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osteoporosis
metabolic disease in which the bone demineralization results in decreased density and subsequent fractors
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osteopenia
- low bone mass
- which occurs when there is disruption in the bone remodeling process (osteoclastic activity is greater than osteoblastic activity)
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BMD determines _____ and peaks at _____
- bone strength
- 25-30 years of age
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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
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Causes of Secondary Osteoporosis
- DM
- Hyperthyroidism
- Hyperparathyroidism
- Cushing's Syndrome
- Growth Hormone Deficiency
- Pagets Disease
- Prolonged immobilization
- Bone Cancer
- metabolinc acidosis
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All ethnic backgrounds have some risk for osteoporosis but _______ have the greatest risk
- thin white females
- and at an earlier age
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why is protein deficiency a cause of osteoporosis
because 50% of calcium is bound to protein
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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
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classic sign of osteoporosis is
Kyphosis (humpback)
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osteoporosis occurs most commonly in
postmenopausal women and men in their 60s and 70s
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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
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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
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regional osteoporosis occurs when
- a limb is immobilized
- Fracture, limb immobility or paralysis
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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
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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
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vit D
drug therapy must be given to ___
necessary to give to institutionalized patients
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what is the most common med to cause osteoporosis
steroids
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what is calcitonin
- a hormone that gets rid of extra calcium in the blood
- used to treat osteoporosis
- paget's disease
- and hypercalcemia
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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
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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
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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
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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
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Diet Therapy for Osteoporosis
- Protein (50% calcium binds to it)
- Magnesium
- Vit K
- Trace Minerals
- Calcium and Vit D
- Avoid Caffeine and Alcohol
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lifestyle changes for osteoporosis
- walking for 30 mins day, 3-5 day week
- avoid high impact aerobics
- prevent falls
- strengthen abdominal muscles
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intervention for fall prevention
- hazard free environment
- no rugs
- well lit hallways
- no heels on shoes
- hip protectors
- lo beds
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Osteomalacia
Loss of bone related to Vitamin D deficiency
Cause Vit D Defv, lack of sunlight, (adult equal of rickets)
major Tx: Vit D
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Osteomalacia is a common complication of ____
- partial or total gastrectomy, or bariatric surgery, due to malabsorption
- Chrohn's Disease (malabsorption)
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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
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Paget's Disease most dreaded complication is
- osteogenic sarcoma
- bone cancer
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Osteomyelitis
- infection of the bony tissue
- can be severe and difficult to treat
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Acute Osteomyelitis
Exogenous: infection enters from outside the body (open Fracture)
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Chronic Osteomyelitis
- Endogenous/Hematogenous
- infection carried by the bloodstream fro other areas
Most Common Type
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Contiguous
- osteomyelitis
- infection results from skin infection of adjacent tissue
- (DM foot ulcer)
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most common cause of contiguous spread of osteomyelitis
DM foot ulcers
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osteomyelitis drug therapy
- long term IV Abx
- possibly multiple agents
- pain meds (very Painful)
- Wound irrigation and Abx solutions
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infection control for osteomyelitis
- Clean tech now reccommended
- may require contact precautions if MRSA or other resistant pathogen
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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
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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
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muscle flap
- used to fill dead space after debridement
- flap provides wound coverage and enhances blood flow to promote healing
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Amuptation
if the infection can not be resolved the limb may have to be amputated
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Benign bone tumors can be
- Chondrogenic (from cartiloage)
- Osteogenic (from bone)
- Fibrogenic ( from fibrous tissue)
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Giant Cell Ca
- lesion is aggressive and can metastasize in the lung although classified as benign
- affect women 20-30
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bone cancer usually spread to _____
lung
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Primary Tumors
- those that originate in the bone
- Usually the distal femur 50%
- classic sunburst presentation
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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
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bone cancer in the ribs in not uncommon after ___
radiation for breast or lung cancer
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secondary bone tumors are those that ___
start as primary tumors of the prostate, breast, kidney, thyroid, and lungs
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nursing intervention include
- treatment aimed at reducing or removing the tumor
- chemo
- radiation
- surgical management
- Pain Management is major Problem
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Dupuytren's contracture
fingers contract down
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ganglion cyst
round cystlike lesion often overlying wrist joint or tendon
can be aspirated but excision is preferred
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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)
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Hammertoe
dorsiflexion of any Metatarsalphalageal joint
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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
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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)
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Scoliosis is frequent in
females
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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
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Lordosis
Beerbelly or Preg Lady
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osteoporosis starts as ___
osteopenia
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hyperparathyroid causes
calcium to be released from the bone into the blood
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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
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