Nursing- MS problems

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Nursing- MS problems
2015-08-23 19:06:58

muscles and bones
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  1. Common Medications: review
    • analgesic
    • muscle relaxants- flexirel
    • NSAIDS, anti-imflammatory s/e GI bleed (take with food or milk
    • glucocorticoids- icr BS, retains fluid (HTN)
    • antibiotics- what organism or we after. why give one vs the other
    • stool softners- why? problem with the bone mobility it poor, pain meds give constipation,
    • vitamin/mineral supplements
    • anticoagulants
    • anti gout
  2. What is pathophysiology
    is the study of functional changes in the body that occur in response to disease or injury
  3. Metabolic bone/joint disorders
    • metabolic bone disease are disorders of the bone strength, usually caused by abormalities of minerals (such as calcium, phosphorus), vit d, bone mass and bone structure
    • osteoporosis
    • gout
    • osteomalacia
  4. Osteoporosis
    • is a skeletal disease that is characterized by low bone mass and deterioration of bone tissue
    • bone fragility ad susceptibility to fracture
  5. Patho of Osteoporosis
    • Osteoporosis is xterized by reduced bone mass, deterioration of the bone matrix
    • diminished architectural strength
    • the rate of bone reaborption is greater than bone formation. breaking down is more than making of the boneresulting in reduced/losing total bone mass
    • bone get progressively porous (open), brittle and fragile
    • fracture is the indicator
  6. Risk factors
    • look at hand out
    • Genetics- caucasian/asain, thin, fhx, female (bc hormonal changes)
    • Age- postmenapausal, low testerone, dec calcitonin (this protects the bone)
    • Nutrition- low ca, vit d,. high phosphate (carbonated beverages)
    • Physical excerises
    • lifestyle- smoking, caffeine, lack of exposure to skin
    • medication- eg-steriods, depo provera, antiseizure,
  7. osteoporosis prevention
    • no smoking and excessive alcohol, limit caffeine- inc weak bones
    • exercise 20-30 min 3x week
    • balance diet- foods rick in calcium (diary products, egg yolk, salmon)
  8. Diagnostics
    • Assessment- usually whe something happens
    • x-ray
    • bone mineral density
    • ultrasound
  9. Osteoporosis management
    • arrest/slow process to relieve those symptoms/complication
    • well balanced diet, foods rich in calcium, high fiber
    • exercise and physical activity
    • medications: calcium supplement (u need to have juice), fosamax (u have to take this 1st thing in the morning, at least 30mins, 1 full glass of water- u need water cause this can cause ulceration of the esophagus- look for chest pain coughing up blood), hormone replacement
    • se of calcium is constipation
    • give with juice to help absorb?? look this up
  10. osteoporosis medications
    • calcium supplements, with vita d
    • take calcium with meals or with a beverage high in vita c to promote absorption
    • recommended daily dose should be split and not taken as a single dose
    • common s/e abd distention and constipation

