Caring for Older Adults with Mobility Issues Flashcards
Exam 3
1
Q
What is fundamental to active aging?
A
Mobility is fundamental to active aging
2
Q
What is mobility intimately linked to?
A
Mobility is fundamental to active aging and is intimately linked to health status and quality of life.
3
Q
Mobility in Older Adults
How is mobility broadly defined?
A
Mobility is broadly defined as the ability to move oneself (e.g., by walking, by using assistive devices, or by using transportation) within community environments that expand from one’s home, to the neighborhood, and to regions beyond.
4
Q
Mobility in Older Adults
What leads to falls and fractures?
A
Age related changes + Risk Factors= Falls and fractures.
5
Q
Mobility in Older Adults
What is a goal for older adults?
A
Goal for older adults -maintain mobility skills & avoid falls and fractures
6
Q
Gerontologic ConsiderationsEffects of Aging on MS System:
What are functional problems experienced by older adults related to?
A
Many of the functional problems experienced by the older adult are related to changes of the musculoskeletal system.
7
Q
Gerontologic ConsiderationsEffects of Aging on MS System
When do signs of musculoskeletal impairment being?
A
Although some changes begin in early adulthood, obvious signs of musculoskeletal impairment may not appear until later adult years.
8
Q
Gerontologic ConsiderationsEffects of Aging on MS System
How do effects of musculoskeletal changes range?
A
Effects of musculoskeletal changes may range from mild discomfort and decreased ability to perform activities of daily living to severe, chronic pain and immobility:
9
Q
Gerontologic ConsiderationsEffects of Aging on MS System
Effects of musculoskeletal changes may range from mild discomfort and decreased ability to perform activities of daily living to severe, chronic pain and immobility:
What kind of problems occur?
A
Functional problems
10
Q
Gerontologic ConsiderationsEffects of Aging on MS System
Effects of musculoskeletal changes may range from mild discomfort and decreased ability to perform activities of daily living to severe, chronic pain and immobility:
What is a decrease?
A
Decreased muscle mass and strength
Decreased flexibility
11
Q
Gerontologic ConsiderationsEffects of Aging on MS System
Effects of musculoskeletal changes may range from mild discomfort and decreased ability to perform activities of daily living to severe, chronic pain and immobility:
What is altered?
A
Bone remodeling process is altered: ( results in Decreased bone density)
12
Q
Gerontologic ConsiderationsEffects of Aging on MS System
Effects of musculoskeletal changes may range from mild discomfort and decreased ability to perform activities of daily living to severe, chronic pain and immobility:
What is there a risk for?
A
Risk for falls (balance, altered proprioception)
13
Q
Gerontologic ConsiderationsEffects of Aging on MS System
Alterations in musculoskeletal system can result in what?
A
Alterations may affect the older adult’s ability to complete self-care tasks and pursue other usual activities.
14
Q
Gerontologic ConsiderationsEffects of Aging on MS System
Why does this risk for falls increase in older adults?
A
The risk for falls also increases in the older adult due in part to a loss of strength.
15
Q
Gerontologic ConsiderationsEffects of Aging on MS System
Aging can also bring changes in what? What could this lead to?
A
Aging can also bring changes in the patient’s balance, thus making the person unsteady, and proprioception (awareness of self in relation to the environment) may be altered.
16
Q
Gerontologic ConsiderationsEffects of Aging on MS System
What causes a loss of bone density? What does loss of bone density lead to?
A
The bone remodeling process is altered in the older adult. Increased bone resorption and decreased bone formation cause a loss of bone density, contributing to development of osteopenia and osteoporosis.
17
Q
Gerontologic ConsiderationsEffects of Aging on MS System
How much muscle mass and strength is lost by age 70? What else can lead to skeletal muscle movement problems?
A
Muscle mass and strength also decrease with aging. Almost 30% of muscle mass is lost by age 70. A loss of motor neurons can cause additional problems with skeletal muscle movement.
18
Q
Gerontologic ConsiderationsEffects of Aging on MS System
What happens to tendons and ligaments? What happens to joints?
A
Tendons and ligaments become less flexible, and movement becomes more rigid. Joints in the aging adult are also more likely to be affected by osteoarthritis.
19
Q
Normal Age-Related Changes in Musculoskeletal System
What are bones?
A
Bones-Framework for musculoskeletal system
20
Q
Normal Age-Related Changes in Musculoskeletal System
Bones: What is there an increase of? What is there a decrease of?
