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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
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What is pathophysiology
is the study of functional changes in the body that occur in response to disease or injury
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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
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Osteoporosis
- is a skeletal disease that is characterized by low bone mass and deterioration of bone tissue
- bone fragility ad susceptibility to fracture
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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
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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,
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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)
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Diagnostics
- Assessment- usually whe something happens
- x-ray
- bone mineral density
- ultrasound
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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
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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
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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
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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
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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
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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
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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
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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)
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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
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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
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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
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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
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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
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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
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Diag of osteomalacia
- dec serum calcium ad phosphorus
- x-ray
- bone biopsy- how soft the bone is
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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
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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
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