114 chapter 53

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114 chapter 53
2014-02-11 23:37:57
114 chap 53
chap 53
chap 53, interventions for clients with musculoskeletal problems
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  1. osteoporosis
    metabolic disease in which the bone demineralization results in decreased density and subsequent fractors
  2. osteopenia
    • low bone mass
    • which occurs when there is disruption in the bone remodeling process (osteoclastic activity is greater than osteoblastic activity)
  3. BMD determines _____ and peaks at _____
    • bone strength
    • 25-30 years of age
  4. Risk Factors of Primary Osteoporosis
    • Excessive Caffeine
    • Malabsorption of nutrients
    • old age both genders all races
    • parental H/O osteoporosis (especially mother)
    • H/O low trauma fracture after 5
    • Low Body Weight
    • Chronic low calcium and/or Vit D intake (lack of sunlight)
    • Protein Deficiency (50% calcium is bound to protein)
    • Estrogen or Androgen deficiency
    • Smoking
    • high alcohol intake
    • lack of physical exercise
  5. Causes of Secondary Osteoporosis
    • DM
    • Hyperthyroidism
    • Hyperparathyroidism
    • Cushing's Syndrome
    • Growth Hormone Deficiency
    • Pagets Disease
    • Prolonged immobilization
    • Bone Cancer
    • metabolinc acidosis
  6. All ethnic backgrounds have some risk for osteoporosis but _______ have the greatest risk
    • thin white females
    • and at an earlier age
  7. why is protein deficiency a cause of osteoporosis
    because 50% of calcium is bound to protein
  8. how to prevent osteoporosis
    • ensure adequate calcium intake
    • (milk, Cheese, Green leafy Veg)
    • Avoid Sedentary lifestyle
    • Continue program of weight barring exercise
    • Decrease risk factors
  9. classic sign of osteoporosis is
    Kyphosis (humpback)
  10. osteoporosis occurs most commonly in
    postmenopausal women and men in their 60s and 70s
  11. Primary Osteoporosis
    • decrease in estrogen promotes and increases the rate of bone reabsorption
    • decrease in testosterone levels & altered ability to absorb calcium in men result in generalized osteoporosis
  12. Secondary Osteoporosis results from
    an associated medical condition such as hyperparathyroidism (increase in circulating calcium), long term drug therapy, long term immobility, long term steroid use
  13. regional osteoporosis occurs when
    • a limb is immobilized
    • Fracture, limb immobility or paralysis
  14. Hormone replacement therapy (HRT)
    • estrogen-primary prevention strategy for reducing bone loss but usually risks outweigh benefits
    • can increase womens risk for breast cancer, cardiovascular disease and stroke
  15. Parathyroid Hormone (PTH) (FORTEO)
    • stimulates new bone formation and increases BMD
    • SQ injection (teach patient how to give daily injections)May have physical dexterity to give daily injections
  16. vit D
    drug therapy must be given to ___
    necessary to give to institutionalized patients
  17. what is the most common med to cause osteoporosis
  18. what is calcitonin
    • a hormone that gets rid of extra calcium in the blood
    • used to treat osteoporosis
    • paget's disease
    • and hypercalcemia
  19. Bisphosphonates
    • most common for osteoporosis
    • inhibits bone resorption by binding with the crystal elements in bone
    • Fosamax, Boniva, Actonel,
    • Must be taken with 8 ounces of water on empty stomach for maximum absorption
  20. Complications of Bisphosphonates
    • Esophagaitis
    • Esophageal Ulcers and irritation

    Pt with poor renal function or GERD not a canidate

    full glass water, take sitting up, take on empty stomach, do not crush
  21. IV Bisphosphonates
    • recent addition for patients who cannot tolerate PO meds or have proven ineffective
    • Aredia 3-6 months
    • Reclast 1 year

    small risk of osteonecrosis, usually of the jaw, especially when being treated for cancer
  22. Estrogen Agonist/Antagonist
    • Mimic Estrogen
    • Should NOT be given to women with H/O DVT
    • Teach to monitor S/S

    • EVISTA given to postmenopausal women increases BMD by decreasing bone resorption and LOWERS SERUM CHOLESTEROL
    • Can cause Elevated Liver Function
  23. Diet Therapy for Osteoporosis
    • Protein (50% calcium binds to it)
    • Magnesium
    • Vit K
    • Trace Minerals
    • Calcium and Vit D
    • Avoid Caffeine and Alcohol
  24. lifestyle changes for osteoporosis
    • walking for 30 mins day, 3-5 day week
    • avoid high impact aerobics
    • prevent falls
    • strengthen abdominal muscles
  25. intervention for fall prevention
    • hazard free environment
    • no rugs
    • well lit hallways
    • no heels on shoes
    • hip protectors
    • lo beds
  26. Osteomalacia
    Loss of bone related to Vitamin D deficiency

