Summary

Osteoporosis is a bone disease in which a person’s bone mineral density and bone mass decreases, causing changes to the quality or structure of the bone. Osteopenia, a decrease in bone mineral density, is the precursor condition to osteoporosis.

The underlying pathophysiology of osteoporosis involves too much resorption of small amounts of minerals from the bone over time. Common clinical manifestations of osteoporosis include bone fractures, back pain, kyphosis, and a loss of total height over several years. The gold standard diagnostic test for osteopenia and osteoporosis is the dual-energy x-ray absorptiometry (DEXA or DXA) scan, which uses low-dose radiation x-rays to determine bone density of the hip, wrist, or spine. Treatment options for osteoporosis involve a combination of modifying lifestyle risk factors and prescribing pharmacological interventions.

OA is a degenerative joint disorder that causes the cartilage to gradually become thinner. As the cartilage layer wears down, more pressure is placed on the bones, causing pain. Common clinical manifestations of OA include joint pain and swelling, limited range of motion, muscle weakness, and “grating” sensations with joint movement. Diagnostic tests for OA include physical examination and assessment, imaging, arthrocentesis, and serum inflammatory markers. Treatment for OA includes both pharmacological interventions (e.g., NSAIDs, analgesics) and nonpharmacological interventions (e.g., exercise, assistive devices).

Fractures, or breaks in the bone structure, are one of the most common types of musculoskeletal traumas. When a bone fracture occurs, the soft tissue surrounding the bone is also usually affected, potentially resulting in soft tissue injuries such as edema, hemorrhage, tendon damage, or severed nerves. The specific clinical manifestations of fractures will vary depending on the anatomic location affected, but they usually include pain, edema, inability to move the affected part, bruising, and extremity deformities. The only definitive way to diagnose a bone fracture is to visualize the break in the bone structure, which can be done with imaging studies including x-ray, CT scan, and MRI. In some cases, the fracture will heal on its own; in other cases, more invasive interventions such as immobilization, reduction, fixation, or surgery may be required.

Muscular dystrophy (MD) is a rare genetic disorder that causes progressive muscle weakness over time; over 30 specific types exist. The underlying pathophysiology of MD is caused by genetic mutations, either inherited or spontaneous. Clinical manifestations of MD vary depending on the specific type, but common findings include muscle weakness and atrophy, contractures, and frequent falls or clumsiness. Because most MDs are diagnosed in childhood, it is often the child’s parents who notice the first signs that may indicate a muscular problem. Treatment for MD involves a combination of pharmacological interventions (e.g., long-term corticosteroids) and nonpharmacological interventions (e.g., physical and occupational therapies).

Systemic lupus erythematosus (SLE) is the most common form of lupus, an autoimmune disorder that results in widespread information and tissue damage. The organs most-commonly damaged by SLE include the skin, joints, heart, lungs, kidneys, and brain, so most clinical manifestations will involve these body systems. The most specific diagnostic test for SLE is the antinuclear antibody (ANA) test, which looks for autoantibodies commonly associated with lupus. The main goals of nursing care for patients with SLE are to manage symptoms, prevent or limit the effects of disease flares, and improve the patient’s overall quality of life. Treatment for SLE includes the use of anti-inflammatory medications such as NSAIDs and corticosteroids, as well as immunosuppressants and biologic medications.

Rheumatoid arthritis (RA) is an autoimmune disorder that causes inflammation of the synovial joints in the body. RA can affect all the joints in the body, but it most-commonly affects the joints in the hands. Symptoms include joint pain, swelling, and stiffness that is worse in the morning. Diagnostic tests for RA include rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), in addition to imaging such as x-ray, ultrasound, or MRI. Pharmacologic treatment for RA includes use of disease-modifying antirheumatic drugs (DMARDs), nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids.

There are several different types of soft tissue injuries, including sprains, strains, contusions, tendinitis, and bursitis. The most common clinical manifestations associated with soft tissue injuries include swelling, redness, pain, muscle weakness, and spasms. Most often, physical assessment of the affected part of the body is enough to confirm a diagnosis of a soft tissue injury. For injuries that are less obvious upon visual inspection, imaging studies such as CT or MRI may be indicated. The main goals of nursing care for patients with soft tissue injuries are to manage symptoms and heal the affected part of the body. One of the main nursing interventions for patients with soft tissue injuries is using the “RICE” acronym, which stands for rest, ice, compression, and elevation.