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2010-03-23 13:37:33
geri week 9 janice

Geriatrics week 9
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  1. Overview of Musculoskeletal System
    • Allows us to be upright
    • Necessary to allow us to comfortably carry out the most basic activities of daily living.
  2. The gerontological nurse in the musculoskeletal system: (2)
    • Attends to the needs of older adults with musculoskeletal problems
    • Works to promote healthy bone joints.
  3. Define Osteoporosis - Primary and Secondary
    • from porous bones
    • Primary: Process of lack of calcium, age, weight exercising, most common in women
    • Secondary: Caused by another disease sate or by medications -- Paget's disease or long term steroid use
    • Characterized by low bone mineral density (BMD) and subsequent deterioration of the bone structure
  4. Nonmodifiable risk factors for Osteoporosis
    • Female gender
    • caucasian race
    • Northern European Ancestry
    • Advanced age
    • Family history of osteoporosis
  5. Modifiable risk factors for Osteoporosis
    • Low body weight (underweight)
    • Low calcium intake
    • Estrogen deficiency
    • Low testosterone
    • Inadequate exercise or activity
    • Use of steroids or anticonvulsants
    • Excess coffee or alcohol intake
    • Current cirgarette
  6. Implications for Gerontological Nursing and healthy aging in Osteoporosis
    • Diagnosed through a DEXA scan
    • Presumed in most older adults by
    • 1. Nontraumatic fractures
    • A loss of 3" or more in height
    • Kyphosis - development of a C shape to the cervical vertebra
  7. Reducing Osteoporosis Related Risk and Injury
    • Exercise: Weight-bearing physical activity helps maintain bone mass
    • Nutrition
    • Lifestyle changes that reduce risk factors
    • Fall prevention
    • Basic body mechanics
    • Home safety
  8. Pharmacological Interventions of Osteoporosis
    • Adequate intake of calcium and vitamin D
    • Combination calcium-vitamin D: Calcitrate-D
    • Bisphosphonates: Foxamax, Actonel, and Boniva
    • Selective estrogen receptor modulators (SERMs)
    • Parathyroids hormones: Teriparatide (Forteo)
    • Calcitonin (Miacalcin)
  9. Definition of Arthritis
    • The term used to refer to more than 100 diseases that affect 46.6 million individuals of all ages in the United States
    • The number one reason for activity limitations from middle age on
  10. What is Osteoarthritis?
    • Most common type of arthritis
    • A degenerative joint disorder
    • Risk factors: increased age, obesity, family history, (over use syndrome) repetitive use or trauma to the join
  11. What happens to your body in Osteoarthritis?
    • The normal soft and resilient cartilaginous lining becomes thin and damaged
    • The join space narrows, and the bones of the joint rub together causing destruction, pain, swelling, and loss of motion.
    • Cannot be "cured" without a joint replacement
  12. Most common spots for arthritis are:
    What is the alternative to prevent pain for arthritis?
    • Neck
    • hips
    • knees
    • lower back
    • - Surgery: Joint replacement
  13. What is polymyalgia Rherumatica (PMR)
    • Causes severe stiffness, especially in the morning, and lasts >1 hour
    • Severe stiffness and pain in the muscles of the neck, shoulders, lower back, buttocks, and thighs rather than the joints
    • Symptoms may be quickly relieved by small doses of corticosteroids
  14. What is Giant Cell Arteritis (GCA)
    • AKA temporal arteritis
    • An acute inflammation of the artieries of the scalp, especially in the temporal area
    • Restricts blood flow
    • If not treated early it can results in blindness
    • Treatments in high doses steroids
  15. Rheumatoid Arthritis
    • A chronic, systemic inflammatory joint disorder
    • Considered an autoimmune disease
    • Products from the inflamed lining of the joint invade and destroy the cartilage and bone within the joint
    • characterized by pain and swelling in multiple joints in a symmetrical pattern
    • Generalized fatigue and malaise, and occasional fevers
  16. What is the difference between Rheumatoid Arthritis and Osteoarthritis?
    • Osteoarthritis: Wearing away of cartilage. Bone on bone causes pain
    • Rheumatoid Arthritis: Chronic, systemic inflammatory joint disorder, an autoimmune disease
  17. Rheumatoid Arthritis:
    • Disease-modifying antirheumatic drugs (DMARDs): enbrel, Remicade, Humira, interleukin
    • Monitor the progression of the disease
    • Provide comfort and support
    • Monitor the effectiveness of treatment
  18. Gouty Arthritis (Gout)
    • Results from the accumulation of uric acids crystals in a joint
    • May be a one-time acute illness or it may become a chronic conditions with acute attacks
    • The proximal joint of the great toe is the most typical site
    • Also occurs in the ankle, knee, wrist, or elbow
  19. Gouty Arthritis - describe the pain
    • Pain in the affected joint
    • Joint is bright purple-red, hot, and too painful to touch
    • Acute attack may become chronic with periods of exacerbations and remission
  20. Gourty Arthritis Risk Factors:
    • High blood pressure
    • Diet high in purines
    • Medications: VVV
    • Thiazide diuretics
    • Salicylates (e.g., aspirin)
    • Niacin
    • Cyclosporines
    • Levodopa (Synamet)
  21. Examples of Foods high in purines (aggravates gout)
    • Asparagus
    • beef kidneys
    • brain
    • sweetbread
    • dried beans and peas
    • Game meat
    • gravy
    • herring, mackerel, and sardines
    • mushrooms
    • scallops
  22. Treatments of gouty arthritis
    • Avoidance of drugs or foods that are high in purines and alcohol
    • Allopurinol or colchicine: Decrease uric acid production
    • Probencid: Increase excretion of uric acid
    • Increase fluids to help flush the uric acid through the kidneys (2 L/day if not contraindicated)
  23. Implications for Gerontological Nursing and Healthy aging in Gouty Arthritis
    • Assessment
    • Examine the joint and muscles for tenderness, swelling, warmth, and redness
    • Hands are examined for the presence or absence of osteopytes
    • heberden's nodes or bouchard's nodes
    • Evaluate passive ROM and active ROM
    • Test the flexibility of the hands
  24. Interventions for Arthritis
    • Adequate and prompt treatment
    • pain control
    • medications administration
    • evaluation
    • patient teaching
    • surgical replacement of the joint (arthroplasty)
  25. Complementary and Alternative interventions of OA
    • Glucosamine
    • Acupuncture
    • Massage
  26. Functional Decline
    • Every day spent in bed takes 3.8 days to return a baseline function aka DECONDITIONING
    • 2 days = 7.6 days
    • 3 days = 11.4 days
    • 4 days = 15.2 days
    • (It you lie in bed for 2 days, it'll take 7.6 days of walking around to recover, etc)
    • Falls more likely to occur when baseline function is diminished