Diseases/Disorders of the Bone. Common Foot Disorders Hallux valgus Hallux valgus Hammertoe...
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Transcript of Diseases/Disorders of the Bone. Common Foot Disorders Hallux valgus Hallux valgus Hammertoe...
Diseases/Disorders Diseases/Disorders of the Boneof the Bone
Common Foot DisordersCommon Foot Disorders
Hallux valgusHallux valgus HammertoeHammertoe
Hallux ValgusHallux Valgus
BunionBunion Enlargement and lateral displacement of Enlargement and lateral displacement of
great toegreat toe Due to chronic pressure against the great Due to chronic pressure against the great
toetoe HeredityHeredity Pointed-toe shoes or high heelsPointed-toe shoes or high heels Metatarsophalangeal (MTP) joint enlargedMetatarsophalangeal (MTP) joint enlarged Callus developsCallus develops
HammertoeHammertoe
Flexion of the proximal interphalangeal Flexion of the proximal interphalangeal joint with hyperextension of the MTP and joint with hyperextension of the MTP and distal interphalangeal jointsdistal interphalangeal joints
Affects any toeAffects any toe Causes painful corns to developCauses painful corns to develop
Foot DisordersFoot Disorders
Corrective shoes and orthotic devicesCorrective shoes and orthotic devices Analgesics and corticosteroidsAnalgesics and corticosteroids SurgerySurgery Nursing CareNursing Care
PainPain Risk for InfectionRisk for Infection
OsteomalaciaOsteomalacia
Adult ricketsAdult rickets Inadequate mineralization of boneInadequate mineralization of bone Insufficient amounts of calcium or Insufficient amounts of calcium or
phosphatephosphate No mineralization of bone matrixNo mineralization of bone matrix
Bone unable to bear weightBone unable to bear weight Results in deformities and pathologic Results in deformities and pathologic
fracturesfractures Cause is lack of vitamin DCause is lack of vitamin D
Paget’s DiseasePaget’s Disease
Increase of osteoclastsIncrease of osteoclasts Osteoblasts are stimulated but produce Osteoblasts are stimulated but produce
soft and poorly mineralized bonesoft and poorly mineralized bone Prone to fractureProne to fracture Cause unknownCause unknown
Osteomalacia/Paget’s Osteomalacia/Paget’s DiseaseDisease
Replace vitamin DReplace vitamin D Calcium and phosphate supplementsCalcium and phosphate supplements Biphosphonates and calcitonin drugsBiphosphonates and calcitonin drugs
OsteoporosisOsteoporosis
““Porous Bones”Porous Bones” Fragile bones with risk of fracturesFragile bones with risk of fractures 80% are women over the age of 6080% are women over the age of 60 Cause unclearCause unclear
Osteoporosis – Risk FactorsOsteoporosis – Risk Factors
Cannot be ChangedCannot be Changed AgeAge FemaleFemale Family historyFamily history Endocrine Endocrine
disordersdisorders
Can be ChangedCan be Changed Calcium deficiencyCalcium deficiency Estrogen deficiencyEstrogen deficiency SmokingSmoking Excess alcoholExcess alcohol Sedentary lifestyleSedentary lifestyle MedicationsMedications
OsteoporosisOsteoporosis
Reduced bone massReduced bone mass Imbalance of bone growth and Imbalance of bone growth and
maintenancemaintenance Peak bone mass at age 35Peak bone mass at age 35 Formation does not keep pace with Formation does not keep pace with
resorption, resulting in loss of bone massresorption, resulting in loss of bone mass
OsteoporosisOsteoporosis
Type IType I Postmenopausal women ages 51–75Postmenopausal women ages 51–75 Caused by estrogen deficiencyCaused by estrogen deficiency
Type IIType II Men and women over age 70Men and women over age 70 Slow developmentSlow development Calcium deficiencyCalcium deficiency
OsteoporosisOsteoporosis
Focus is on stopping or slowing processFocus is on stopping or slowing process Relieving symptomsRelieving symptoms Preventing complicationsPreventing complications Bone density measurementBone density measurement
OsteoporosisOsteoporosis
CalciumCalcium Vital in preventionVital in prevention Adequate intake may slow processAdequate intake may slow process Calcium needs change over lifetimeCalcium needs change over lifetime NIH calcium intake recommendationsNIH calcium intake recommendations
NIH Recommended Daily Calcium Intake.NIH Recommended Daily Calcium Intake.