A
increased resorption
decreased Calcium absorption
21
Q
Normal Age-Related Changes in Musculoskeletal System
Muscles: What happens to motor neurons? What does this result in?
A
Motor neurons will die with ageresulting in a denervation of the muscle fibers within the motor unit. This denervation causes the muscle fibers to atrophy and eventually die, leading to a decrease in muscle
22
Q
Normal Age-Related Changes in Musculoskeletal System
Sarcopenia: What is it?
A
Sarcopenia-age related loss of muscle mass –increased risk for frailty and falls
23
Q
Normal Age-Related Changes in Musculoskeletal System
What is the importance of joints and connective tissue?
A
Joints and Connective Tissue-Directly affects all activities of daily living (ADLs)
changes in cartilage & ligaments
24
Q
Normal Age-Related Changes in Musculoskeletal System
Crepitus or crepitation-
A
Crackling sounds and a grating sensation that accompany movement
25
Normal Age-Related Changes in Musculoskeletal System
What happens with nervous system?
Nervous System-delayed reaction time, slow reflex
26
Normal Age-Related Changes in Musculoskeletal System
Nervous System-delayed reaction time, slow reflex:
What does this lead to?
Increase in Body sway: measure of motion of the body while standing
27
Normal Age-Related Changes in Musculoskeletal System
How are changes in assessment findings?
***changes in the assessment finding aren’t necessarily symmetrical
28
Normal Age-Related Changes in Musculoskeletal System
Osteoclasts: What are they?
Osteoclasts break down old bone and deliver it into the bloodstream (resorption),
29
Normal Age-Related Changes in Musculoskeletal System
Osteoblasts: What are they?
osteoblasts build the bone where it needs to be reinforced (ossification).
30
Is the following statement true or false?
Exercise programs to increase strength and endurance in the older adult population may help delay the onset of the age-related functional consequences of decreased strength and endurance
True
31
Age related changes in skeletal muscles are controlled by what? What do they directly effect?
Age-related changes in skeletal muscles, which are controlled by motor neurons, directly affect all activities of daily living.
32
What is the end result of age-related changes?
The end result of these age-related changes is a decline in motor function and a loss of strength and endurance, even in healthy older adults.
33
What may increase strength and endurance and may help delay onset of age-related consequences of disability and loss of function?
Exercise programs to increase strength and endurance may help delay the onset of the age-related consequences of disability and loss of function
34
Overtime, what specific bone change can occur?
Changes to the spinal column ( decrease bone density, slower remodeling, less water between vertebras)
35
Osteopenia and osteoporosis
Bone density: What is it?
amount of minerals in bone
36
Osteopenia and osteoporosis
Bone scan: What is it?
Bone scan (DXA) =dual-energy x-ray absorptiometry
37
What is considered the gold standard of BMD studies by the WHO?
Bone scan (DXA) =dual-energy x-ray absorptiometry
38
Osteopenia and osteoporosis
Bone scan (DXA): What does it do?
measures bone density in the spine, hips, and forearm.
39
Osteopenia and osteoporosis
Bone scan (DXA): What are the most common sites of fragility fractures. from osteoporosis?
(considered the gold standard of BMD studies by the World Health Organization),
measures bone density in the spine, hips, and forearm.
These represent the most common sites of fragility fractures from osteoporosis.
40
Osteopenia and osteoporosis
What are DXA studies also useful for?
DXA studies are also useful to evaluate changes in bone density over time and assess the effectiveness of osteoporosis treatment.
41
Osteopenia and osteoporosis
How is DXA scan scored?
Scored according to standard deviations below that of a healthy 30 yr. old of same sex and race called a T score
Bone density is scored according to standard deviations:
42
Osteopenia and osteoporosis:
National Osteoporosis Foundation Diagnostic Classifications
What is considered normal?
-1.0 and above
43
Osteopenia and osteoporosis:
National Osteoporosis Foundation Diagnostic Classifications
What is considered osteopenia?
Between -1.0 and -2.5
44
Osteopenia and osteoporosis:
National Osteoporosis Foundation Diagnostic Classifications
What is considered osteoporosis?
At or below -2.5
45
Osteopenia and osteoporosis:
National Osteoporosis Foundation Diagnostic Classifications
What is considered severe or established osteoporosis?
-2.5 or lower and fragility fracture
46
Osteopenia and osteoporosis:
Osteoporosis is considered what kind of disease? Why?
