Care of Patients with Musculoskeletal Patients Flashcards
Osteoporosis:
chronic metabolic disease in which bone loss causes decreased density and possible fracture
Bone is a dynamic tissue that is constantly undergoing changes in a process called
bone remodeling
Osteoporosis and osteopenia (low bone mass) occur when
Osteoclastic (bone reabsorption) activity is greater than osteoblastic (bone building) activity
The result is a decreased bone mineral density (BMD): determines bone strength and peals between 25-30 years of age
A T-score represents the
number of standard deviations above or below the average BMD for young, healthy adults
Osteopenia is present when the T score is at
-1 and above -2.5
Osteoporosis is diagnosed when the T score is
at or lower than -2.5
Medicare reimburses for BMD testing every 2 yr in people ages of 65 and older who are:
Estrogen deficient Have vertebral abnormalities Receive long term steroid therapy Have primary hyperparathyroidism Being monitored while on osteoporosis therapy
Generalized osteoporosis involves many structures in the skeleton and is further divided into 2 categories:
Primary: occurs in postmenopausal women and in men in their seventh or eighth decade of life
Secondary: result from other medical conditions, such as hyperparathyroidism; long term drug therapy, such as with corticosteroids; or prolonged immobility, such as seen w/ spinal cord injury
Excessive ______ in the diet can cause calcium loss in the urine
caffeine
What can also reduce bone density?
Protein deficiency
Yet, excessive protein intake may increase calcium loss in the urine
Other risk factors of Osteoporosis:
Excessive alcohol and tobacco use
Kyphosis:
curvature of the thoracic spine, “dowager’s hump”
-2-3 in shorter w/in previous 20 years
The most common type of osteoporotic fracture:
back pain accompanied by tenderness and voluntary restriction of spinal movement suggests one or more compression vertebral fractures
Quality of life might also be impacted by
pain, insomnia, depression, and fallophobia (fear of falling)
Lab assessments:
biochemical markers Bone specific alkaline phosphate (BSAP) Osteocalcin N-telopeptide (NTX) C-telopeptide (CTX)
Imaging assessments:
Most common: Dual x-ray absorptiometry (DXA or DEXA)
- painless scan that emits less radiation than a chest x-ray
- best tool
Peripheral quantitative ultrasound (pQUS) is an effective and low cost tool that can detect osteoporosis and predict risk for hip fracture
Nutrition therapy and lifestyle changes:
Avoid alcohol and caffeine
Lactose intolerance - choose a variety of soy and rice products
Calcium and Vit D are added to many fruit juices, bread, and cereal products
The promotion of a single nutrient will not prevent or treat osteoporosis
Exercise is important in prevention & management
Encourage active ROM
Drug therapy:
Provider may prescribe calcium and vit D supplements, bisphosphonates, or estrogen agonist/antagonists
Hypercalcemia can cause serious
damage to the urinary system and other body systems
Bisphosphonates (BPs) do what?
slow bone reabsorption by binding w/ crystal elements in bone, especially spongy, trabecular bone tissue
Oral BPs are commonly associated w/ a serious problem called
esophagitis (inflammation of esophagus)
Osteomalacia:
loss of bone related to a Vit D deficiency
Ex. rickets = children’s version
Osteomalacia and osteoporosis can occur
at the same time
Manifestations of osteomalacia:
Nonspecific
Muscle weakness and bone pain may be mistaken as arthritis or another connective tissue disorder
Paget’s disease or osteitis deformans:
chronic metabolic disorder in which bone is excessively broken down (osteoclastic activity) and re-formed (osteoblastic activity)
Manifestations of Paget’s disease
Common:
Fragility fractures
Different size and shape of skull: soft, thick, enlarged
Deafness
Vertigo
Changes in vision, swallowing, hearing, and speech
Less common:
Hyperparathyroidism and gout
Hyperuricemia and gout occur because increased metabolic activity of bone creates an increase in nucleic acid catabolism
Increased cardiac output
Diagnostic assessment of Paget’s disease
Serum alkaline phosphatase (ALP) and urinary hydroxyproline levels are primary lab findings
Drug therapy for Paget’s disease
Bisphosphonates = 1st line defense
NSAIDs
Other interventions for Paget’s
gentle massage
application of heat
exercise program
Bacteria, viruses, or fungi can cause infection in bone known as
osteomyelitis
Ischemia of bone tissue follows and results in necrotic bone. This area of necrotic bone separates from surrounding bone tissue, and what is formed?
sequestrum = prevents bone healing and causes superimposed infection, often in the form of bone abscess
Osteomyelitis is categorized as
exogenous, infectious organisms enter from outside the body
and Endogenous
Osteomyelitis has 2 major types:
Acute osteomyelitis: results from bacteremia, underlying disease, or nonpenetrating trauma
Ex. Salmonella infections of GI tract may spread to bone - Endogenous
Chronic osteomyelitis: develops especially in older adults who have foot ulcers when treatment is to short, delayed, or inappropriate - gram negative bacteria - Exogenous
Poor dental hygiene and periodontal (gum) infection can be causative factors in
contiguous osteomyelitis in facial bones
Older adults may have __________ because of lower core body temperature and compromised immune system that occur w/ normal aging
extreme temperature elevation
What is less common in those with chronic osteomyelitis?
fever, swelling, and erythema
What is more common in those with chronic osteomyelitis?
ulceration resulting in sinus tract formation, localized pain, and drainage
Interventions for Osteomyelitis: nonsurgical management
Antimicrobial (antibiotics) therapy
In precense of copious wound drainage, Contact precautions are used
Oxygen therapy
Interventions for Osteomyelitis: surgical management
Surgery is reserved for chronic osteomyelitis
Sequestrctomy may by performed to debride necrotic bone and allow revascularization of tissue
Bone grafts
Microvascular bone transfers - most common donor sites are the patient’s fibula and iliac crest
Assess and document the patient’s Neurovascular (NV) status:
Pain Movement Sensation Warmth Temperature Distal pulses Capillary refill
