Degenerative, Inflammatory and Metabolic Bone Disorders - Cheat Sheet
Your last-minute revision companion for musculoskeletal nursing. Master OA vs RA distinction, gout management, osteoporosis prevention, hip precautions, and critical nursing diagnoses.
Osteoarthritis (OA) vs Rheumatoid Arthritis (RA) — THE MASTER COMPARISON
Important facts
- OA: Asymmetric, weight-bearing joints (knees, hips, spine, DIP fingers), pain worse with activity, stiffness <30 min
- OA: Heberden's nodes (DIP) and Bouchard's nodes (PIP) on fingers—pathognomonic
- OA: NO systemic signs (no fever, fatigue, weight loss)
- RA: Symmetric (bilateral), small joints first (hands, wrists, feet), pain worse in morning
- RA: Morning stiffness >1 hour is classic; systemic signs present (fatigue, low-grade fever, weight loss, malaise)
- RA: Labs—elevated ESR, CRP, positive rheumatoid factor (RF), anti-CCP antibodies
- RA: Deformities include ulnar deviation, swan-neck, boutonnière deformities
- OA: Non-inflammatory or low-inflammatory; RA: markedly inflammatory
Key definitions
Osteoarthritis
Example
60-year-old with Heberden's nodes on fingers and knee pain worse with activity
Degenerative, non-inflammatory, wear-and-tear joint disease with progressive cartilage loss, osteophyte formation, and asymmetric joint involvement.
Rheumatoid Arthritis
Example
35-year-old with bilateral hand/wrist swelling, morning stiffness >1 hour, fever, positive RF and anti-CCP
Chronic, systemic, autoimmune inflammatory disease attacking synovial membrane, forming pannus and causing symmetric joint destruction with systemic manifestations.
Pannus
Example
Seen on imaging as destructive lesions at joint margins
Inflammatory tissue mass in synovium that invades and erodes cartilage and bone in RA.
Diagrams to know
- Side-by-side comparison of OA vs RA joint changes
- Timeline: OA progressive cartilage loss vs RA pannus formation and erosion
- Hand deformity patterns: Heberden's/Bouchard's vs ulnar deviation/swan-neck
OA & RA Pharmacology & Nursing Management
Important facts
- OA TREATMENT: Acetaminophen first-line, NSAIDs added, weight reduction, low-impact exercise, joint protection, heat for stiffness, cold for acute inflammation
- RA TREATMENT: Balance rest and activity, heat/cold, joint protection, DMARDs (especially methotrexate), NSAIDs, short-course corticosteroids, biologic agents
- METHOTREXATE: Anchor DMARD for RA—give FOLIC ACID to reduce side effects, monitor for hepatotoxicity and bone marrow suppression, TERATOGENIC (avoid pregnancy)
- NSAIDs: Contraindicated in renal disease, GI ulcers, aspirin sensitivity; monitor for GI upset, renal impairment
- BIOLOGICS (etanercept, infliximab): TNF-alpha inhibitors—increase infection risk; screen for TB before use; counsel on symptoms of infection
- Short-course CORTICOSTEROIDS: Control RA inflammation but not long-term curative; taper to prevent rebound
- NURSING: Teach joint protection, activity pacing, sleep hygiene, stress management, medication adherence; refer to OT/PT
Key definitions
DMARD (Disease-Modifying Antirheumatic Drug)
Example
Methotrexate, biologics (etanercept, infliximab)
Agents that slow or halt RA disease progression; methotrexate is anchor drug.
NSAIDs
Example
Ibuprofen, naproxen, indomethacin
Anti-inflammatory analgesics; first-line for OA pain and RA inflammation, not curative.