Osteoporosis is a “silent disease”- usually asymptomatic until fracture occurs?
47
Osteopenia and osteoporosis:
Osteoporosis: What occurs with this?
Fragility fracture: little to no trauma
48
Bone scan (DXA) =dual-energy x-ray absorptiometry
The United States Preventive Services Task Force (USPSTF) recommends bone density testing for women of what age?
The United States Preventive Services Task Force (USPSTF) recommends bone density testing for women aged 65 and older, regardless of risk factors.
49
Bone scan (DXA) =dual-energy x-ray absorptiometry
For postmenopausal women under the age of 65, bone density testing may be recommended why?
For postmenopausal women under the age of 65, bone density testing may be recommended if they have additional risk factors such as a history of fractures, low body weight, smoking, or a family history of osteoporosis.
50
Bone scan (DXA) =dual-energy x-ray absorptiometry
The USPSTF recommendations for men?
The USPSTF does not have specific recommendations for bone density testing in men.
51
Bone scan (DXA) =dual-energy x-ray absorptiometry
When would testing be recommended for men?
However, testing may be considered for men who have risk factors such as low body weight, a history of fractures, smoking, or certain medical conditions that increase the risk of osteoporosis.
52
Bone scan (DXA) =dual-energy x-ray absorptiometry
What meds someone is taking would bone density be recommended for?
Bone density testing may be recommended for individuals who are taking medications known to increase the risk of osteoporosis, such as long-term use of glucocorticoids (steroids) or certain cancer treatments.
53
Bone scan (DXA) =dual-energy x-ray absorptiometry
What kind of meds increase the risk of osteoporosis?
medications known to increase the risk of osteoporosis, such as long-term use of glucocorticoids (steroids) or certain cancer treatments.
54
Trajectory of Bone Loss for Women
Bone mass peak for women compared to men?
Lower peak bone mass than men
55
Trajectory of Bone Loss for Women
Amount in bone bank in women compared to men? Why?
Less in the "bone bank” because of thinner bones and small frame
56
Trajectory of Bone Loss for Women
In women, when could loss of bone mass occur?
Lose bone mass with lactation
57
Trajectory of Bone Loss for Women
In women, when is there a rapid withdrawal from bone bank?
Rapid withdrawal from "bone bank" during perimenopause
58
Trajectory of Bone Loss for Women
In women, what increases the risk for osteoporosis?
Longer life span increases risk for osteoporosis
59
Trajectory of Bone Loss for Women
Women have how much bone loss yearly?
woman have 7% bone loss yearly and 1-2% post menopausal years (when levels of bone-bolstering estrogen fall.)
60
Trajectory of Bone Loss for Women
Peak bone mass: What is it? When is it usually reached?
Peak bone mass is the greatest bone density in one's lifetime, which is usually reached between the late 20s or early 30s.
61
Trajectory of Bone Loss for Women
Why is peak bone mass a significant milestone?
It is a significant milestone because the greater the peak bone mass, the more protection one has against developing osteopenia and osteoporosis.
62
Trajectory of Bone Loss for Women
Who is osteoporosis most common in?
Osteoporosis is more common in women than in men for several reasons:
63
Trajectory of Bone Loss for Women
Osteoporosis is more common in women than in men for several reasons:
Women tend to have lower calcium intake than men throughout their lives (men between 15 and 50 years of age consume twice as much calcium as women).
Women have less bone mass because of their generally smaller frame.
Bone resorption begins at an earlier age in women and becomes more rapid at menopause.
Pregnancy and breastfeeding deplete a woman’s skeletal reserve unless calcium intake is adequate.
Longevity increases the likelihood of osteoporosis
64
Metabolic Bone Diseases
What is the most common metabolic bone disease?
Osteoporosis
65
Metabolic Bone Diseases
Osteoporosis: Effects how many men and women in their lifetimes?
impacts 50% of women and 25% of men during their lifetimes
66
Metabolic Bone Diseases
Osteoporosis: Effects how many people in the US?
20 million women and 8 million men diagnosed in the United States
67
Metabolic Bone Diseases
Osteoporosis: How long is it asymptomatic?
Asymptomatic till -Fragility fracture (Osteoporotic fracture) occurs with little to no trauma
68
Metabolic Bone Diseases
Osteoporosis: as it progresses, what happens?
As it progresses-Pain/loss of height/increased risk for fractures
69
Metabolic Bone Diseases
Osteoporosis:
Presentation on assessment?