    Cause Vit D Defv, lack of sunlight, (adult equal of rickets)

    major Tx: Vit D
  27. Osteomalacia is a common complication of ____
    • partial or total gastrectomy, or bariatric surgery, due to malabsorption
    • Chrohn's Disease (malabsorption)
  28. Pagets Disease
    • chronic metabolic disorder, bone is excessively broken down (increased osteoclast activity)
    • second most common after osteoporosis, cause may be genetic
    • usually Dx after 50
    • Often confined to 1 bone 
    • Hip and pelvis most often but can even be ear bone involved
  29. Paget's Disease most dreaded complication is
    • osteogenic sarcoma
    • bone cancer
  30. Osteomyelitis
    • infection of the bony tissue
    • can be severe and difficult to treat
  31. Acute Osteomyelitis
    Exogenous: infection enters from outside the body (open Fracture)
  32. Chronic Osteomyelitis
    • Endogenous/Hematogenous
    • infection carried by the bloodstream fro other areas

    Most Common Type
  33. Contiguous
    • osteomyelitis
    • infection results from skin infection of adjacent tissue
    • (DM foot ulcer)
  34. most common cause of contiguous spread of osteomyelitis
    DM foot ulcers
  35. osteomyelitis drug therapy
    • long term IV Abx
    • possibly multiple agents
    • pain meds (very Painful)
    • Wound irrigation and Abx solutions
  36. infection control for osteomyelitis
    • Clean tech now reccommended
    • may require contact precautions if MRSA or other resistant pathogen
  37. Hyperbaric Oxgyen Therapy
    • treatment to increase tissueperfusion for clients with chronic unremitting osteomyelitis
    • affected area exposed to high concentrations of O2 that diffuses to promote healing
    • Given in conjunction with high doses of Abx and surgical debridement
  38. Sequestrectomy
    debridement of infected bone allows revascularization of bone (bone will not heal in the presence of necrotic tissue)

    Bone Graft if sequestrectomy is large
  39. muscle flap
    • used to fill dead space after debridement
    • flap provides wound coverage and enhances blood flow to promote healing
  40. Amuptation
    if the infection can not be resolved the limb may have to be amputated
  41. Benign bone tumors can be
    • Chondrogenic (from cartiloage)
    • Osteogenic (from bone)
    • Fibrogenic ( from fibrous tissue)
  42. Giant Cell Ca
    • lesion is aggressive and can metastasize in the lung although classified as benign
    • affect women 20-30
  43. bone cancer usually spread to _____
  44. Primary Tumors
    • those that originate in the bone
    • Usually the  distal femur 50%
    • classic sunburst presentation
  45. Ewing's Sarcoma
    not common but malignant

    pain swelling leukocytosis and anemia

    onion skin appearance on the bone

    children and young adult most commonly affected
  46. bone cancer in the ribs in not uncommon after ___
    radiation for breast or lung cancer
  47. secondary bone tumors are those that ___
    start as primary tumors of the prostate, breast, kidney, thyroid, and lungs
  48. nursing intervention include
    • treatment aimed at reducing or removing the tumor
    • chemo
    • radiation
    • surgical management
    • Pain Management is major Problem
  49. Dupuytren's contracture
    fingers contract down
  50. ganglion cyst
    round cystlike lesion often overlying wrist joint or tendon

    can be aspirated but excision is preferred
  51. Hallux Valgus
    • deformity referred to as bunion
    • very painful
    • great toe deviates laterally

    Bunionectomy-remove over growth of bone (long healing time 6-12 wks)
  52. Hammertoe
    dorsiflexion of any Metatarsalphalageal joint
  53. Plantar Fasciitis
    • inflammation of the plantar fascia in the arch of the foot
    • Common in runners
    • severe pain in morning when getting out of bed, and with weight barring
    • rest, ice, stretches, arch support, NSAIDS
    • Worse in the Mornings
  54. Scoliosis
    • changes in the vertebrae as they rotate and move
    • Congenital
    • When curvature reaches 60* cardiopulmonary compromise results (life threatening)
    • Spinal Instability at 50* (needs surgery)
  55. Scoliosis is frequent in
  56. Surgical for scoliosis
    • <50 curvature indicates conservative treatment
    • >50 requires surgical intervention

    • Surgical Fusion and often Harrington Rods
    • Post op limitations can be 3 weeks to 6 onths
  57. Lordosis
    Beerbelly or Preg Lady
  58. Kyphosis
  59. osteoporosis starts as ___
  60. hyperparathyroid causes
    calcium  to be released from the bone into the blood
  61. what Hgb is low
    you don't have a place for the O2 and nutrient s to attach and flow to the part of the body needing healing help

    Cannot carry oxygen