5 steps for a good Informative Speech
1. Attention Getting Opener – It can either be through some rhetorical questions or through a good story and also through some shocking or exciting happenings.
2. Preview- You have to give a brief description of what you r going to follow in the speech.
3. Body- It is the longest part and it should contain visual aids , evidences, some personal experiences, facts, references, to support your body.
4. Review- You have to summarize what you said throughout the speech .
5. Memorable concluding events- It can be the final step which closes your speech with a good quotes, or some remarkable quotes or may be with some pictures and also it can be the visualizing the materials that u talked about.
Wednesday, December 3, 2008
Loneliness
Loneliness is a terrible feeling that a man has
Loneliness actually is the most terrible stage of life that a man passes through. This is one of the terrible feeling that no one ever like to be in their life. This is actually very crucial to the people. It leads the people to other continuum like Depression, stress, anxiety and so on. During this particular situation all the simple support seems to be an oasis to them. May be they will get over dependent on them or whatever it may be. This is really a apathetic situation, where all our friends will disappear, and no support and totally we will be depressed . We will feel like all the world is closed before us. Me as a person, I am going through this dreadful situation now. I am so depressed that I could not even think or do my daily routine with satisfaction. Nothing will be perfect for us . All of my friends with me before is like some aliens to me. Actually I came to the conclusion that this is one of the good situation which make you aware of what this world is and what the people is like. Also will make all the people sef dependent and will give more courage and will make you more fit in this world.Which make our motto in this world. Survival for the Fittest successful!!!!!!!!!!!!!!!!!!!!!!!!!!!
Loneliness actually is the most terrible stage of life that a man passes through. This is one of the terrible feeling that no one ever like to be in their life. This is actually very crucial to the people. It leads the people to other continuum like Depression, stress, anxiety and so on. During this particular situation all the simple support seems to be an oasis to them. May be they will get over dependent on them or whatever it may be. This is really a apathetic situation, where all our friends will disappear, and no support and totally we will be depressed . We will feel like all the world is closed before us. Me as a person, I am going through this dreadful situation now. I am so depressed that I could not even think or do my daily routine with satisfaction. Nothing will be perfect for us . All of my friends with me before is like some aliens to me. Actually I came to the conclusion that this is one of the good situation which make you aware of what this world is and what the people is like. Also will make all the people sef dependent and will give more courage and will make you more fit in this world.Which make our motto in this world. Survival for the Fittest successful!!!!!!!!!!!!!!!!!!!!!!!!!!!
major features of industrial revolution
The main features involved in the Industrial Revolution were technological, socioeconomic, and cultural. The technological changes included the following: (1) the use of new basic materials, chiefly iron and steel, (2) the use of new energy sources, including both fuels and motive power, such as coal, the steam engine, electricity, petroleum, and the internal-combustion engine, (3) the invention of new machines, such as the spinning jenny and the power loom that permitted increased production with a smaller expenditure of human energy, (4) a new organization of work known as the factory system, which entailed increased division of labour and specialization of function, (5) important developments in transportation and communication, including the steam locomotive, steamship, automobile, airplane, telegraph, and radio, and (6) the increasing application of science to industry. These technological changes made possible a tremendously increased use of natural resources and the mass production of manufactured goods.
What is Sociology?
Sociology is the scientific study of human groups. It provides tools for understanding how and why our society functions, impact of social intuitions on individual lives, and the challenges of social interaction between individuals and society. Through teaching, research, and service learning, the Department of Sociology provides critical understanding of ways people relate to one another through the organization of society and how its structures and cultures influence our lives. Subject matters of sociology ranges from family life to organizations, from crime to education, from the divisions of race and social class to the shared beliefs of a common culture, from poverty to wealth. Few fields have such a broad and exciting scope.
Sociology enables you to see the world in a new light. In a country like the United States where individualism is celebrated, it is very easy to forget that the way we behave and feel is socially produced. Whether they be friendships, families, church groups, socioeconomic classes, complex organizations, or nations, much of our lives are socially constructed. This is the basic premise of sociology.
Sociology also helps people liberate themselves. In his Invitation to Sociology, Peter Berger stated that “sociology can help people to take charge of their lives by making them aware of their situation in society and the forces acting upon them…By discovering the workings of society, they gain an understanding of how this process takes place.” The wisdom of sociology is the discovery that things are not what they seem.But sociology offers more. When people see things, they ask what they are. Sociologists ask what they
Sociology enables you to see the world in a new light. In a country like the United States where individualism is celebrated, it is very easy to forget that the way we behave and feel is socially produced. Whether they be friendships, families, church groups, socioeconomic classes, complex organizations, or nations, much of our lives are socially constructed. This is the basic premise of sociology.
Sociology also helps people liberate themselves. In his Invitation to Sociology, Peter Berger stated that “sociology can help people to take charge of their lives by making them aware of their situation in society and the forces acting upon them…By discovering the workings of society, they gain an understanding of how this process takes place.” The wisdom of sociology is the discovery that things are not what they seem.But sociology offers more. When people see things, they ask what they are. Sociologists ask what they
osteo artheiritis
Osteo Artheritis
INTRODUCTION
Osteoarthritis is a disease of the joints. Also know as degenerative joint disease, it is the most common form of arthritis, affecting more than 20 million American adults. It is a separate condition from and should not be confused with rheumatoid arthritis, another painful inflammatory condition. Osteoarthritis is caused by cartilage breakdown; cartilage provides a cushion between the bones of the joints. Healthy cartilage allows bones to glide over one another and acts as a shock absorber during physical movement. In osteoarthritis, the cartilage breaks down and wears away. This causes the bones under the cartilage to rub together, causing pain, swelling, and loss of joint motion (Spine Universe,USA, 2008). In India overall 36.1% of the elderly population was found with Arthritis, which was more prevailing in rural areas than in the Urban areas. Arthritis was observed in 35.8% in males and 36.4% of females (Ministry of Health, India, 2003).
