from excessive loss
sports or from an Immune cells attack the ↓Testosterone, of calcium from the
accident and even synovium (responsible ↑Thyroid hormone) body
injuries that occurred for producing synovial Renal disorder – those
Low intake of calcium,
many years ago. fluid) individuals who cannot
vitamin D, ↑phosphate
Obesity – Carrying ↓ metabolize vitamin D
Sedentary lifestyle
extra body weight inflammation, thickening,
joint erosion Lack of weight-bearing
contributes to exercise PATHOPHYSIOLOGY
osteoarthritis, and the ↓
panus (thickening of Medications that affect
more you weigh, the Inadequate mineralization
synovium) calcium absorption and
greater your risk. ↓
↓ metabolism e.g.
Increased weight adds Unmineralized osteoid
leading to further damage o Corticosteroids
stress to weight- ↓
of the cartilages and o Anti-seizure
bearing joints, such as Leading to softening of
bones o Heparin
hips and knees. Also, bone
o Thyroid hormone
fat tissue produces
proteins that can cause MANIFESTATIONS MANIFESTATIONS
PATHOPHYSIOLOGY
harmful inflammation in Joint pain (arthralgia) Bone pain
and around your joints. Morning stiffness >1 Muscle weakness
Imbalance in bone
hour = severe Difficulty walking
resorption and formation
PATHOPHYSIOLOGY Symmetric joint pain ↓ Decreased in mobility
Inflammation ↑osteoclast and Tenderness to touch
WEAR and TEAR (bone Swelling ↓osteoblast formation Skeletal deformities
rubbing) Warm to touch ↓ (spinal kyphosis)
↓ Systemic infection Leading to ↓ bone density
pain, swelling, decreased (abnormal vital signs, PHARMACOLOGIC MNGT
in mobility weight loss) MANIFESTATIONS Vitamin D + Calcium
↓
Asymptomatic until you supplements
osteophytes (bone spurs) DIAGNOSTIC TOOLS have fracture (hips, Malabsorption drugs
will form X-ray – shows bony spine, wrists)
erosions and narrowed Chronic pain SURGICAL
MANIFESTATIONS joint spaces Decreased in mobility INTERVENTIONS
Joint pain (arthralgia) MRI
Swelling ↑ Mortality – prone to Rarely indicated
Ultrasound fracture/fall If severe,
Morning stiffness <30 Arthrocentesis – shows Vertebroplasty, Total
minutes synovial fluid that is DIAGNOSTIC TOOL Hip Replacement and
Crepitus (cracking or cloudy, milky, or dark Dual-energy X-ray Total Knee
popping sounds in a yellow absorptiometry (DXA) Replacement surgery
joint) Blood tests Undetectable on are being used
Limited range of motion (Rheumatoid Factors routine X-rays until
Joint deformity (RF), Anti-CCP NURSING MANAGEMENT
there has been 25% to
Muscle weakness antibodies) 40% demineralization Educate the
resulting in importance of Vitamin
DIAGNOSTIC TOOLS NURSING MANAGEMENT radiolucency of the D synthesis (through
X-ray Pain cannot be relieve bones. exposure to UV
MRI by rest but medications lights/sun)
Blood tests can help PHARMACOLOGIC MNGT Increase intake of
o Erythrocyte (Acetaminophen, Bisphosphonates - e.g. Vitamin D and calcium
Sedimentation NSAIDS) Denosumab (used to Assistive devices (e.g.
Rate (ESR) Disease-modifying treat osteoporosis by crutches, canes,
o C-reactive protein Antirheumatic Drugs decreasing the walkers)
(CRP) (DMARDs) – e.g. osteoclast formation
Methotrexate, and bone cancer)
NURSING MANAGEMENT Hydroxychloroquine, Hormonal replacement
Pain can be relieve by Sulfasalazine therapy
rest and medications Corticosteroids – e.g. Calcium + Vitamin D
(Acetaminophen, Hydrocortisone, supplements
NSAIDS) Prednisolone,
Weight management Prednisone
SURGICAL o Overgrowth in the cartilage and bones usually
INTERVENTIONS happens at the end of the bone near the growth
Vertebroplasty o Occurs in ages 10-30 years old
(Kyphoplasty) – A o Cause is IDIOPHATIC and is genetically inherited
treatment that injects
special cement into a BONE CYSTS
cracked or broken Expanding lesions within the bone
spinal bone to help This are fluid-filled areas inside growing bone that have
relieve pain. not developed into osseous tissue or actual bone
Total Hip Replacement
(THR) and Total Knee OSTEOID OSTEOMA
Replacement (TKR) Painful tumor in children and young adults
surgery – uses a Usually occurs in long bones
titanium metals and/or Common in MALE ages 4-25 years old
cobalt-chromium Cause is IDIOPHATIC
NURSING MANAGEMENT OSTEOCLASTOMAS
Prevent fall by raising Benign for long periods but may invade local tissue and
the side rails cause destruction
Encourage weight- Giant cell tumor
bearing and resistance Common in FEMALE Chinese ages 20-40 years old
exercises (promotes
↑bone density) BONE TUMORS (MALIGNANT)
Increase intake of
Vitamin D and calcium Primary Tumors
Paget’s Disease 1) OSTEOSARCOMA
Chronic disease The MOST PAINFUL TYPE of bone cancer, most
Causes abnormal bone remodeling, increase osteoblastic common, and most often fatal.