Presentation on assessment: a gradual loss of height Kyphosis or “dowager’s hump “
70
Metabolic Bone Diseases
Osteoporosis: What is it?
Osteoporosis: An imbalance between bone resorption and bone formation, leading to a decrease in bone density and increased fracture risk.
71
Metabolic Bone Diseases
Osteoporosis: How long does bone density increase?
Until about age 30 more new bone is added than taken away, so bone density increases.
72
Metabolic Bone Diseases
Osteoporosis: From age 30-50 how is bone density?
From about age 30 to age 50, bone density tends to stay stable with equal amounts of bone formation and bone breakdown.
73
Metabolic Bone Diseases
Osteoporosis: After age 50, how is bone density?
After age 50, bone breakdown (resorption) outpaces bone formation and bone loss often accelerates, particularly at the time of Peri and menopause.
74
Risk Factors for Osteoporosis and Fragility Fractures
Factors That Increase the Risk for Osteoporosis:
What kind of deficiencies would lead to osteoporosis?
Vitamin D deficiency
Hormonal deficiency (with regard to estrogen in women)
Low calcium intake, both past and current
75
Risk Factors for Osteoporosis and Fragility Fractures
Factors That Increase the Risk for Osteoporosis:
Excess of what could lead to osteoporosis?
Excessive alcohol intake (> 2 drinks/day)
76
Risk Factors for Osteoporosis and Fragility Fractures
Factors That Increase the Risk for Osteoporosis:
What kind of pathological conditions can lead to osteoporosis?
Pathologic conditions (e.g., endocrine disorders, inflammatory conditions, malabsorption syndromes)
77
Risk Factors for Osteoporosis and Fragility Fractures
Factors That Increase the Risk for Osteoporosis:
History of what can lead to osteoporosis?
Family history of osteoporosis or fragility fracture
78
Risk Factors for Osteoporosis and Fragility Fractures
Factors That Increase the Risk for Osteoporosis:
What other meds can lead to osteoporosis?
Medications (e.g., corticosteroids, antiseizure, antithrombotics, antiviral, proton pump inhibitors (PPI’s)
79
Risk Factors for Osteoporosis and Fragility Fractures
Factors That Increase the Risk for Osteoporosis:
For both women and men, what could lead to osteoporosis?
Age 65 or 70 years or older for women and men, respectively
Inadequate physical activity, especially weight-bearing and muscle-strengthening exercises
80
Risk Factors for Osteoporosis and Fragility Fractures
Risk Factors for Fragility Fracture, in Addition to Risks for Osteoporosis
What status for women? What for men?
Postmenopausal status for women
Female sex
75 years or older for men
81
Risk Factors for Osteoporosis and Fragility Fractures
Risk Factors for Fragility Fracture, in Addition to Risks for Osteoporosis
What else?
Previous fragility fracture
Undertreatment of osteoporosis
Low body mass index
Falls
Rheumatoid arthritis
82
Health promotion and teaching about Osteoporosis
What is done?
Assessment of risk factors
Education about prevention
83
Health promotion and teaching about Osteoporosis
Assessment of risk factors: What are you assessing?
Non-modifiable and modifiable risk factors
84
Health promotion and teaching about Osteoporosis
Assessment of risk factors:
Nonmodifiable:
age,
*Gender,
ethnicity,
family Hx
85
Health promotion and teaching about Osteoporosis
Assessment of risk factors:
Modifiable:
* modifiable -
Exercise level,
smoking,
diet (nutritional deficits and alcohol intake)
86
Health promotion and teaching about Osteoporosis
Assessment of risk factors:
Education about prevention
Education about prevention –Education about positive lifestyle changes
87
Health promotion and teaching about Osteoporosis
Assessment of risk factors:
Education about prevention- Education about positive lifestyle changes- like what?
Diet, exercise, and other risk modifications
88
Health promotion and teaching about Osteoporosis
Progression of osteoporosis can be slowed how?
* Progression of osteoporosis can be slowed by increasing calcium intake and weight-bearing exercise.
89
Health promotion and teaching about Osteoporosis
What is no longer done to prevent osteoporosis?
*Estrogen replacement therapy is no longer routinely given to prevent osteoporosis because of increased risk of heart disease as well as breast and uterine cancer.
90
PREVENTION OF OSTEOPOROSIS
How much calcium a day?