SIGNS AND SYMPTOMS
1. Pain is the primary symptom of osteoarthritis and is linked to functional impairment and disability in osteoarthritis patients. Usually osteoarthritis pain develops gradually. With mild to moderate osteoarthritis, pain typically worsens with use of the joint and improves with rest. As the disease progresses, pain is usually more persistent and may not be relieved by rest or basic treatments for osteoarthritis (About.com, USA, 2008).
Another common signs and symptoms of the Osteoarthritis are as follows.
2. Tenderness in the joint when you apply light pressure
3. Stiffness in a joint, that may be most noticeable when you wake up in the morning or after a period of inactivity
4. Loss of flexibility may make it difficult to use the joint
5. Grating sensation when you use the joint
6. Bone spurs, which appear as hard lumps, may form around the affected joint
7. Swelling in some cases
Osteoarthritis symptoms most commonly affect the hands, hips, knees and spine. Unless you've been injured or placed unusual stress on a joint, it's uncommon for osteoarthritis symptoms to affect your jaw, shoulder, elbows, wrists or ankles.
The above picture shows how Osteoarthritis affects the normal functioning of the bone (Revolution Health, Washington, 2008).
CAUSES OF OSTEOARTHERITIS
After the years of researches the scientists found that there are several factors which leads to the cause of Osteoarthritis. They are as follows,
1. Joint Wear-And-Tear
The aging process clearly can contribute to the breakdown in the joints and cause osteoarthritis, but not all elderly people develop detectable OA. In addition, athletes and laborers often subject their joints to prolonged wear-and-tear, which places them at increased risk of developing arthritis in later years.
2. Joint Injury Or Overuse
Along with continual wear-and-tear, osteoarthritis has been linked with damaging events such as:
Fractures and infections that can harm the internal tissues of a joint. Individuals who experience repeated knee injuries - such as basketball, football, or soccer players - are much more likely to develop osteoarthritis as they get older.
In addition, people who overuse their joints by subjecting them to repeated stresses and strains are at increased risk. This is particularly evident in specific occupations such as jackhammer operators, who often develop arthritis of the hands or elbows, and ballet dancers, who develop arthritis of the feet.
3. Inactivity
Physical inactivity can be as harmful to the joints as overuse. A lack of exercise or varied movement can weaken the muscles that support the joints and decrease joint flexibility. Eventually, an underused joint may become stiff, painful, dysfunctional, and prone to injury and osteoarthritis.
4. Excess Body Weight
Heavy individuals are at increased risk of developing arthritis because their joints may be strained by excess weight. This is especially evident in weight-bearing joints such as the knees and hips, which often show the first signs of weight-related strain and injury.
Since being overweight can increase the chances of joint damage and worsen arthritic symptoms, most experts recommend weight-loss programs for overweight people who are at risk for osteoarthritis. Weight gain also should be avoided to help prevent the arthritis that may occur with aging.
5. Heredity
Current research suggests that the genes inherited from one's parents may make an individual more likely to develop osteoarthritis than someone who does not have these genes.
Osteoarthritis of the fingers occurs very commonly in families and is most common in women.
In addition, OA is more likely to develop in people who are born with heredity defects that make their joints fit together incorrectly, such as:
6. Bow legs
7. A hip dislocation
8. Laxity (double-jointedness) (e-HEALTH MD, 2008)
DIAGONOSES OF OSTEOARTHERITIS
Some of the basic diagnostic methods for the examination of the Osteoarthritis are as follows.
1. X-ray
Osteoarthritis is often visible in x-rays. Cartilage loss is suggested by certain characteristics of the images:
· The normal space between the bones in a joint is narrowed.
· There is an abnormal increase in bone density.
· Bony projections, cysts, or erosions are visible.
If the doctor suspects other conditions, or if the diagnosis is uncertain, additional tests are necessary.
It is important to note that a negative x-ray does not rule out osteoarthritis. Likewise, some people may have minimal symptoms even though an x-ray clearly shows they have arthritis.
An MRI exam of an arthritic joint is generally not needed, unless the doctor suspects other causes of pain.
2. Physical Exam
The affected joint in patients with osteoarthritis will generally be tender to pressure right along the joint line. Joint movement may cause a crackling sound. The bones around the joints may feel larger than normal. The joint's range of motion is often reduced, and normal movement is often painful.
3. Blood Tests
Blood test results may help identify other causes of arthritis (if present) besides osteoarthritis. Some examples include:
· Elevated levels of rheumatoid factor (specific antibodies in the synovium) are usually found in patients with rheumatoid arthritis
· The erythrocyte sedimentation rates (ESR, or "sed rate") indicates inflammatory arthritis or related conditions, such as rheumatoid arthritis or systemic lupus erythematosus.