Diagrams to know
- Methotrexate side effects monitoring flowchart
- DMARD initiation and escalation pathway
Gout — Purine Metabolism & Acute Management
Common values
Value
<6.8 mg/dL
Symbol
SUA
Quantity
Normal serum uric acid
Value
>6.8 mg/dL
Symbol
Gout risk
Quantity
Hyperuricemia threshold
Important facts
- GOUT CLASSIC SITE: Great toe (podagra); may also affect ankles, knees, wrists, fingers
- ACUTE ATTACK: Sudden onset, red, hot, swollen, exquisitely tender joint; lasts days to weeks
- TRIGGERS: High-purine diet, alcohol (especially beer), dehydration, diuretics, NSAIDs, leukemia treatment, acute illness
- DIET MANAGEMENT: AVOID high-purine foods—organ meats (liver, kidney), red meat, shellfish, sardines, anchovies, alcohol, high-fructose drinks
- DIET ENCOURAGE: Increase fluid intake 2–3 L/day to prevent urate stone formation; maintain healthy weight (avoid crash dieting—raises uric acid)
- ACUTE ATTACK DRUGS: Colchicine (watch for nausea, vomiting, diarrhea—signs of toxicity), NSAIDs, corticosteroids
- CHRONIC URATE-LOWERING: Allopurinol (xanthine oxidase inhibitor reduces urate production), probenecid (increases urate excretion)
- CRITICAL: DO NOT START ALLOPURINOL DURING ACUTE ATTACK—may worsen it; start 2–4 weeks after attack resolves
- AVOID ASPIRIN: Raises serum uric acid and may precipitate attacks
- ACUTE MANAGEMENT NURSING: Rest, elevate, immobilize joint, cold application, bed cradle to protect from linens weight, pain management
Key definitions
Gout
Example
Sudden red, hot, swollen, exquisitely tender great toe (podagra)
Metabolic arthritis caused by monosodium urate crystal deposition in joints, triggered by hyperuricemia.
Hyperuricemia
Example
Caused by overproduction or underexcretion of uric acid
Elevated serum uric acid (>6.8 mg/dL), the underlying metabolic defect in gout.
Tophi
Example
May lead to deformity and joint destruction if untreated
Deposits of monosodium urate crystals in chronic gout, forming nodules on ear, fingers, and other sites.
Diagrams to know
- Gout acute attack vs chronic management timeline
- Purine metabolism and urate formation pathway
Osteoporosis — Bone Loss & Prevention
Common values
Value
>−1
Symbol
Normal bone
Quantity
DEXA T-score (normal)
Value
−1 to −2.5
Symbol
Precursor state
Quantity
DEXA T-score (osteopenia)
Value
≤−2.5
Symbol
Established disease
Quantity
DEXA T-score (osteoporosis)
Important facts
- OSTEOPOROSIS: Often silent until fracture occurs—hip, vertebral (compression fractures), wrist (Colles fracture)
- RISK FACTORS: Postmenopausal estrogen loss, advanced age, female sex, small thin frame, low calcium/vitamin D, sedentary lifestyle, smoking, excess alcohol, long-term corticosteroid use (most important modifiable)
- DIAGNOSIS: DEXA T-score ≤ −2.5 indicates osteoporosis; −1 to −2.5 = osteopenia (precursor state)
- CALCIUM INTAKE: 1000–1200 mg/day (dietary: milk, cheese, yogurt, leafy greens, fortified foods; supplements if intake inadequate)
- VITAMIN D INTAKE: 800–1000 IU/day (exposure to sunlight, fatty fish, egg yolks, fortified milk, supplements)
- EXERCISE: Weight-bearing exercise (walking, jogging) stimulates bone formation; strength training and balance improve fracture prevention
- BISPHOSPHONATES (alendronate, risedronate): Inhibit osteoclast-mediated bone resorption; slow bone loss and reduce fracture risk
- BISPHOSPHONATE TEACHING: Take on EMPTY STOMACH in morning with FULL GLASS OF PLAIN WATER; REMAIN UPRIGHT (sitting/standing) for ≥30 min to prevent esophagitis/erosion; may cause jaw osteonecrosis (rare)
- HORMONE REPLACEMENT THERAPY: May prevent bone loss in postmenopausal women, but cardiac/thromboembolism risks limit use
- FALL PREVENTION: Remove hazards, adequate lighting, assistive devices, vision/hearing checks—fracture is feared outcome
Key definitions
Osteoporosis
Example
Postmenopausal woman with DEXA T-score ≤ −2.5
Metabolic bone disease with low bone mass and deteriorated bone microarchitecture, leading to increased fragility and fracture risk.
DEXA Scan
Example
T-score ≤ −2.5 = osteoporosis; −1 to −2.5 = osteopenia
Dual-energy X-ray absorptiometry; gold-standard diagnostic imaging for bone mineral density.