OsteoporosisOsteoporosis
MedicationsMedications Calcium supplementsCalcium supplements Hormone replacementHormone replacement Other drugsOther drugs
Osteoporosis – Nursing CareOsteoporosis – Nursing Care
Risk for InjuryRisk for Injury Imbalanced Nutrition: Less than Body Imbalanced Nutrition: Less than Body
RequirementsRequirements PainPain
OsteoporosisOsteoporosis
TeachingTeaching PreventionPrevention Calcium intake in dietCalcium intake in diet Physical activityPhysical activity Hormone replacement therapyHormone replacement therapy SmokingSmoking Fall preventionFall prevention
ArthritisArthritis
Inflammation of a jointInflammation of a joint LocalizedLocalized
OsteoarthritisOsteoarthritis SystemicSystemic
Rheumatoid arthritisRheumatoid arthritis Systemic lupus erythematosusSystemic lupus erythematosus
OsteoarthritisOsteoarthritis
Degenerative joint disease with Degenerative joint disease with progressive loss of joint cartilageprogressive loss of joint cartilage
Most common typeMost common type Leading cause of disability in older adultsLeading cause of disability in older adults Equal in men and womenEqual in men and women
OsteoarthritisOsteoarthritis
Risk factorsRisk factors AgeAge Repetitive joint use and traumaRepetitive joint use and trauma HeredityHeredity ObesityObesity Congenital and acquired defectsCongenital and acquired defects
OsteoarthritisOsteoarthritis
Entire joint affectedEntire joint affected Cartilage loses strength and elasticity and Cartilage loses strength and elasticity and
erodes and ulcerateserodes and ulcerates Underlying bone exposedUnderlying bone exposed Cartilage-coated osteophytes (bony Cartilage-coated osteophytes (bony
outgrowths)outgrowths)
OsteoarthritisOsteoarthritis
Manifestations and complicationsManifestations and complications Inflammation in the jointInflammation in the joint PainPain Decrease in joint range of motionDecrease in joint range of motion Enlarged jointsEnlarged joints Herniated diskHerniated disk
OsteoarthritisOsteoarthritis
HistoryHistory Physical and x-ray examinationPhysical and x-ray examination Weight reduction and exerciseWeight reduction and exercise Heat for local pain reliefHeat for local pain relief MedicationsMedications SurgerySurgery ArthroscopyArthroscopy
ArthroplastyArthroplasty
Reconstruction or replacement of the Reconstruction or replacement of the jointjoint Total joint replacementTotal joint replacement
Hip, knee, shoulder, elbow, ankle, wrist, Hip, knee, shoulder, elbow, ankle, wrist, joints of finger and toesjoints of finger and toes
Infection is major problemInfection is major problem
Total hip replacement.Total hip replacement.
Total knee replacement.Total knee replacement.
Osteoarthritis – Nursing Osteoarthritis – Nursing CareCare
Assessment focuses on effects of the Assessment focuses on effects of the disease and ADLsdisease and ADLs
Nursing diagnosisNursing diagnosis Chronic PainChronic Pain Impaired Physical MobilityImpaired Physical Mobility Self-Care DeficitSelf-Care Deficit
Osteoarthritis – Nursing Osteoarthritis – Nursing CareCare
TeachingTeaching Environmental safetyEnvironmental safety Use of assistive devices to maintain Use of assistive devices to maintain
independenceindependence MedicationsMedications Activity and weight bearingActivity and weight bearing Signs and symptoms of infectionSigns and symptoms of infection
Rheumatoid ArthritisRheumatoid Arthritis
Chronic systemic inflammatory disorder of Chronic systemic inflammatory disorder of the jointsthe joints
More women than menMore women than men Ages 30–50Ages 30–50 Multiple jointsMultiple joints Remission and exacerbationsRemission and exacerbations
Rheumatoid ArthritisRheumatoid Arthritis
Autoimmune responseAutoimmune response Autoantibodies (rheumatoid factors) bind Autoantibodies (rheumatoid factors) bind
with IgG to form immune complexeswith IgG to form immune complexes Complement activated and WBCs Complement activated and WBCs
attracted to the areaattracted to the area Cells phagocytize immune complexes and Cells phagocytize immune complexes and
also destroy the jointalso destroy the joint
Joint inflammation and destruction in rheumatoid arthritis.Joint inflammation and destruction in rheumatoid arthritis.
