NURS 150, Unit 6

Osteoporosis, Osteoarthritis (OA), Rheumatoid Arthritis

(RA)
STUDENT RESOURCES

LEARNING OBJECTIVES

On Musculoskeletal Conditions: Osteoporosis, Osteoarthritis, & Rheumatoid Arthritis

Upon completion of this chapter, you will be able identify:

Osteoporosis
Learning Framework
(For Health Problems see the following section)
Etiology
Incidence and prevalence in Canada
Common risk factors
Pathophysiology
- Definition
- Process
Clinical Manifestations
- Common signs and symptoms
Diagnostic tests
- Common diagnostic tests, tools, and findings (normal and abnormal)
- Bone mineral density (BMD)
- Serum Calcium, Phosphorus, and alkaline phosphatase levels
Collaborative Care
- Lifestyle (Activity)
- Diet modifications
- Calcium supplements
- Vitamin D supplements
- Medications
Nursing Process
- Assessment (History and Physical Examination)
- Interventions (Education, Patient centered regimen)

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Arthritis(Osteo & Rheumatoid)
Etiology
- Incidence and prevalence in Canada
- Common risk factors
Pathophysiology
- Definition
- Process
Clinical Manifestations
- Common signs and symptoms
- Osteo (Systemic, Joint, and Deformity)
- Rheumatoid Arthritis (Joints, Extra-articular movements, and Complications)
Diagnostic tests
- Common diagnostic tests, tools, and findings (normal and abnormal)
- Osteo (Bone scan, CT, MRI, erythrocyte sedimentation rate [ESR], synovial fluid)
- Rheumatoid Arthritis (Rheumatoid Factor [RF]; Common serum tests; Synovial fluid; EARLY onset tests
vs. LATE stage tests)
- Collaborative Care
- Osteo (Rest & Joint protection; Heat and Cold applications; Nutrition & Activity; Complimentary
therapy; Medication)
- Rheumatoid (Medication, Nutrition, Lifestyle)
Nursing Process
- Assessment
- Nursing Diagnosis
- Planning & Intervention (Health Promotion; Acute Intervention; Ambulatory / Home)
- Evaluation
READINGS & PREPARATION
1. Lewis et al.(Evolve) , chapter 66 on Osteoporosis, pages 1871-1876
2. Lewis et al., (Evolve) chapter 67 on Osteoarthritis (OA) and Rheumatoid Arthritis (RA), pages 1881 -
1899
3. Slides on Evolve under Unit 5 & 6
i. Osteoporosis

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ii.
OA & RA
SUMMARY

OSTEOPOROSIS
Etiology and The risk of osteoporosis has been identified in previous discussions of
menopause, corticosteroid use, and other disorders, so review the risk factors as
Pathophysiology needed.

ETIOLOGY:

Identify previously
discussed conditions that
predispose to osteoporosis Major Risk Factors:
and the role of
osteoporosis in hip
fractures in the older
adult.

Minor Risk Factors:

PATHOPHYSIOLOGY:

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Clinical Manifestations Describe the insidious onset of the disease and the common skeletal
manifestations that occur.

Diagnostic Studies .

Review the use of bone

density testing in
diagnosing osteoporosis
NURSING AND Remember the necessity of calcium intake, exercise, and reducing modifiable
COLLABORATIVE risk factors in the management of osteoporosis. Review the drugs that are used
MANAGEMENT: in the treatment of osteoporosis and the benefits of estrogen replacement
OSTEOPOROSIS therapy.
Drug Therapy
Collaborative Care
.
.
.
.
.
.
.

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.
.
.
.

OSTEOARTHRITIS
Because the term arthritis is commonly used to describe a variety of joint pain and aches, it is important to
clarify the differences between the various arthritic conditions, especially between osteoarthritis (OA) and
rheumatoid arthritis (RA). Osteoarthritis clearly as a progressive noninflammatory disease that affects joints
and surrounding tissues for later comparison with rheumatoid arthritis, a systemic disease.

Etiology and Describe the pathophysiological changes that occur in the joints with OA,
Pathophysiology and discuss the proposed etiologies of the disorder.
Stress that although OA is
primarily a disease of the Idiopathic OA(formerly primary) cause:
elderly, it is not considered a
normal finding of aging.
Secondary OA cause:

1. .
2. .
3. .
4. .
5. .
6. .
7. .

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Clinical Manifestations 1. Systemic
Emphasizing the joint
symptoms that occur, 2. Joints
especially the characteristic
pain with motion and weight-
bearing, stiffness after rest, 3. Deformity
and Heberdens nodes. Identify
the joints most commonly
affected and the contributing
factors.

Diagnostic Studies Describe the x-ray findings in late OA. Systemic and joint inflammation is
rarely indicated by laboratory tests.

Collaborative Care 1. .
Discuss the
nonpharmacological 2. .
interventions indicated to
manage OA and the 3. .
appropriate use of heat and
cold applications. Describe the 4. .
drug therapy used in the
treatment of OA, including the 5. .
use of complementary and
alternative therapies. Explain
how the only indication for
dietary change is weight loss if

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the person is overweight.

NURSING MANAGEMENT: Nursing Assessment

OSTEOARTHRITIS
Focus on assisting clients with
OA to prevent further Nursing Diagnoses
limitation of mobility and
modify their activity patterns
to control the symptoms of
Planning
the disease.
The teaching plans developed
by the nurse for the client
should reflect the nature of the Nursing Implementation
disease, techniques of pain
management, modification of
home and work environments, Evaluation
exercise, joint protection, and
balance of activity and rest
specific for this client.
RHEUMATOID ARTHRITIS

Etiology and
Pathophysiology

Throughout the worksheet of

rheumatoid arthritis (RA),
differentiate it from
osteoarthritis in all aspects.

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Describe the high incidence of
RA in women of childbearing
age, the autoimmune nature of
the disease characterized by
both RA antibodies and HLA-
DR4 antigens, and the disease
progression through
established stages.
Clinical Manifestations Common articular and extraarticular symptoms and complications of RA.
Complications

RA is a systemic disorder, and

differentiate the articular
symptoms from the extra-
articular manifestations.
Diagnostic Studies Discuss the inflammatory and immune effects of RA that can be detected in
laboratory tests and the progressive joint changes revealed by x-ray.

Collaborative Care Diagnostic Collaborative Care

Stressing the interdisciplinary 1. .
approach to the treatment of 2. .
RA and other rheumatoid >
conditions and the need for >
comprehensive client >
education regarding drug >

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therapy. >
Collaborative Therapy
Many drugs and combinations 1. .
of drugs are used in the 2. .
treatment of RA. 3. .
4. .
5. .
6. .
7. .
8. .
9. .
10.

NURSING MANAGEMENT: Nursing Assessment

RHEUMATOID ARTHRITIS
Nursing Diagnoses
Emphasize that although the
nursing management of clients
Planning
with OA and RA is similar, the
client with RA is likely to have
Nursing Implementation
more deformity and disability
at a younger age, requiring
more intensive intervention.
Evaluation

Age-Related Review the factors that increase the older clients risk for drug toxicity and
Considerations: Arthritis the alterations in dosing that may be required. Discuss the problems
related to rheumatic disease in older adults and the concerns related to the
How would you modify the skeletal effects of corticosteroid therapy in the older adult.

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nursing care plans if the client
with RA were an older adult ?

CLASSROOM ACTIVITIES
Case study
TEST YOUR KNOWLEDGE
What you need to know for Test #1

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