Ns.

Hasan, Muhammad Nur MSN

From Herlihy, B. & Maebius, N. (2000). The human body in health and illness. Philadelphia: W.B.
Saunders.
Osteogenic Cells
Osteoblasts
Osteocytes
Osteoclasts
 Framework Protects Organs
Support Storage
Movement Hematopoiesis
Shape Remodeling
Maintain Position Reformation
Attachment of Movable Joints
Muscles
From Applegate E: The Anatomy and Physiology Learning System, ed. 2, Philadelphia, 2000, W.B.
Saunders.
 Ossification
Resorption &
Formation
Local stress
Vit. D
Parathyroid hormone
Calcitonin
Blood supply
 Bones
Muscles
Joints
Ligaments
 Bone Mineral Density (BMD)

30
Age (yrs)
70
Males
Females
 Growth Factors Genetics

Hormones

Smoking BONE
Medications

Nutrition Alcohol Exercise/loading

 Excessive loss Low intake Poor absorption

Low Ca+2+2
Estrogen Inactivity
other heredity Low Ca
intake deficiency

Fatigue Reduced Poor

stress Bone Mass architecture

Environmental
stability falls Fragility Force hazards

Bone fracture
100 Trabecular
Compact
Bone mass %

MENOPAUSE

50
30 40 80
Age (yrs)
Bone Mineral Density (BMD) Females
Males

exercise

30 70
Age (yrs)
 Inflammatory joint
disease
Noninflammatory
joint disease
 Rheumatoid
arthritis
Ankylosis
Spondylitis
Gouty arthritis
 BOUTONNIERE DEFORMIT

MUSCLE ATROPHY
SWAN NECK DEFORMITY
From Lemmi FO, Lemmi CAE: Physical assessment findings CD-ROM, Philadelphia, 2000, W.B.
Saunders.
From Lemmi FO, Lemmi CAE: Physical assessment findings CD-ROM, Philadelphia, 2000, W.B.
Saunders.
 Nonsteroidal
antiinflammatory
drugs (nsaids)
Corticosteroids
Antineoplastic
medications
Gold salts (pain and
inflamation)
 PHYSICAL MOBILITY
SELF-CARE
 FATIGUE
BODY IMAGE
DISTURBANCE
 Synovectomy
Arthrodesis
Joint replacement
(arthroplasty)
 Chronic Inflammatory Disease
Systemic autoimmune disease
Differs from RA
Signs & Symptoms
Treatment
 Description
Phases
Assessment
Implementation
From Clinical Slide Collection of the Rheumatic Diseases, 1991,1995,1997. Used with
permission of the American College of Rheumatology.
 Degenerative joint
disease
(osteoarthritis) is
the most common
 DESCRIPTION
Also known as
degenerative joint
disease (DJD)

JOINT CHANGES IN OSTEOARTHRITIS

 HEBERDENS NODES

SEVERE OSTEOARTHRITIS

From Kamal A, Brockelhurst J: Color atlas of geriatric medicine, ed. 2, St. Louis, 1991, Mosby.

BOUCHARDS NODES
 OSTEOTOMY
TOTAL JOINT
REPLACEMENT (TJR)
 Assist
Instruct
Review
 Osteoporosis
Osteomalacia
Pagets Disease
DOWAGERS HUMP
From Black, J., Hawks, J., and Keene, A. (2001). Medical-surgical nursing, ed 6, Philadelphia: W.B.
Saunders.
From Lemmi FO, Lemmi CAE: Physical assessment findings CD-ROM, Philadelphia, 2000, W.B.
Saunders.
From Mosbys Medical, Nursing, and Allied Health Dictionary, ed 6, (2002). St. Louis: Mosby.
 Metabolic disease
Bone volume unchanged
Osteomalacia adults
Rickets - children
 Osteitis Deformans
Increased metabolic activity
Usually no TX
Affects men and women equally
 Health History
Initial Interview
Assessment Data
Pain
Altered Sensations
 Physical Assessment
Posture
Gait
Bone Integrity
Joint Function
Muscle Strength & Size
Skin
Neurovascular Status
 Autoimmune disorders
Calcium deficiency
Degenerative conditions
Falls
Hyperuricemia
Infection
 Medications
Metabolic disorders
Neoplastic disorders
Obesity
Postmenopausal states
Trauma and injury
 Imaging Procedures
X-ray
Computed Tomography (CT)
Magnetic Resonance Imaging
(MRI)
Arthrography
Bone Densitometry
 Nuclear Studies Laboratory Studies
Bone Scan (CBC)
Endoscopic Studies Urinalysis (Calcium)
Arthroscopy Blood Chemistry
Other Studies Serum Calcium
Arthrocentesis Serum Phosphate
Electromyography Uric Acid
Biopsy Serum Creatinine
LDH, SGOT, CPK