Dowager's Hump
Example
Progressive forward curvature of upper back with height loss
Kyphosis of thoracic spine from vertebral compression fractures in osteoporosis.
Diagrams to know
- Bone remodeling cycle and effect of bisphosphonates
- Risk factors and prevention strategies flowchart
Osteomyelitis — Bone Infection & IV Antibiotic Therapy
Important facts
- OSTEOMYELITIS ETIOLOGY: Hematogenous spread (most common), adjacent soft tissue infection, direct inoculation (open fracture, surgery)
- CAUSATIVE ORGANISM: Staphylococcus aureus (80%–90%); also Streptococcus, Gram-negative rods, anaerobes
- CLINICAL PRESENTATION: Bone pain, fever, chills, swelling, warmth, erythema over affected bone; if chronic, may have draining sinus tract
- DIAGNOSIS: Blood cultures (positive in early hematogenous disease), elevated WBC/ESR/CRP, imaging (X-ray, MRI, bone scan), bone biopsy for culture/sensitivity
- TREATMENT: Prolonged IV antibiotics (4–6 weeks minimum, often 6–12 weeks) based on culture sensitivity; surgical debridement of dead bone (sequestrum) if needed; prolonged immobilization
- ANTIBIOTIC SELECTION: Empiric broad-spectrum until culture/sensitivity available (e.g., nafcillin or oxacillin for S. aureus); switch to organism-specific therapy
- NURSING CARE: Immobilize and elevate affected limb (prevent pathologic fracture), manage pain, maintain IV access (often central line for prolonged therapy), aseptic wound care, monitor for antibiotic side effects
- NUTRITION: Protein and vitamin C to support bone healing; monitor for malnutrition with chronic infection
- PSYCHOSOCIAL: Extended illness (months) requires coping support, education on IV antibiotic home therapy (often PICC line or Port), adherence to long-term follow-up
- COMPLICATION: Pathologic fracture (weakened bone prone to breaking), chronic osteomyelitis with recurrent flares, sepsis if untreated
Key definitions
Osteomyelitis
Example
Post-surgical infection after open fracture fixation with fever, bone pain, swelling
Acute or chronic infection of bone, usually bacterial (Staphylococcus aureus most common), with inflammatory response and bone destruction.
Sequestrum
Example
Seen on imaging as separated fragment of dead bone
Dead bone fragment isolated during osteomyelitis infection; often requires surgical removal.
Diagrams to know
- Osteomyelitis pathogenesis: entry routes and inflammatory cascade
- IV antibiotic management timeline and nursing monitoring
Total Hip Replacement (THR) — Hip Precautions & Dislocation Prevention
Important facts
- HIP PRECAUTIONS RULE 1—NO HIP FLEXION >90°: Avoid low chairs, low toilets, bending forward, tying shoes, putting on pants; use raised toilet seats, long-handled reacher, sock aid, shoe horn
- HIP PRECAUTIONS RULE 2—NO LEG ADDUCTION PAST MIDLINE: Keep abduction pillow between legs at all times (sitting, lying); NEVER cross legs; keep legs apart
- HIP PRECAUTIONS RULE 3—NO INTERNAL ROTATION: Keep toes pointing forward/upward; avoid inward-facing feet or pigeon-toe position
- TURNING IN BED: Turn only as ordered (usually onto unaffected side); keep abduction pillow between legs; log-roll to maintain hip alignment if needed
- DISLOCATION SIGNS (REPORT IMMEDIATELY): Sudden severe hip pain, leg shortened and internally or externally rotated, inability to move or bear weight, audible/palpable 'pop'
- POSTOPERATIVE CARE: DVT/PE prevention (anticoagulants, compression devices, early mobilization), wound care (monitor drain, signs of infection), pain management, quad/glute setting exercises, isometric abduction
- PHYSICAL THERAPY: Early PT (usually POD1–2); progressive weight-bearing as tolerated, walker/crutches initially, then cane; ambulation on level surfaces first
- TOTAL KNEE REPLACEMENT (TKR): Similar principles; CPM (continuous passive motion) machine often used to maintain ROM; emphasis on knee extension and flexion exercises
- ACTIVITY RESTRICTIONS: No driving until cleared by surgeon (usually 6 weeks); return to ADLs gradually; avoid high-impact activities (jogging, jumping)
- LONG-TERM OUTCOMES: Most patients achieve pain relief and improved function; longevity of prosthesis 15–20+ years; may need revision later
Key definitions
Hip Precautions
Example
No crossing legs, no hip flexion >90°, maintain abduction pillow between legs
Strict movement restrictions after total hip replacement to prevent prosthetic dislocation by limiting hip flexion, adduction, and internal rotation.