· Elevated uric acid levels in the blood may indicate gout.
A number of other blood tests may help identify other rheumatological illnesses.
4. Tests of the Synovial Fluid
If the diagnosis is uncertain or infection is suspected, a doctor may attempt to withdraw synovial fluid from the joint using a needle. There will not be enough fluid to withdraw if the joint is normal. If the doctor can withdraw fluid, problems are likely, and the fluid will be tested for factors that might confirm or rule out osteoarthritis:
· Cartilage cells in the fluid are signs of osteoarthritis.
· A high white blood cell count is a sign of infection.
· High uric acid in the fluid is an indication of gout.
· Other factors may be present that suggest different arthritic conditions, including Lyme disease and rheumatoid arthritis.
· In people with known osteoarthritis, researchers may look for certain factors in synovial fluid (sulfated glycosaminoglycan, keratin sulfate, and link protein) that can suggest a more or less severe condition.
Treatment for the Osteoporosis
By treating arthritis early and following a well-designed treatment plan, you can:
Reduce your symptoms
Increase joint movement
Lessen joint-damaging effects
Osteoarthritic joints are not always painful, and when pain is present, it can vary in intensity. In some people severe osteoarthritis is completely pain-free, whereas in others even minor joint changes are quite painful. The response to arthritis pain is broad and very personal.
Because of this, it is important to have an individually designed treatment program. What works for one person may not necessarily work for another, even if both have osteoarthritis of the same joint.
1. Weight Control
Controlling your weight can:
Lessen pain by reducing stress on the weight-bearing joints (hips, knees, back, feet)
Increase self-esteem and avoid the risk of psychological suffering and/or depression that can affect overweight individuals
2. Exercise
Strengthening and stretching exercises can help by:
Relieving pain and improving joint movement
Building up the muscles around the joint, making the joint more stable and resisting further damage.
3. Heat And Cold Therapy
Heat and cold treatments are well-known to reduce the pain, stiffness, and occasional swelling associated with osteoarthritis. But this is generally temporary. There is no 'set' formula for therapy. Heat works better for some individuals, whereas others favor cold.
Heat often is used to relieve pain or relax muscles before the start of exercise.
Heating pads or hot packs can be positioned over stiff joints. Some people prefer "moist heat" in the form of warm towels, a warm shower or bath, or a heated whirlpool or hot tub.
Other heat treatments include ultrasound and immersion of painful hands into warm wax. All are able to bring soothing heat to sore joints.
Heat should be applied at a comfortable temperature and seems to be most beneficial when used over the muscles adjacent to the joint.
Cold can lessen pain in a sore joint by numbing the local tissues.
It may be applied in the form of a reusable pack or ice.
Ice and cold packs never should be placed directly on the skin, as they are likely to cause skin damage. Instead, ice and cold packs should be wrapped in a towel before they are applied.
4. Pain Medication
Medicines to control OA pain must be pain-specific, since osteoarthritis can cause both sudden and chronic pain.
If a person experiences unexpected, severe pain from a damaged joint, he or she might benefit from strong pain relievers and muscle relaxants.
By contrast, such medications usually are not useful or appropriate for chronic pain, which is more effectively treated by self-management techniques such as proper joint use, joint protection, exercise, medication scheduling, and weight control.
Medications include as follows,
1. OTC pain relievers like acetaminophen (Tylenol®) and aspirin are familiar choices for the treatment of osteoarthritis.
2. Nonsteroidal anti-inflammatory drugs (NSAIDs) relieve pain as well as inflammation like Declophenac.
3. NSAID partners may be prescribed by a physician to lessen the side effects of NSAIDs like Antacids.
4. Cox II inhibitors are reasonably new medications that reduce the pain of osteoarthritis and also reduce the chance of developing ulcers, and so partially preventing the GI complaints associated with NSAIDs. These medicines, which are available by prescription only, include:
Celecoxib (Celebrex®)
Rofecoxib (Vioxx®)
5. Muscle relaxants sometimes are prescribed for osteoarthritis if muscle spasms contribute to a person's discomfort. These include:
Cyclobenzaprine (Flexeril®)
Carisoprodol (Soma®)
Methocarbamol (Robaxin®)
Other Pain Relief Options
Transcutaneous electrical nerve stimulation (TENS) is a technique that directs small pulses of electricity to specific nerves. The aim is to reduce the sensitivity of nerve endings in the spinal cord, thereby closing the pain "gates." Although TENS is not effective in all arthritis sufferers, some people find it to be a practical means of pain control. The procedure, which produces a tingling sensation at the site of the electrical pads, has few side effects (some people have reported allergic reactions to the jelly used to apply the pads). TENS instruction usually is provided by a physiotherapist, who can explain how to position the pads, select the correct electrical frequency and pulse strength, and time how long the treatment should last.
Acupuncture may provide short-term relief of pain. If performed properly with sterile needles, acupuncture can do no harm. Acupuncture therapy is believed to work by stimulating the body's own pain-relieving hormones. However, acupuncture cannot "cure" arthritis; its effects are temporary.
Therapeutic massage
Yoga
Physical therapy
Stress Control
Emotional stress sometimes causes arthritic symptoms to worsen. Repeated daily stresses - such as money problems, traffic jams, or shopping difficulties - may increase joint discomfort.