Calcium: At least 1000mg/day
91
PREVENTION OF OSTEOPOROSIS
How much Vitamin D a day?
Vitamin D: 800 Iu-1000Iu /day ( 20mcg -25mcg) (Iu=international units)
92
Osteoporosis is classified as primary when...
Osteoporosis is classified as primary when it is associated with age-related changes and as secondary when it is caused by medications or pathologic disturbances.
93
Which statement about osteoporosis is true?
A. Primary osteoporosis occurs with pathologic problems
B. Secondary osteoporosis occurs as a result of age-related changes
C. Osteoporosis can cause serious negative functional consequences even in the absence of additional risk factors
D. Estrogen levels have a minimal impact on the development of osteoporosis
C. Osteoporosis can cause serious negative functional consequences even in the absence of additional risk factors
94
Osteoporosis is classified as secondary when...
Osteoporosis is classified as primary when it is associated with age-related changes and as secondary when it is caused by medications or pathologic disturbances.
95
What is a major cause of osteoporosis in women?
Estrogen decline is a major cause of osteoporosis in woman
96
Pharmacology and Nursing Responsibilities for Osteoporosis
What types of therapy exist?
Anabolic therapy
Antiresorptive therapy
97
Pharmacology and Nursing Responsibilities for Osteoporosis
Anabolic therapy: How does it work?
works by stimulating osteoblasts to enhance the formation of new bone.
98
Pharmacology and Nursing Responsibilities for Osteoporosis
Anabolic therapy: works by stimulating osteoblasts to enhance the formation of new bone.
What can this lead to?
This can lead to an increase in bone mass and strength.
99
Pharmacology and Nursing Responsibilities for Osteoporosis
Anabolic therapy: Who are they used for?
Anabolic therapies are typically considered for individuals at higher risk of fractures or those who have not responded well to antiresorptive treatments.
100
Pharmacology and Nursing Responsibilities for Osteoporosis
Parathyroid Hormone:
Teriparatide (Forteo™)
101
Pharmacology and Nursing Responsibilities for Osteoporosis
Parathyroid Hormone: Teriparatide (Forteo™): Who/What is it used for?
used for the treatment of osteoporosis in men and postmenopausal women who are at high risk of fractures.
It is also prescribed for the treatment of glucocorticoid-induced osteoporosis (caused by the long-term use of corticosteroids)
and for increasing bone mass in men with primary or hypogonadal osteoporosis.
102
Pharmacology and Nursing Responsibilities for Osteoporosis
Parathyroid Hormone: Teriparatide (Forteo™): What is the recommended duration of treatment?
*The recommended maximum duration of teriparatide treatment is typically limited to two years due to concerns about potential long-term safety.
103
Pharmacology and Nursing Responsibilities for Osteoporosis
Parathyroid Hormone: Teriparatide (Forteo™):
Recommended maximum duration of teriparatide treatment is typically limited to two years; After this period, what is done?
After this period, patients may transition to other osteoporosis medications, such as antiresorptive therapies, to help maintain the gains in bone density achieved with teriparatide.
104
Pharmacology and Nursing Responsibilities for Osteoporosis
What other drugs are used for treatment of osteoporosis?
Parathyroid Hormone: Teriparatide (Forteo™)
PTHrP Analogue : Abaloparatide (Tymlos™)
Romosozumab (Evenity™)
105
Pharmacology and Nursing Responsibilities for Osteoporosis
PTHrP Analogue :
Abaloparatide (Tymlos™)
106
Pharmacology and Nursing Responsibilities for Osteoporosis
Abaloparatide (Tymlos™) has what kind of properties? What is it used to treat?
Abaloparatide (Tymlos™) also has PTHrP-like properties.
It is used for the treatment of osteoporosis in postmenopausal women at high risk of fractures.
107
Pharmacology and Nursing Responsibilities for Osteoporosis
Romosozumab ("Evenity™): What is it?
is a medication used for the treatment of osteoporosis in postmenopausal women at high risk of fracture.
108
Pharmacology and Nursing Responsibilities for Osteoporosis
Romosozumab ("Evenity™): What class of drugs does it belong to?
. It belongs to a class of drugs known as sclerostin inhibitors
109
Pharmacology and Nursing Responsibilities for Osteoporosis
Romosozumab ("Evenity™): How does this drug work?
Romosozumab works by inhibiting the action of sclerostin, .