Hip Dislocation (Prosthetic)
Example
Patient reports sudden sharp hip pain and leg appears shorter and inward-rotated
Femoral head slides out of acetabular socket; most common early complication after THR, presenting with severe pain, shortened/rotated leg, and inability to bear weight.
Diagrams to know
- Hip precautions visual guide with prohibited and allowed positions
- Post-THR progression pathway from acute care to home discharge
Low Back Pain — Mechanical Causes, Red Flags, & Nursing Interventions
Important facts
- LOW BACK PAIN EPIDEMIOLOGY: Most common after age 30; mechanical causes in 90%, serious pathology in <5% (cancer, infection, fracture, cauda equina)
- MECHANICAL CAUSES: Muscle strain, degenerative disc disease, facet joint osteoarthritis, disc herniation, spondylolisthesis
- ACUTE MANAGEMENT: Activity modification (avoid bed rest >1–2 days), NSAIDs, muscle relaxants (cyclobenzaprine), heat or cold, PT/exercises
- BODY MECHANICS TEACHING: Bend at KNEES not waist, keep objects close to body when lifting, avoid twisting motions, maintain good posture, sleep on firm mattress, strengthen core muscles, maintain healthy weight
- CORE STRENGTHENING: Pelvic tilts, bridges, dead bugs, planks, bird dogs—essential for long-term back stability
- RED-FLAG FINDINGS (URGENT EVALUATION NEEDED): New onset bowel/bladder incontinence, saddle anesthesia (perineal/buttock/inner thigh), progressive bilateral leg weakness, severe night pain unrelieved by position, fever with back pain, unintentional weight loss, hx of cancer
- CAUDA EQUINA SYNDROME: SURGICAL EMERGENCY—requires immediate MRI and neurosurgical consultation; decompressive laminectomy indicated
- IMAGING: Plain X-rays for suspected fracture; MRI for suspected disc herniation or serious pathology; CT/myelography if MRI contraindicated
- HERNIATED DISC CONSERVATIVE CARE: NSAIDs, muscle relaxants, PT, epidural steroid injection may be tried before surgery
- SURGICAL INDICATIONS: Persistent radiculopathy (4–6 weeks conservative), neurologic deficit progression, cauda equina syndrome
- POST-SPINAL SURGERY CARE: Log-roll technique to keep spine aligned, monitor for CSF leak (clear drainage on dressing—notify surgeon immediately), assess for new neurologic deficits, activity restrictions as ordered, pain management
Key definitions
Low Back Pain (Mechanical)
Example
Construction worker with acute lumbar strain after heavy lifting
Pain due to musculoskeletal causes (muscle strain, degenerative disc disease, facet joint disease) without neurologic compromise.
Herniated Intervertebral Disc
Example
L4–L5 disc herniation causing right leg pain, numbness, weakness radiating to foot
Nucleus pulposus protrusion through anulus fibrosus, potentially compressing nerve root and causing radiculopathy (sciatica).
Sciatica
Example
Sharp, burning leg pain with numbness and weakness in L5 or S1 distribution
Radiating leg pain caused by sciatic nerve root compression, often from disc herniation; pain travels from buttock to foot.
Cauda Equina Syndrome
Example
Loss of bowel/bladder control with severe bilateral leg pain—EMERGENCY
Surgical emergency: compression of multiple nerve roots in lumbosacral spine causing bowel/bladder incontinence, saddle anesthesia, bilateral leg weakness.
