Editing Medical-Surgical Nursing (section)

=== Chronic Bone and Joint Disease ===

Osteoarthritis is degenerative cartilage wear producing asymmetric joint pain that worsens with use and improves with rest, with morning stiffness typically lasting under thirty minutes and Heberden and Bouchard nodes. Rheumatoid arthritis is a systemic autoimmune disease producing symmetric joint inflammation with morning stiffness lasting more than an hour, fatigue, low-grade fever, and eventual deformity. Heat helps rheumatoid stiffness before activity; cold helps acute inflammation and swelling.

Osteoporosis is loss of bone density, often silent until a fracture occurs, with vertebral compression fractures, kyphosis, and height loss. Teach adequate calcium and vitamin D, weight-bearing exercise, smoking and alcohol reduction, and fall prevention. Bisphosphonates are taken in the morning on an empty stomach with a full glass of plain water, and the patient must remain upright for at least thirty minutes to prevent esophageal erosion.

Gout is uric acid crystal deposition producing sudden severe pain, redness, and swelling, classically in the great toe. Teach hydration, weight management, and avoidance of purine-rich foods such as organ meats, sardines, anchovies, and beer.