Although emotional anxiety does not appear to be as important a factor in osteoarthritis as it is in rheumatoid arthritis, osteoarthritic pain may develop after stressful life events, like the loss of a loved one or separation from a spouse.
Arthritis itself is a source of stress.
Individuals may feel trapped in a vicious cycle in which arthritic pain causes stress and stress causes more pain.
In addition, they may have a low self esteem and feel a loss of control because of arthritis-related concerns such as pharmaceutical bills, side effects from medicines, limited mobility, or unwelcome physical changes.
Stress management techniques are especially significant, because they can help people to regain a sense of control while relieving their arthritic pain.
Proven techniques for stress management include:
Muscle relaxation
Controlled breathing
Biofeedback
Self-hypnosis
Time management
Social support
Assertiveness training
Coping skills training
Injections Into The Joint
Corticosteroids, such as prednisone, are medications that lessen inflammation, swelling, and pain. These medicines generally are not used for OA; however, the direct injection of corticosteroids into an inflamed joint can markedly reduce the swelling of soft tissues and relieve pain.
Unfortunately, corticosteroids can cause adverse side effects (such as joint degradation) when injected indiscriminately over long periods of time directly into a joint. Therefore, they should be used only to treat occasional bouts of joint pain and swelling in OA, particularly in younger people.
A single injection may be sufficient to relieve OA for several months. The effect lasts for different amounts of time in different people.
They don't work for everyone
Injectable hyaluronic acid - which currently is marketed under the brand names Hyalgan® and Synvisc® - is a new FDA-approved treatment for osteoarthritis of the knee. This form of therapy, known as "visco-supplementation," involves the injection of hyaluronic acid into the joint once a week for three to five weeks, depending on the product brand.
Hyaluronic acid is a lubricating substance that is found in the normal joint fluid. If, as in osteoarthritis of the knee, inflammation breaks down hyaluronic acid within the joint, then lubrication is lost.
Hyaluronic acid injection does not cause the side effects of most oral pain relievers. Therefore it is suitable for people who still suffer discomfort after being treated by pain medication, exercise, or physical therapy.
Hyaluronic acid injection may provide relief for up to 12 months, but there is no indication that the treatment alters the progression of arthritis.
Ongoing studies are investigating whether this method is effective for the shoulders and hips, but, to date, there is little information on the long-term effects of hyaluronic acid injection.
In general, the treatment is well tolerated, and allergic reactions are rare.
Surgery
Although recent advances in joint surgery have improved the lives of millions of people throughout the world, surgery is NOT the first line of treatment for osteoarthritis.
Before surgery is ever contemplated, simpler treatments must be tried. Moreover, most surgeons prefer not to perform operative procedures in younger people unless their quality of life is severely affected by arthritis.
When surgery is necessary, it is performed by an orthopedic surgeon - a specialist in surgery of the bones and joints.
There are four main types of surgery available:
Fusion (permanent joining of the bones in a joint, preventing motion)
Osteotomy (realigning the joint)
"Scoping" the joint (washing out the joint)
Total joint replacement (replacement of a damaged joint with an artificial man-made joint)
Fusion of the joint, otherwise known as arthrodesis is a procedure in which the surfaces of the joint are removed and the bone ends are united. This provides pain relief and stability, but the joint cannot bend.
Lack of mobility is a serious disadvantage of this procedure. Nevertheless, this is the preferred surgery for some younger individuals who have a single involved joint. Mobility in the other joints often will compensate for the loss of movement in the fused joint. The joints most commonly fused are smaller joints, such as those in the toes or fingers.
Younger people with severe arthritis of the hip or knee in whom fusion was once offered, are now considered for total joint replacement though depending on the individual, a fusion may sometimes be preferable
Osteotomy is an operation in which the surgeon cuts the bone below the affected joint, realigns it, and resets it in a better position. This procedure changes and improves the contact between the remaining healthy areas of cartilage in the joint. Afterwards, the painful areas do not rub against each other.
Osteotomy provides pain relief and leaves the joint mobile; however, it can only be performed in a joint that is not already stiff. Osteotomy usually is reserved for joints with uneven damage. It is not performed frequently, although the procedure sometimes is a good choice for younger arthritis sufferers, since it can prevent further joint damage and postpone the need for joint replacement surgery. (For example, osteotomy of the tibia [shinbone] is performed to correct curvature and weight-bearing in the lower leg of adults with OA of the knee.)
"Scoping" the joint is an expression used to describe arthroscopy - the examination of the inside of a joint using a device equipped with a tiny video camera. By means of arthroscopy, the physician can look for damaged tissue directly within the joint.
A small incision is made through the skin alongside the affected joint. Then, microsurgical tools are used to remove areas of cartilage or cartilage fragments that are causing irritation and thoroughly wash out the joint. Arthroscopy is an outpatient procedure and does not require an overnight stay in the hospital.
Joint "scoping" may provide temporary relief from symptoms - especially those caused by cartilage tears or particles; however, it does not stop the progression of osteoarthritis. It may help for a month in some, six months or much longer in others, and sometimes not at all.
Total joint replacement involves the complete removal of the painful joint, which is exchanged for a man-made appliance. The artificial joint can be fashioned from a combination of materials, including stainless steel, Vitallium™ (a cobalt-chromium alloy), titanium, and high-density polyethylene plastic. Silicone rubber occasionally is used for joint replacements (hand, base of the thumb), if the surgeon elects not to fuse the joint.
