Osteoarthritis

Hip Replacement
Osteoporosis

OSTEOARTHRITIS
Degenerative joint disease
Pathophysiology:
Deterioration of the articular cartilage
Cartilage becomes stiff and loses elasticity
Bone spurs joint deformity, pain, and
disability

OSTEOARTHRITIS
Degenerative joint disease
Whos at risk?
Obese - wt stress on the joints
Repetitive trauma bending, lifting, repetitive
motions
Age incidence greatly increased after age 60,
but it can develop in any age
Genetics

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 routines
Pharmacology:
-Acetaminophen or
Tylenol
- NSAIDs
- Opioids in severe
cases

Other 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&DB

Pre-op Prep:
Lab results: CBC,
WBC, PT, PTT, UA,
CXR
Temp
Skin prep
Pre-op prophylactic
antibiotics
Assess for risk of
DVT

Post-operative Care for the Patient w/ a

Hip Replacement
General guidelines:
Avoid hip flexion
Keep legs in abduction
prevents dislocation

Anti-emboli measures
- Sequential pneumatic
stockings
- IV Heparin or sub q
Lovenox Coumadin
- Exercises

Post-operative Care for the Patient w/ a

Hip Replacement
Medicate for pain
Check circulation of legs
Check incision (may be
lateral or anterior)
Check for dislocation
Neuro assessment of leg
Prevent external rotation
of the hip

Prevent skin impairment

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

Post-operative Care for the Patient w/ a

Hip Replacement
If hemovac is used
Instructions to go home:
- need toilet seat extension
- NO crossing the legs sitting or standing

OSTEOPOROSIS
Pathophysiology
There is a in bone density due to an in bone
reabsorption.
- Calcitonin and Estrogen promotes bone
formation
- Both 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 women
Dietary
Lack of weight
Actual Calcium need for adults
bearing exercises
Women
Men
25-50 yrs 1,000 mg
25-65 yrs
Older age
1,000 mg

50-65 yrs

1,000-1,500 mg > 65 yrs

1,500 mg

> 65 yrs

1,500 mg

Preg/lactating 1,200-1,500
mg

OSTEOPOROSIS
Secondary Osteoporosis:
2nd to renal failure, liver failure
2nd to medications affects the bodys use of
calcium
- corticosteroids, heparin, INH, diuretics
2nd to ETOH abuse
2nd to malignancy, DM
2nd to immobility

OSTEOPOROSIS
Risk Factors:
Small-framed, non-obese (< 127 lbs) Caucasian
or Asian women
Age
Menopause
Family history
Diets low in Ca and Vit D
Sedentary lifestyle
Excessive 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 Osteoporosis

Curvature of the spine

Kyphosis: dowagers
hump
urine Ca levels
Fractures wrist, hip,
pelvis, vertebral collapse
Loss of height

Nursing
Interventions for
Osteoporosis

Prevention!!!
Diet
Weight bearing exercises
Resistance training

Medications
1. Stabilizes bone loss
- Ca carbonate/ Ca citrate
- Estrogen replacement
therapy
2. Build bone mass
- Fosamax, Actonel
- Evista: Selective
Estrogen Receptor
Modulators (SERMs)
- Effective in preventing
40% of spinal fx only
- Calcitonin
- Forteo: parathyroid
hormone