and osteoclastic activity resulting to large and weakening of
bones 2) CHONDROSARCOMA
Variable – hindi malala, hindi rin sobrang lala A type of bone cancer that develops in cartilage
cells (CHONDROCYTES) in the pelvis, shoulder,
RISK FACTORS ribs, long bones
Idiopathic Treatment: Surgery + Radiation Therapy /
Viral infections Chemotherapy
Genetic
Environmental 3) EWING SARCOMA
Came from Primitive Neuroectodermal Tumors
MANIFESTATIONS (PNET) – found in soft tissues, pelvis, femur, ribs
Asymptomatic
Bone pain 4) FIBROSARCOMA
Came from FIBROBLAST that produces connective
Deformities (abnormal enlargement and weakening of
tissues like collagen
bones)
A painless or tender soft lump in legs, arms or
Hearing loss
trunk.
Neurologic symptoms (only if the skull is affected) Treatment: Surgery + Radiation Therapy /
Chemotherapy
PHARMACOLOGIC MNGT
Bisphosphonates Soft Tissue Sarcomas
Calcitonin
NSAIDS 1) LIPOSARCOMA
Came from ADIPOSE TISSUE cells
NURSING MANAGEMENT Painless and slow-growing tumor
Pain management (e.g. hot compress, pain meds) Treatment: Surgery + Radiation Therapy
Prevent fall by raising the side rails
2) FIBROSARCOMA OF SOFT TISSUES
Osteomyelitis Septic Arthritis
Caused by bacteria Also caused by bacteria 3) RHABDOMYOSARCOMA
(Staphylococcus and fungi Came from RHABDOMYOBLAST (immature cells)
Aureas) and fungi which Spreads to bloodstream Most common soft tissue cancer in children
destructs the bone (hematogenous spread) Rapid-growing tumor
tissues. then the infection will go Treatment: Surgery + Radiation Therapy /
Begins near tissue and to synovium to destruct Chemotherapy
spreads to the bone then the cartilages.
the infection will go to Direct inoculation Prognosis depends on the type and whether the tumor
synovium to destruct the through trauma or has metastasized.
cartilages. surgery
The effect will lead to The effect will lead to Bone Tumor—Metastatic (Secondary)
bone necrosis or bone articular cartilage More common than primary bone tumors
abscess. destruction. Common primary sites that metastasize (kidney,
prostate, lung, breast, ovary, thyroid)
MANIFESTATIONS MANIFESTATIONS Metastatic tumors are most frequently found in the
Localized bone pain Pain and inflammation in skull, spine, pelvis, femur, and humerus and often
(long bones) in the one or more bones involve more than one bone (polyostotic)
upper and lower legs (large joints) in hip or Treatment is PALLIATIVE
Inflammation knee Goal: Relieve pain and promote quality of life
Flu-like symptoms Flu-like symptoms
Systemic infection (in Systemic infection (in Medical and Nursing Management of Bone Tumors
severe cases) severe cases) Medical management
o Primary: surgical incision, radiation therapy,
PHARMACOLOGIC MNGT PHARMACOLOGIC MNGT chemotherapy
Antibiotic Antibiotic o Secondary: palliative
Analgesics Analgesics Nursing management
o Monitoring and managing potential complications
BONE TUMORS (BENIGN) Delayed wound healing
More common, generally are slow growing, and present Infection
few symptoms Hypercalcemia
Most common is OSTEOCHONDROMA
o Patient and family education regarding diagnosis,
disease process, and treatment