The hip and knee have shown the greatest successes of all joint replacement surgery. Over 90 percent of people are free of pain and have good mobility following hip replacement surgery for osteoarthritis. Other joints that are less commonly replaced are the shoulder and elbow.
Unfortunately, joint replacements tend to last only 10 to 20 years. But another replacement generally can be performed, if needed. This repeat surgery is called a revision.
The role of Nurse in the caring of elderly with Osteoporosis
The importance of osteoporosis lies in the increased fracture risk associated with reduced bone mineral density (BMD). Although osteoporosis is not painful, osteoporotic fractures are associated with significant morbidity and mortality; furthermore the occurrence of a fracture leads to an increased risk of subsequent fracture in both women and men.
Identification of patients over 50 years of age with a history of fracture for assessment of osteoporosis is essential as these patients are at highest risk of further fractures and are likely to benefit from treatment for the 'secondary prevention' of fractures. Specialist nurses have a key role in the Fracture Liaison Service, established in 1999 in Glasgow, to provide routine assessment to all women and men presenting to orthopedics and accident and emergency with new fractures.
For patients at risk of osteoporosis there may be opportunities to reduce the risk of their first fracture, 'primary prevention'. With few exceptions, endocrinopathies adversely influence bone mineralization and are associated with increased risk of osteoporosis. Endocrine nurses have a key role in the long-term care of patients with endocrine dysfunction and are ideally placed to engage with their patients in education and management strategies to address osteoporosis, to achieve both primary and secondary prevention of osteoporotic fracture.
Conclusion
Osteoporosis is one of the leading disabilities in the elderly in most part of the world at present. It is one of the disabilities which causes some terrible effects on the elderly. It can become a risk factor as well. Because sometimes Osteoarthritis can cause the weakness and also the helplessness in the leg which even leads to the some risk factors of the elderly such as the fall and then it can leads to the fractures so it should be treated well and these patients should get additional care and a good management in coping with his disability and also the proper treatment. The main role of the nurse in such types of disability is to teach them and to support them I n managing the disease.
References
1. British Endocrine Society, http://www.endocrine-abstracts.org/ea/0009/ea0009s53.htm, London, 2005.
2. Spine Universe, http://www.google.com/search?hl=en&q=spine+universe, New York , 2008.
3. Ministry of Health, http://mohfw.nic.in/, India, 2008.
4. About.com, http://www.about.com/,USA, 2008.
5. E-Health MD, http://www.ehealthmd.com/, New York, 2008.
INTRODUCTION
Osteoarthritis is a disease of the joints. Also know as degenerative joint disease, it is the most common form of arthritis, affecting more than 20 million American adults. It is a separate condition from and should not be confused with rheumatoid arthritis, another painful inflammatory condition. Osteoarthritis is caused by cartilage breakdown; cartilage provides a cushion between the bones of the joints. Healthy cartilage allows bones to glide over one another and acts as a shock absorber during physical movement. In osteoarthritis, the cartilage breaks down and wears away. This causes the bones under the cartilage to rub together, causing pain, swelling, and loss of joint motion (Spine Universe,USA, 2008). In India overall 36.1% of the elderly population was found with Arthritis, which was more prevailing in rural areas than in the Urban areas. Arthritis was observed in 35.8% in males and 36.4% of females (Ministry of Health, India, 2003).
SIGNS AND SYMPTOMS
1. Pain is the primary symptom of osteoarthritis and is linked to functional impairment and disability in osteoarthritis patients. Usually osteoarthritis pain develops gradually. With mild to moderate osteoarthritis, pain typically worsens with use of the joint and improves with rest. As the disease progresses, pain is usually more persistent and may not be relieved by rest or basic treatments for osteoarthritis (About.com, USA, 2008).
Another common signs and symptoms of the Osteoarthritis are as follows.
2. Tenderness in the joint when you apply light pressure
3. Stiffness in a joint, that may be most noticeable when you wake up in the morning or after a period of inactivity
4. Loss of flexibility may make it difficult to use the joint
5. Grating sensation when you use the joint
6. Bone spurs, which appear as hard lumps, may form around the affected joint
7. Swelling in some cases
Osteoarthritis symptoms most commonly affect the hands, hips, knees and spine. Unless you've been injured or placed unusual stress on a joint, it's uncommon for osteoarthritis symptoms to affect your jaw, shoulder, elbows, wrists or ankles.
The above picture shows how Osteoarthritis affects the normal functioning of the bone (Revolution Health, Washington, 2008).
CAUSES OF OSTEOARTHERITIS
After the years of researches the scientists found that there are several factors which leads to the cause of Osteoarthritis. They are as follows,
1. Joint Wear-And-Tear
The aging process clearly can contribute to the breakdown in the joints and cause osteoarthritis, but not all elderly people develop detectable OA. In addition, athletes and laborers often subject their joints to prolonged wear-and-tear, which places them at increased risk of developing arthritis in later years.
2. Joint Injury Or Overuse
Along with continual wear-and-tear, osteoarthritis has been linked with damaging events such as:
Fractures and infections that can harm the internal tissues of a joint. Individuals who experience repeated knee injuries - such as basketball, football, or soccer players - are much more likely to develop osteoarthritis as they get older.