Rheumatoid ArthritisRheumatoid Arthritis
Systemic symptomsSystemic symptoms FatigueFatigue AnorexiaAnorexia Weight lossWeight loss Aching and stiffnessAching and stiffness
Destruction of joints and immobilityDestruction of joints and immobility
Typical hand deformities associated with rheumatoid arthritis. (Typical hand deformities associated with rheumatoid arthritis. (Source:Source: Custom Medical Stock Photos, Custom Medical Stock Photos, Inc.)Inc.)
Rheumatoid ArthritisRheumatoid Arthritis
DiagnosisDiagnosis History and physical examHistory and physical exam Rheumatoid factorsRheumatoid factors Erythrocyte sedimentation rateErythrocyte sedimentation rate Synovial fluid aspirateSynovial fluid aspirate X-raysX-rays
Rest and exerciseRest and exercise
Rheumatoid Arthritis - Rheumatoid Arthritis - TreatmentTreatment
MedicationsMedications Aspirin and NSAIDsAspirin and NSAIDs SteroidsSteroids Drugs to modify the autoimmune responseDrugs to modify the autoimmune response
SurgerySurgery Relieve pain and repair or replace jointsRelieve pain and repair or replace joints Arthrodesis (joint fusion)Arthrodesis (joint fusion)
Rheumatoid Arthritis - Rheumatoid Arthritis - TreatmentTreatment
PlasmapheresisPlasmapheresis Total lympoid radiationTotal lympoid radiation
Rheumatoid Arthritis – Rheumatoid Arthritis – Nursing CareNursing Care
Assessment focuses on progress of Assessment focuses on progress of disease and effect on functional abilitiesdisease and effect on functional abilities
Nursing diagnosesNursing diagnoses PainPain FatigueFatigue Ineffective Role PerformanceIneffective Role Performance Disturbed Body ImageDisturbed Body Image
Rheumatoid Arthritis – Rheumatoid Arthritis – Nursing CareNursing Care
TeachingTeaching Disease and systemic effectsDisease and systemic effects Rest and exerciseRest and exercise MedicationsMedications Assistive devicesAssistive devices SafetySafety
OsteomyelitisOsteomyelitis
Infection in the boneInfection in the bone Staphylococcus aureusStaphylococcus aureus Any ageAny age Older adults at riskOlder adults at risk Pathogens enter the bone from an open woundPathogens enter the bone from an open wound Spread to the bone from local tissueSpread to the bone from local tissue
OsteomyelitisOsteomyelitis
Pathogens lodge and multiplyPathogens lodge and multiply Cause inflammatory and immune system Cause inflammatory and immune system
responseresponse Phagocytes attempt to contain the infection, Phagocytes attempt to contain the infection,
but release enzymes that destroy bone tissuebut release enzymes that destroy bone tissue Canals in the marrow cavity of the bone allow Canals in the marrow cavity of the bone allow
the infection to spreadthe infection to spread Spreads along the surfaceSpreads along the surface Disruption of blood supply leads to necrosisDisruption of blood supply leads to necrosis
OsteomyelitisOsteomyelitis
OsteomyelitisOsteomyelitis
OsteomyelitisOsteomyelitis
Early diagnosis and antibiotic therapyEarly diagnosis and antibiotic therapy WBCWBC Blood and tissue culturesBlood and tissue cultures MRIMRI Bone scanBone scan
Medications intravenouslyMedications intravenously SurgerySurgery
CulturesCultures DebridementDebridement
Osteomyelitis – Nursing Osteomyelitis – Nursing CareCare
PainPain HyperthermiaHyperthermia Impaired Physical MobilityImpaired Physical Mobility TeachingTeaching
Medications and wound managementMedications and wound management Rest and limited weight bearingRest and limited weight bearing Good nutritionGood nutrition