    • Foxamax (alendronate) bisphosphonates- slops or stop bone loss
    • u have to take this 1st thing in the morning, at least 30mins, 1 full
    • glass of water- u need water cause this can cause ulceration of the
    • esophagus-
    • look for difficulty swallowing, chest pain coughing up blood, new or worsening heart burn, stomach pain- notify MD
  11. Osteoporosis medication
    • calcitonin (miacalcin)- hormone slows bone loss
    • forteo is a form of PTH? and has been show to stimulate new bone formation
    • estrogen replacement therapy- if going thru menopause (estrogen and progestin- estrogen alone is known to cause ovarian cancer)
    • evista- selective estrogen receptor modulator (SERMs) this is not estrogen but mimcs estroge effect on bones
  12. Gout
    • disease of kings
    • a condition in which there is a imbalance in a purine metabolism, which incr uric acid in the joints and leads to formation of uric acid crystals
    • purines are natural substances found in all body cells, and in many foods
    • past linked to a disease of royalty
    • primary gout
    • secondary gout
  13. Patho gout
    • purines are found in the body cells and as cells dies they are eliminate as uric acid
    • problem with uric acid elimination leads to hyperuricemia
    • hyperuricemia is > 6.8
    • due to oversecretion of UA or and decreased excretion of UA
    • urate crystals deposits develop within a joint, inflammatory response occurs
    • kidneys get rid of them if not secreted the will end up in the joints
  14. Patho of Gout
    • subsequent development of symptoms is directly related to hyperuricemia
    • acute gouty arthritis
    • - big toe most commons
    • - abrupt onset at night, severe unilateral pain, low grade fever, redness/erythema, swelling, warmth, decre mobility (wbc trying to figure out what is going on)
    • - repeated attacks: tophi (accumulation of clumps of uric in body tissues) can deposit in perpherial areas
    • triggers- crash diets high in protein, diet high in fructose- proteins can crush your kidneys
  15. Diag for gout
    • H&p
    • serum uric acid
    • 24 hour urine- how well the kidneys are working- 30ml/hr
    • x-ray
    • joint aspiration: synovial fluid (arthrocentasis)***
    • - check for infection
    • - if too much UA
  16. nursing management for gout
    • Prevention
    • bedrest, immobilize the joint
    • diet
    • ice- pain
    • education:
    • triggers
    • diet- avoid food high in purines (organ meat, anchovies, mackeral, salmon, shrimp, fructose)
    • weight- not when flared up
    • early recognition
    • teaching: re vita c/ASA (not really but it was in a journal)
  17. Acute management Gout
    • medications***
    • colchicines
    • - decrea deposit (or blocks) uric acid and -decre imflammatory reaction to urate crystals
    • -no analgesics affect
    • symptoms can abate within 12 hours
    • - s/e: GI, diarrhea, cramps nausea
    • NAIDS
    • Glucocorticoids- BS, BP, infection
    • joint aspiration
  18. Chronic Gout meds
    • Allopurinol- look at UA level
    • - xanthine oxidase inhibitors- enzyme that converts to uric acid
    • - inhibits the enzyme needed for conversion of purines to uric acid, decreases serum level
    • s/e: GI, rashes, bone marrow suppresion
    • teaching: encourage patient to drink 2-3 L of fluid to decre the risk of renal stones, avoid
  19. Chronic gout meds
    • probenicid
    • -uricosuric agent, inhibits the proximal tuble reabsorption of urate, increasing the urinary excertion of UA
    • s/e: GI, rash, h/a
    • teaching: multiple drug reactions (antibiotics), encourage fluids to decr risks of stone formation, take with food to decr GI upset, monitor creatine clearace
    • lifestyle changes
    • wt loss, diet, avoid alcohol, if directic induced stop med
  20. complication of gout
    • joint pain and stiffiness
    • tophi- accumulation of clumps of uric acid in body tissues
    • - synovium, olecranon bursa most common
    • -multiple sites
    • - joint enlargement and deformity sinus tract with infection
    • gouty nephopathy- uric acid renal calculi, kidney stones
    • htn
  21. Osteomalacia
    • osteomalacia is a metabolic bone disease refers to softening of the bones ofte caused by a vit d deficiency
    • the condition is called rickets in children
    • susceptible to bow and fracture
    • bones start moving all over the place
    • incr fractures
  22. Patho  of osteomalacia
    • disturbance of calcium and phosphorus balance due to vita d def
    • inadequate mineralization of bone
    • bone becomes soft and demineralized
    • affect all bone especially- spine, pelvis, and lower extremities
    • defciency of activation of vita D.
    • malabsorption/malnutrition
    • excessive calcium loss
    • gi disorders- gastrectomy
    • renal disorders
    • hyperparathyriodism- incr PTH
    • medications- antiseizures
  23. Diag of osteomalacia
    • dec serum calcium ad phosphorus
    • x-ray
    • bone biopsy- how soft the bone is
  24. s/s of osteomalacia
    • bone pain and tenderness
    • muscle weakness
    • malaise, fatigue, unsteady gait
    • deformities
    • multiple fractures in advance stage- risk for falls
    • priority is SAFETY
  25. Management for osteomalacia
    • nursing care
    • - emotional support- how can they be in the community
    • - assessment: pain, injury and long term complication
    • exposure to sun light- use sun block
    • diet:
    • - incre calcium, vita d, protein (not too much)
    • medications- supplements
    • positioning and excerise
    • long term care- they need help