In addition, people who overuse their joints by subjecting them to repeated stresses and strains are at increased risk. This is particularly evident in specific occupations such as jackhammer operators, who often develop arthritis of the hands or elbows, and ballet dancers, who develop arthritis of the feet.
3. Inactivity
Physical inactivity can be as harmful to the joints as overuse. A lack of exercise or varied movement can weaken the muscles that support the joints and decrease joint flexibility. Eventually, an underused joint may become stiff, painful, dysfunctional, and prone to injury and osteoarthritis.
4. Excess Body Weight
Heavy individuals are at increased risk of developing arthritis because their joints may be strained by excess weight. This is especially evident in weight-bearing joints such as the knees and hips, which often show the first signs of weight-related strain and injury.
Since being overweight can increase the chances of joint damage and worsen arthritic symptoms, most experts recommend weight-loss programs for overweight people who are at risk for osteoarthritis. Weight gain also should be avoided to help prevent the arthritis that may occur with aging.
5. Heredity
Current research suggests that the genes inherited from one's parents may make an individual more likely to develop osteoarthritis than someone who does not have these genes.
Osteoarthritis of the fingers occurs very commonly in families and is most common in women.
In addition, OA is more likely to develop in people who are born with heredity defects that make their joints fit together incorrectly, such as:
6. Bow legs
7. A hip dislocation
8. Laxity (double-jointedness) (e-HEALTH MD, 2008)
DIAGONOSES OF OSTEOARTHERITIS
Some of the basic diagnostic methods for the examination of the Osteoarthritis are as follows.
1. X-ray
Osteoarthritis is often visible in x-rays. Cartilage loss is suggested by certain characteristics of the images:
· The normal space between the bones in a joint is narrowed.
· There is an abnormal increase in bone density.
· Bony projections, cysts, or erosions are visible.
If the doctor suspects other conditions, or if the diagnosis is uncertain, additional tests are necessary.
It is important to note that a negative x-ray does not rule out osteoarthritis. Likewise, some people may have minimal symptoms even though an x-ray clearly shows they have arthritis.
An MRI exam of an arthritic joint is generally not needed, unless the doctor suspects other causes of pain.
2. Physical Exam
The affected joint in patients with osteoarthritis will generally be tender to pressure right along the joint line. Joint movement may cause a crackling sound. The bones around the joints may feel larger than normal. The joint's range of motion is often reduced, and normal movement is often painful.
3. Blood Tests
Blood test results may help identify other causes of arthritis (if present) besides osteoarthritis. Some examples include:
· Elevated levels of rheumatoid factor (specific antibodies in the synovium) are usually found in patients with rheumatoid arthritis
· The erythrocyte sedimentation rates (ESR, or "sed rate") indicates inflammatory arthritis or related conditions, such as rheumatoid arthritis or systemic lupus erythematosus.
· Elevated uric acid levels in the blood may indicate gout.
A number of other blood tests may help identify other rheumatological illnesses.
4. Tests of the Synovial Fluid
If the diagnosis is uncertain or infection is suspected, a doctor may attempt to withdraw synovial fluid from the joint using a needle. There will not be enough fluid to withdraw if the joint is normal. If the doctor can withdraw fluid, problems are likely, and the fluid will be tested for factors that might confirm or rule out osteoarthritis:
· Cartilage cells in the fluid are signs of osteoarthritis.
· A high white blood cell count is a sign of infection.
· High uric acid in the fluid is an indication of gout.
· Other factors may be present that suggest different arthritic conditions, including Lyme disease and rheumatoid arthritis.
· In people with known osteoarthritis, researchers may look for certain factors in synovial fluid (sulfated glycosaminoglycan, keratin sulfate, and link protein) that can suggest a more or less severe condition.
Treatment for the Osteoporosis
By treating arthritis early and following a well-designed treatment plan, you can:
Reduce your symptoms
Increase joint movement
Lessen joint-damaging effects
Osteoarthritic joints are not always painful, and when pain is present, it can vary in intensity. In some people severe osteoarthritis is completely pain-free, whereas in others even minor joint changes are quite painful. The response to arthritis pain is broad and very personal.
Because of this, it is important to have an individually designed treatment program. What works for one person may not necessarily work for another, even if both have osteoarthritis of the same joint.
1. Weight Control
Controlling your weight can:
Lessen pain by reducing stress on the weight-bearing joints (hips, knees, back, feet)
Increase self-esteem and avoid the risk of psychological suffering and/or depression that can affect overweight individuals
2. Exercise
Strengthening and stretching exercises can help by:
Relieving pain and improving joint movement
Building up the muscles around the joint, making the joint more stable and resisting further damage.
3. Heat And Cold Therapy
Heat and cold treatments are well-known to reduce the pain, stiffness, and occasional swelling associated with osteoarthritis. But this is generally temporary. There is no 'set' formula for therapy. Heat works better for some individuals, whereas others favor cold.
Heat often is used to relieve pain or relax muscles before the start of exercise.
Heating pads or hot packs can be positioned over stiff joints. Some people prefer "moist heat" in the form of warm towels, a warm shower or bath, or a heated whirlpool or hot tub.
Other heat treatments include ultrasound and immersion of painful hands into warm wax. All are able to bring soothing heat to sore joints.
Heat should be applied at a comfortable temperature and seems to be most beneficial when used over the muscles adjacent to the joint.