Diagrams to know
- Spinal nerve anatomy and disc herniation compression sites
- Red-flag assessment flowchart for urgent vs routine back pain
- Log-rolling technique and proper postoperative positioning
Nursing Diagnoses & Pathophysiology Links
Important facts
- Pain Management in Arthritis: Maslow priority—address pain before mobility/self-care; use pharmacologic (analgesics, NSAIDs, DMARDs) + non-pharmacologic (rest, heat/cold, elevation, positioning)
- Mobility Issues Post-THR: Impaired mobility related to surgical trauma and precautions; nursing interventions include PT supervision, assistive devices, safety measures, gradual progression
- Infection Risk (Post-surgical & Chronic Infection): Monitor wound for signs (warmth, erythema, drainage, fever); maintain asepsis; screen for systemic signs (fever, elevated WBC); teach infection precautions (especially biologic DMARD users)
- Long-term Compliance: Critical nursing diagnosis for gout (diet adherence), osteoporosis (calcium/vitamin D, bisphosphonate adherence), RA (DMARD adherence); educate on consequences of non-compliance
- Psychosocial Support: Chronic arthritis, prolonged IV therapy, lifestyle restrictions (hip precautions) impact self-esteem and mental health; refer for counseling, support groups
- Activity Intolerance: RA/OA with pain and deformity may limit activity; balance rest and activity per NCM protocols; encourage joint protection and energy conservation
- Self-Care Deficit: Advanced arthritis, post-surgical limitations, age-related decline may impair ADL independence; assess and provide adaptive equipment, caregiver training
Key definitions
NANDA Diagnosis: Acute Pain
Example
AEB severely swollen, red great toe with client guarding and grimacing
Unpleasant sensory experience related to inflammatory or tissue-damaging process (e.g., acute gout attack, post-THR).
NANDA Diagnosis: Impaired Physical Mobility
Example
AEB inability to bear weight, use of assistive device, restricted ROM
Limitation in independent movement due to musculoskeletal damage, pain, or imposed restrictions (e.g., hip precautions post-THR).
NANDA Diagnosis: Risk for Infection
Example
Related to surgical incision, biologic DMARD use increasing infection risk
Increased vulnerability to pathogenic organisms, especially after surgical procedures or with compromised immune response (e.g., post-THR, long-term DMARDs).
NANDA Diagnosis: Deficient Knowledge
Example
AEB client unable to list high-purine foods or demonstrate proper bisphosphonate technique
Lack of understanding about disease management, medication, or self-care (e.g., gout diet, bisphosphonate administration, hip precautions).
Diagrams to know
- NANDA-I diagnostic tree for musculoskeletal disorders
- Nursing process applied to post-THR care
Must remember
- OA = Degenerative, asymmetric, weight-bearing joints, Heberden's/Bouchard's nodes, stiffness <30 min, NO systemic signs. RA = Autoimmune, symmetric, small joints, morning stiffness >1 hour, systemic signs, positive RF/anti-CCP.
- OA first-line drug is ACETAMINOPHEN. RA anchor DMARD is METHOTREXATE—give FOLIC ACID, monitor liver/marrow, TERATOGENIC.
- GOUT: Avoid HIGH-PURINE foods (organ meats, shellfish, alcohol). Use COLCHICINE + NSAIDs for ACUTE flare. Use ALLOPURINOL for LONG-TERM prevention—NEVER start during acute attack. Push fluids 2–3 L/day.
- BISPHOSPHONATES (osteoporosis): Take on EMPTY STOMACH, full glass plain WATER, STAY UPRIGHT ≥30 minutes to prevent esophagitis.
- TOTAL HIP PRECAUTIONS: NO hip flexion >90°, NO leg adduction past midline (use abduction pillow, don't cross legs), NO internal rotation. Report shortened, rotated leg immediately (dislocation).
- OSTEOMYELITIS: Usually Staph aureus. Treat with PROLONGED IV ANTIBIOTICS (4–6+ weeks). Handle limb gently (pathologic fracture risk). Debride dead bone (sequestrum) if needed.
- LOW BACK PAIN RED FLAGS: Bowel/bladder incontinence, saddle anesthesia, bilateral leg weakness, progressive neurologic deficit—consider CAUDA EQUINA SYNDROME (SURGICAL EMERGENCY).
- BODY MECHANICS for back pain: Bend at KNEES not waist, keep objects close, avoid twisting, firm mattress, core strengthening. Log-roll post-spinal surgery to maintain alignment.
- RA BIOLOGICS (etanercept): Increase infection risk; screen for TB before use; monitor for signs of infection. Short-course CORTICOSTEROIDS control inflammation but taper to prevent rebound.