110
Pharmacology and Nursing Responsibilities for Osteoporosis
Romosozumab ("Evenity™): Romosozumab works by inhibiting the action of sclerostin, what is sclerostin?
a protein produced by osteocytes (cells embedded in bone tissue) that inhibits bone formation
111
Pharmacology and Nursing Responsibilities for Osteoporosis
Romosozumab ("Evenity™): By blocking sclerostin, what does romosozumab promote?
By blocking sclerostin, romosozumab promotes bone formation and reduces bone resorption, leading to an increase in bone density.)
112
Pharmacology and Nursing Responsibilities for Osteoporosis
Romosozumab ("Evenity™): How long for onset?
*It has a rapid onset of action, leading to rapid increases in bone density within the first year of treatment.
113
Pharmacology and Nursing Responsibilities for Osteoporosis
Romosozumab ("Evenity™): What kind of risks are associated with its use?
*potential cardiovascular risks associated with its use, it is typically reserved for patients at high risk of fractures who have not responded well to other treatments or when other treatments are not suitable.
114
Pharmacology and Nursing Responsibilities for Osteoporosis
Romosozumab ("Evenity™): Who is this drug reserved for because of its risks?
it is typically reserved for patients at high risk of fractures who have not responded well to other treatments or when other treatments are not suitable.
115
Pharmacology and Nursing Responsibilities for Osteoporosis
Antiresorptive therapy: What is it used for?
Antiresorptive therapy is used to slow down or inhibit the resorption (breakdown) of bone tissue (which is a natural part of the bone remodeling cycle.)
116
Pharmacology and Nursing Responsibilities for Osteoporosis
Antiresorptive therapy: What is the primary goal of this therapy?
The primary goal of antiresorptive therapy is to slow down bone resorption, allowing bone formation to catch up and improve bone density.
117
More on slide 18
117
Pharmacology and Nursing Responsibilities for Osteoporosis
Antiresorptive therapy:
five principal classes of agents include
bisphosphonates,
estrogens (HRT),
selective estrogen receptor modulators (SERMs),
calcitonin and
monoclonal antibodies such as denosumab.
118
Antiresorptive Therapy
Bisphosphonates: What does it do to bone density?
Preserves or increases bone density
119
Antiresorptive Therapy
Bisphosphonates: How does it effect bone resportion?
Decreases rate of bone resorption
120
Antiresorptive Therapy
What is the most widely prescribed osteoporosis medications/ antiresorptive agents.
Bisphosphonates
121
Antiresorptive Therapy
Bisphosphonates: What are examples?
Alendronate (Binosto, Fosamax) PO once/week
Risedronate (Actonel, Atelvia) PO once/week /month
Ibandronate (Boniva) PO once/week OR IV 4 times/year
Zoledronic acid (Reclast, Zometa)* annual IV
122
Antiresorptive Therapy
Bisphosphonates:
Alendronate (Binosto, Fosamax)- How often is it given and how?
Alendronate (Binosto, Fosamax) PO once/week
123
Antiresorptive Therapy
Bisphosphonates:
Ibandronate (Boniva) - How often is it given and how?
Ibandronate (Boniva) PO once/week OR IV 4 times/year
124
Antiresorptive Therapy
Bisphosphonates:
Zoledronic acid (Reclast, Zometa)- How often is it given and how?
Zoledronic acid (Reclast, Zometa)* annual IV
125
Antiresorptive Therapy
Bisphosphonates:
IV format has what symptoms?
IV format - can cause fever, headache and muscle aches for up to three days.
126
Antiresorptive Therapy
Bisphosphonates:
PO format has what symptoms (broadly)?
Adverse GI Symptoms
127
Antiresorptive Therapy
Bisphosphonates:
PO format has what symptoms - Adverse GI Symptoms
Like what?
Difficulty swallowing
Esophageal irritation /Esophageal erosions
Heartburn
Nausea
Abdominal Pain
128
Antiresorptive Therapy
Alendronate (Binosto, Fosamax) and Risedronate (Actonel, Atelvia):
The nurse is responsible for teaching the older person the specific instructions for taking Fosamax and Actonel.
What must the nurse teach the patient?
The older person must:
1. take either drug on an empty stomach, first thing in the morning with 8oz of water
2. Remain upright for 30 minutes
3. no eat or drink anything else for 30 minutes
129
Antiresorptive Therapy
Bisphosphonates: How do they work?
They work by inhibiting osteoclast activity (the cells responsible for breaking down bone tissue.)