Cold can lessen pain in a sore joint by numbing the local tissues.
It may be applied in the form of a reusable pack or ice.
Ice and cold packs never should be placed directly on the skin, as they are likely to cause skin damage. Instead, ice and cold packs should be wrapped in a towel before they are applied.
4. Pain Medication
Medicines to control OA pain must be pain-specific, since osteoarthritis can cause both sudden and chronic pain.
If a person experiences unexpected, severe pain from a damaged joint, he or she might benefit from strong pain relievers and muscle relaxants.
By contrast, such medications usually are not useful or appropriate for chronic pain, which is more effectively treated by self-management techniques such as proper joint use, joint protection, exercise, medication scheduling, and weight control.
Medications include as follows,
1. OTC pain relievers like acetaminophen (Tylenol®) and aspirin are familiar choices for the treatment of osteoarthritis.
2. Nonsteroidal anti-inflammatory drugs (NSAIDs) relieve pain as well as inflammation like Declophenac.
3. NSAID partners may be prescribed by a physician to lessen the side effects of NSAIDs like Antacids.
4. Cox II inhibitors are reasonably new medications that reduce the pain of osteoarthritis and also reduce the chance of developing ulcers, and so partially preventing the GI complaints associated with NSAIDs. These medicines, which are available by prescription only, include:
Celecoxib (Celebrex®)
Rofecoxib (Vioxx®)
5. Muscle relaxants sometimes are prescribed for osteoarthritis if muscle spasms contribute to a person's discomfort. These include:
Cyclobenzaprine (Flexeril®)
Carisoprodol (Soma®)
Methocarbamol (Robaxin®)
Other Pain Relief Options
Transcutaneous electrical nerve stimulation (TENS) is a technique that directs small pulses of electricity to specific nerves. The aim is to reduce the sensitivity of nerve endings in the spinal cord, thereby closing the pain "gates." Although TENS is not effective in all arthritis sufferers, some people find it to be a practical means of pain control. The procedure, which produces a tingling sensation at the site of the electrical pads, has few side effects (some people have reported allergic reactions to the jelly used to apply the pads). TENS instruction usually is provided by a physiotherapist, who can explain how to position the pads, select the correct electrical frequency and pulse strength, and time how long the treatment should last.
Acupuncture may provide short-term relief of pain. If performed properly with sterile needles, acupuncture can do no harm. Acupuncture therapy is believed to work by stimulating the body's own pain-relieving hormones. However, acupuncture cannot "cure" arthritis; its effects are temporary.
Therapeutic massage
Yoga
Physical therapy
Stress Control
Emotional stress sometimes causes arthritic symptoms to worsen. Repeated daily stresses - such as money problems, traffic jams, or shopping difficulties - may increase joint discomfort.
Although emotional anxiety does not appear to be as important a factor in osteoarthritis as it is in rheumatoid arthritis, osteoarthritic pain may develop after stressful life events, like the loss of a loved one or separation from a spouse.
Arthritis itself is a source of stress.
Individuals may feel trapped in a vicious cycle in which arthritic pain causes stress and stress causes more pain.
In addition, they may have a low self esteem and feel a loss of control because of arthritis-related concerns such as pharmaceutical bills, side effects from medicines, limited mobility, or unwelcome physical changes.
Stress management techniques are especially significant, because they can help people to regain a sense of control while relieving their arthritic pain.
Proven techniques for stress management include:
Muscle relaxation
Controlled breathing
Biofeedback
Self-hypnosis
Time management
Social support
Assertiveness training
Coping skills training
Injections Into The Joint
Corticosteroids, such as prednisone, are medications that lessen inflammation, swelling, and pain. These medicines generally are not used for OA; however, the direct injection of corticosteroids into an inflamed joint can markedly reduce the swelling of soft tissues and relieve pain.
Unfortunately, corticosteroids can cause adverse side effects (such as joint degradation) when injected indiscriminately over long periods of time directly into a joint. Therefore, they should be used only to treat occasional bouts of joint pain and swelling in OA, particularly in younger people.
A single injection may be sufficient to relieve OA for several months. The effect lasts for different amounts of time in different people.
They don't work for everyone
Injectable hyaluronic acid - which currently is marketed under the brand names Hyalgan® and Synvisc® - is a new FDA-approved treatment for osteoarthritis of the knee. This form of therapy, known as "visco-supplementation," involves the injection of hyaluronic acid into the joint once a week for three to five weeks, depending on the product brand.
Hyaluronic acid is a lubricating substance that is found in the normal joint fluid. If, as in osteoarthritis of the knee, inflammation breaks down hyaluronic acid within the joint, then lubrication is lost.
Hyaluronic acid injection does not cause the side effects of most oral pain relievers. Therefore it is suitable for people who still suffer discomfort after being treated by pain medication, exercise, or physical therapy.
Hyaluronic acid injection may provide relief for up to 12 months, but there is no indication that the treatment alters the progression of arthritis.
Ongoing studies are investigating whether this method is effective for the shoulders and hips, but, to date, there is little information on the long-term effects of hyaluronic acid injection.
In general, the treatment is well tolerated, and allergic reactions are rare.
Surgery
Although recent advances in joint surgery have improved the lives of millions of people throughout the world, surgery is NOT the first line of treatment for osteoarthritis.