- Post-THR complications: Watch for DVT/PE (anticoagulation, compression devices), infection (aseptic wound care), dislocation (hip precautions). Weight-bearing progresses as tolerated; walker/crutches initially, then cane.
Last minute tips
- OA vs RA distinction is exam gold: Memorize the asymmetric/symmetric, weight-bearing/small joints, brief/prolonged stiffness, no systemic/systemic distinctions. One quick comparison question can earn 3–5 points.
- Hip precautions are procedural: Examiners test your ability to teach or demonstrate. Know the 3 rules cold (no flexion >90°, no adduction past midline, no internal rotation) and be ready with specific examples of what's safe vs unsafe (e.g., 'raised toilet seat' vs 'low chair').
- Gout diet is high-yield: High-purine foods (organ meats, shellfish, sardines, anchovies, alcohol especially beer) appear on almost every exam. Also know fluids prevent stones, allopurinol is NOT for acute attacks, and aspirin raises uric acid.
- Bisphosphonate administration is step-by-step nursing care: Empty stomach, full water glass, upright 30 min—test questions ask what you'll teach the patient. Also know esophagitis risk and jaw osteonecrosis (rare but asked).
- Cauda equina syndrome is your emergency trigger: Bowel/bladder incontinence + saddle anesthesia + bilateral leg weakness = STAT MRI + neurosurgery consult. This is one of the few musculoskeletal emergencies on the NLE and appears reliably.
Comparison tables
Osteoarthritis (OA) vs Rheumatoid Arthritis (RA) — COMPREHENSIVE COMPARISON
| Feature | Osteoarthritis (OA) | Rheumatoid Arthritis (RA) |
|---|---|---|
| Pathophysiology | Degenerative, wear-and-tear cartilage loss | Autoimmune, inflammatory synovitis with pannus formation |
| Symmetry | Asymmetric (unilateral or one side worse) | Symmetric (bilateral, equal both sides) |
| Joints Affected | Weight-bearing (knees, hips, spine) + DIP fingers | Small joints first (hands, wrists, feet, MCPs, PIPs) |
| Onset & Progression | Gradual, progressive over years | Insidious or acute, progresses in flares |
| Morning Stiffness | <30 minutes, improves with activity | >1 hour (often 2–3 hours), improves slowly |
| Pain Pattern | Worse with activity, relieved by rest | Worse in morning, improves with activity initially |
| Systemic Signs | ABSENT (no fever, fatigue, weight loss) | PRESENT (fatigue, low-grade fever, weight loss, malaise) |
| Hand Signs | Heberden's nodes (DIP), Bouchard's nodes (PIP) | Ulnar deviation, swan-neck, boutonnière deformities |
| ESR & CRP | Normal or only slightly elevated | Elevated (markedly in active disease) |
| Rheumatoid Factor (RF) | Negative | Positive (70–80%); negative in seronegative RA |
| Anti-CCP | Negative | Positive (more specific than RF) |
| First-Line Drug | Acetaminophen | NSAIDs + DMARDs (methotrexate anchor) |
| Age of Onset | Usually >50 years | Usually 30–60 years (peak 40–60) |
| Sex Predominance | Equal M:F after age 50 | Female predominance (3:1) |
| X-Ray Findings | Joint space narrowing, osteophytes, sclerosis | Periarticular soft tissue swelling, joint space narrowing, erosions |
Gout: Acute Attack Management vs Long-Term Prevention
| Aspect | Acute Attack | Chronic Prevention |
|---|---|---|
| Timing | During flare (days to weeks) | Between attacks (ongoing) |
| Primary Goals | Reduce inflammation, relieve pain, terminate attack | Lower serum uric acid, prevent recurrent attacks, reduce tophi |
| Drugs Used | Colchicine, NSAIDs, corticosteroids | Allopurinol, probenecid |
| Dietary Focus | Strict rest of joint, no purine avoidance urgency | Sustained avoidance of high-purine foods, maintain hydration |
| Fluids | Maintain hydration to dilute urate | 2–3 L/day to prevent stone formation and maintain urate solubility |
| Colchicine Role | Primary agent for acute inflammation | Low-dose prophylaxis may be used to prevent attacks |
| Allopurinol Role | CONTRAINDICATED during acute attack—may worsen | Start 2–4 weeks after attack resolves; reduces urate production |
| Aspirin | Avoid (raises uric acid) | Avoid (raises uric acid); low-dose may be considered only after attack resolved |