130
Antiresorptive Therapy
Bisphosphonates: What are the MAIN side effects of PO bisphosphonates?
The main side effects of PO bisphosphonate are stomach upset and heartburn.
131
Antiresorptive Therapy
Bisphosphonates PO: What should patients not do and why?
Patient should not lie down or bend over for 30 to 60 minutes to avoid the medicine washing back up into the esophagus.
132
Antiresorptive Therapy
Bisphosphonates IV: How to lessen flu like symptoms caused by first infusion?
*Intravenous bisphosphonates causes mild flu-like symptoms in some people, but usually only after the first infusion.
patients can lessen the effect by taking acetaminophen (Tylenol, others) before and after the infusion.
133
Antiresorptive Therapy
Selective estrogen receptor modulators (SERMs): What does it do?
Provide benefits of estrogens without the disadvantages
134
Antiresorptive Therapy
Selective estrogen receptor modulators (SERMs):
What are examples?
Raloxifene (Evista)
Bazedoxifene (Duavee)
135
Antiresorptive Therapy
Selective estrogen receptor modulators (SERMs): Raloxifene (Evista)
What are side effects of Raloxifene (Evista)?
*Side effect ---leg cramps, hot flashes, blood clots
136
Antiresorptive Therapy
Calcitonin: How is it given?
given intra nasally
137
Antiresorptive Therapy
Calcitonin: How effective is it? What does it do?
Safe but less effective treatment for osteoporosis
Decreases spinal fractures by up to 35%
138
Antiresorptive Therapy
Monoclonal antibodies: What are examples?
Denosumab : Xgeva, Prolia
139
Antiresorptive Therapy
Monoclonal antibodies:
Denosumab : Xgeva (SC Q 4 weeks) Prolia (SC Q 6 months)
What does this med do?
inhibits osteoclast formation, function and survival.
Thus, Denosumab can help keep osteoclasts from resorbing bone.
140
Antiresorptive Therapy
HRT: What is it?
Estrogen, sometimes paired with progestin, once commonly used to treat osteoporosis.
141
Antiresorptive Therapy
HRT: What is the danger of this drug? Who is this drug reserved for?
This treatment can increase the risk of bloodwas clots, endometrial cancer, breast cancer and possibly heart disease. It's now usually reserved for women at high risk of fracture who can't take other osteoporosis drugs.
142
Antiresorptive Therapy
HRT: What else can this drug be used for?
Women who are considering hormone replacement therapy to reduce menopausal symptoms, such as hot flashes, may factor in increased bone health when weighing the benefits and risks of estrogen treatment.
143
Antiresorptive Therapy
HRT: What are the current recommendations for using this drug?
Current recommendations say to use the lowest dose of hormones for the shortest period of time.
144
Antiresorptive Therapy
SERM’s-Raloxifene (Evista): What can this drug reduce the risks of?
Taking this drug can reduce the risk of some types of breast cancer.
145
Antiresorptive Therapy
SERM’s-Raloxifene (Evista): What is a common side effect?
Hot flashes are a common side effect.
Raloxifene may also increase risk of blood clots.
146
Antiresorptive Therapy
SERM’s-
Bazedoxifene (Duavee) is a medication that combines two active ingredients:
Bazedoxifene (Duavee) is a medication that combines two active ingredients:
conjugated estrogens and bazedoxifene.
147
Antiresorptive Therapy
SERM’s-
Bazedoxifene (Duavee): What is it used to treat?
It is used to treat certain symptoms associated with menopause in postmenopausal women and to help prevent osteoporosis in women at risk.
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Antiresorptive Therapy
SERM’s-
Bazedoxifene (Duavee): How does this med work?
Bazedoxifene is a selective estrogen receptor modulator (SERM).
It works by binding to estrogen receptors in some tissues (such as bone) as an estrogen agonist (promoting bone health) and as an antagonist (blocking estrogen's effects in other tissues, such as the uterus).
149
Antiresorptive Therapy
Calcitonin: What is this?
The synthetic form of calcitonin, a hormone produced in the thyroid that is a powerful inhibitor of osteoclastic activity (the cells that continuously reabsorb bone), has been shown beneficial in producing modest increases in bone mass.
150
Antiresorptive Therapy
Monoclonal Antibodies denosumab (Xgeva, Prolia)
Who may this be used in?
denosumab (Xgeva, Prolia) might be used in people who can't take a bisphosphonate, such as some people with reduced kidney function.