Before surgery is ever contemplated, simpler treatments must be tried. Moreover, most surgeons prefer not to perform operative procedures in younger people unless their quality of life is severely affected by arthritis.
When surgery is necessary, it is performed by an orthopedic surgeon - a specialist in surgery of the bones and joints.
There are four main types of surgery available:
Fusion (permanent joining of the bones in a joint, preventing motion)
Osteotomy (realigning the joint)
"Scoping" the joint (washing out the joint)
Total joint replacement (replacement of a damaged joint with an artificial man-made joint)
Fusion of the joint, otherwise known as arthrodesis is a procedure in which the surfaces of the joint are removed and the bone ends are united. This provides pain relief and stability, but the joint cannot bend.
Lack of mobility is a serious disadvantage of this procedure. Nevertheless, this is the preferred surgery for some younger individuals who have a single involved joint. Mobility in the other joints often will compensate for the loss of movement in the fused joint. The joints most commonly fused are smaller joints, such as those in the toes or fingers.
Younger people with severe arthritis of the hip or knee in whom fusion was once offered, are now considered for total joint replacement though depending on the individual, a fusion may sometimes be preferable
Osteotomy is an operation in which the surgeon cuts the bone below the affected joint, realigns it, and resets it in a better position. This procedure changes and improves the contact between the remaining healthy areas of cartilage in the joint. Afterwards, the painful areas do not rub against each other.
Osteotomy provides pain relief and leaves the joint mobile; however, it can only be performed in a joint that is not already stiff. Osteotomy usually is reserved for joints with uneven damage. It is not performed frequently, although the procedure sometimes is a good choice for younger arthritis sufferers, since it can prevent further joint damage and postpone the need for joint replacement surgery. (For example, osteotomy of the tibia [shinbone] is performed to correct curvature and weight-bearing in the lower leg of adults with OA of the knee.)
"Scoping" the joint is an expression used to describe arthroscopy - the examination of the inside of a joint using a device equipped with a tiny video camera. By means of arthroscopy, the physician can look for damaged tissue directly within the joint.
A small incision is made through the skin alongside the affected joint. Then, microsurgical tools are used to remove areas of cartilage or cartilage fragments that are causing irritation and thoroughly wash out the joint. Arthroscopy is an outpatient procedure and does not require an overnight stay in the hospital.
Joint "scoping" may provide temporary relief from symptoms - especially those caused by cartilage tears or particles; however, it does not stop the progression of osteoarthritis. It may help for a month in some, six months or much longer in others, and sometimes not at all.
Total joint replacement involves the complete removal of the painful joint, which is exchanged for a man-made appliance. The artificial joint can be fashioned from a combination of materials, including stainless steel, Vitallium™ (a cobalt-chromium alloy), titanium, and high-density polyethylene plastic. Silicone rubber occasionally is used for joint replacements (hand, base of the thumb), if the surgeon elects not to fuse the joint.
The hip and knee have shown the greatest successes of all joint replacement surgery. Over 90 percent of people are free of pain and have good mobility following hip replacement surgery for osteoarthritis. Other joints that are less commonly replaced are the shoulder and elbow.
Unfortunately, joint replacements tend to last only 10 to 20 years. But another replacement generally can be performed, if needed. This repeat surgery is called a revision.
The role of Nurse in the caring of elderly with Osteoporosis
The importance of osteoporosis lies in the increased fracture risk associated with reduced bone mineral density (BMD). Although osteoporosis is not painful, osteoporotic fractures are associated with significant morbidity and mortality; furthermore the occurrence of a fracture leads to an increased risk of subsequent fracture in both women and men.
Identification of patients over 50 years of age with a history of fracture for assessment of osteoporosis is essential as these patients are at highest risk of further fractures and are likely to benefit from treatment for the 'secondary prevention' of fractures. Specialist nurses have a key role in the Fracture Liaison Service, established in 1999 in Glasgow, to provide routine assessment to all women and men presenting to orthopedics and accident and emergency with new fractures.
For patients at risk of osteoporosis there may be opportunities to reduce the risk of their first fracture, 'primary prevention'. With few exceptions, endocrinopathies adversely influence bone mineralization and are associated with increased risk of osteoporosis. Endocrine nurses have a key role in the long-term care of patients with endocrine dysfunction and are ideally placed to engage with their patients in education and management strategies to address osteoporosis, to achieve both primary and secondary prevention of osteoporotic fracture.
Conclusion
Osteoporosis is one of the leading disabilities in the elderly in most part of the world at present. It is one of the disabilities which causes some terrible effects on the elderly. It can become a risk factor as well. Because sometimes Osteoarthritis can cause the weakness and also the helplessness in the leg which even leads to the some risk factors of the elderly such as the fall and then it can leads to the fractures so it should be treated well and these patients should get additional care and a good management in coping with his disability and also the proper treatment. The main role of the nurse in such types of disability is to teach them and to support them I n managing the disease.
References
1. British Endocrine Society, http://www.endocrine-abstracts.org/ea/0009/ea0009s53.htm, London, 2005.
2. Spine Universe, http://www.google.com/search?hl=en&q=spine+universe, New York , 2008.
3. Ministry of Health, http://mohfw.nic.in/, India, 2008.
4. About.com, http://www.about.com/,USA, 2008.
5. E-Health MD, http://www.ehealthmd.com/, New York, 2008.
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