Osteoporosis vs Osteopenia vs Normal Bone — DEXA T-Score Classification
| Classification | DEXA T-Score | Bone Status | Fracture Risk |
|---|---|---|---|
| Normal | >−1 | Normal bone density | Low |
| Osteopenia | −1 to −2.5 | Low bone mass (precursor state) | Intermediate |
| Osteoporosis | ≤−2.5 | Low bone mass with deteriorated structure | High |
| Severe Osteoporosis | ≤−2.5 + prior fragility fracture | Established disease with fracture history | Very High |
Total Hip Replacement: DO's and DON'Ts at a Glance
| Hip Precaution Rule | DO | DON'T |
|---|---|---|
| Hip Flexion | Keep hip <90°: use raised toilet seat, raised chair, long reacher, sock aid | Flex hip >90°: avoid low chair, bending forward, tying shoes, crossing legs |
| Leg Adduction | Keep abduction pillow between legs at ALL times; keep legs apart | Adduct leg past midline or cross legs (high dislocation risk) |
| Rotation | Keep toes pointing forward/upward | Internally rotate (pigeon-toe) or externally rotate excessively |
| Turning in Bed | Turn as ordered (usually unaffected side) with pillow between legs | Roll without maintaining alignment; cross legs during turn |
| Position Changes | Move slowly, maintain alignment, use assistive devices | Quick, jerky movements without protection |
Herniated Disc vs Mechanical Low Back Pain — Clinical Distinction
| Feature | Mechanical Back Pain | Herniated Disc (Radiculopathy) |
|---|---|---|
| Pain Location | Localized to low back, lumbar region | Radiating leg pain (sciatica) below knee, follows nerve distribution |
| Associated Symptoms | Muscle tightness, limited ROM, worse with activity | Numbness, tingling, weakness in leg; may have foot drop |
| Neurologic Findings | Normal strength, sensation, reflexes | Weakness, sensory loss, diminished/absent reflex (radiculopathy pattern) |
| Straight Leg Raise (SLR) Test | Usually normal or limited by pain but without neural tension | Positive (pain radiates down leg; reproduces sciatica) |
| Imaging (X-ray) | Normal or shows degenerative changes | May show disc space narrowing or bulge |
| Imaging (MRI) | Normal or minor degenerative changes | Shows disc herniation, nerve root compression |
| Conservative Treatment | Activity modification, NSAIDs, PT, core strengthening | NSAIDs, PT, epidural steroid injection, activity modification |
| Surgical Indication | Rare; only if intractable pain unresponsive to prolonged conservative care | Persistent/progressive symptoms (4–6 weeks), neurologic deficit, surgical emergency if cauda equina |
Diagrams
OA vs RA: Quick Diagnostic Flowchart
Systematic flowchart to distinguish OA from RA based on symmetry, joint distribution, stiffness duration, and lab findings. Helps rapidly rule in/out each condition.
Gout Management: Acute vs Chronic Prevention
Comprehensive mind map showing the two-phase approach to gout: acute attack management (colchicine, NSAIDs, symptom relief) vs chronic prevention (allopurinol, lifestyle, diet). Critical for exam recall.
Post-THR Dislocation Risk Assessment & Prevention
Flowchart showing the three hip precaution rules and monitoring for dislocation signs. Essential for post-operative nursing management and patient education.
Low Back Pain: Red-Flag Assessment & Urgent vs Routine Management
Critical flowchart distinguishing urgent (cauda equina) from routine low back pain, and showing progression from conservative management to imaging and possible surgical intervention.
Osteoporosis DEXA Interpretation & Management Algorithm
Algorithm for DEXA T-score interpretation, management stratification, and pharmacotherapy with critical bisphosphonate teaching points.
Osteomyelitis: Acute to Chronic Course & Nursing Milestones
Timeline showing the progression of osteomyelitis from acute presentation through prolonged IV antibiotic therapy to discharge, highlighting critical nursing milestones and intervention points.
Methotrexate for RA: Initiation, Monitoring & Safety
Comprehensive flowchart for methotrexate initiation, baseline screening, folic acid concurrent use, monthly monitoring for bone marrow suppression and hepatotoxicity, and patient safety counseling.