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Antiresorptive Therapy
Monoclonal Antibodies denosumab (Xgeva, Prolia)
How is it administered?
Denosumab is delivered by SC injection.
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Antiresorptive Therapy
Monoclonal Antibodies: denosumab (Xgeva, Prolia)
How long do they take this med?
Patients who take denosumab, might have to do so indefinitely.
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Antiresorptive Therapy
Monoclonal Antibodies: denosumab (Xgeva, Prolia)
Why is it important to take this drug consistently?
Recent research indicates that there could be a high risk of spinal fractures after stopping the drug, so it's important to take it consistently.
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Antiresorptive Therapy
Monoclonal Antibodies: denosumab (Xgeva, Prolia)
What does this drug target?
*It is a monoclonal antibody that targets a protein called RANK ligand (RANKL).
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Antiresorptive Therapy
Monoclonal Antibodies: denosumab (Xgeva, Prolia)
*It is a monoclonal antibody that targets a protein called RANK ligand (RANKL).
What role does RANKL play?
RANKL plays a key role in the activation of osteoclasts, ( cells responsible for breaking down bone tissue.)
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Antiresorptive Therapy
Monoclonal Antibodies: denosumab (Xgeva, Prolia)
*It is a monoclonal antibody that targets a protein called RANK ligand (RANKL).
What does this drug do to RANKL?
By inhibiting RANKL, denosumab reduces the activity of osteoclasts and helps to slow down bone resorption (the breakdown of bone).
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Nursing teaching about osteoporosis
What is there a current emphasis on?
Current emphasis is on Primary and secondary prevention.
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Nursing teaching about osteoporosis
Current emphasis is on Primary and secondary prevention:
What is included?
programs to prevent fractures:
Risk identification
Patient teaching
Care coordination
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Nursing teaching about osteoporosis
Current emphasis is on Primary and secondary prevention:
What must programs include?
programs must include nutritional intake: calcium 1000mg & vitamin D 800i.u ,
physical activity to maintain muscular skeletal function and reduce the risk of falls and patient education regarding osteoporosis and fall prevention.
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Risk Factors That Affect Safe Mobility
What do facilities do for fall prevention?
Facilities fall prevention: fall history and fall risk assessment of each client is done on admission and with any change in pt. status
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Risk Factors That Affect Safe Mobility
Risk factors of falls include:
History of falls
Use of walking aids
Pathologic conditions and functional and cognitive impairments (can affect vision, balance, mobility)
Medication effects (prescription and OTC)
Environmental factors (hazards relate to safety)
Physical restraints ( no longer used for fall prevention) *bedrails that a pt. can’t lower themselves are considered restraints *Restraints cause injury/ fatalities
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Which statement related to risk factors for falls and the older adult is true?
A. Falls are most often the result of an isolated risk factor
B. The risk of falling increases in proportion to the number of risk factors
C. Risk factors for falls do not vary according to the environment
D. Functional abilities of the older adult are not considered a risk factor for falls
B. The risk of falling increases in proportion to the number of risk factors
Falls are the result of a combination of risk factors rather than one isolated risk factor, and the risk of falls increases in proportion to the number of risk factors
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Functional Consequences Affecting Musculoskeletal Wellness include:
Effects on musculoskeletal function
Susceptibility to falls and fractures
Fear of falling (FES-I Fall Efficacy Scale International)
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Functional Consequences Affecting Musculoskeletal Wellness include:
Effects on musculoskeletal function: like?
Diminished muscle strength,
endurance, and coordination,
increased difficulty performing ADLs
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Functional Consequences Affecting Musculoskeletal Wellness include:
Susceptibility to falls and fractures: what kind of injuries?
Osteoporotic (Fragility) fractures,
increases with age,
serious consequences ( Hip # most common)
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Functional Consequences Affecting Musculoskeletal Wellness include:
Fear of falling (FES-I Fall Efficacy Scale International)
Excessive anxiety about falling—activity avoidance decline in functioning
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Functional Consequences Affecting Musculoskeletal Wellness include:
risk factors for Fear of Falling:
female,
older age,
Hx of falls,
dependency in ADL’s
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Functional Consequences Affecting Musculoskeletal Wellness
From BMC Geriatrics June 2021 -
Fear of falling seems to be as important as multiple previous falls in terms of limiting older adults’ daily activities
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Functional Consequences Affecting Musculoskeletal Wellness
FES-I ( Falls Efficacy Scale-International): What is it?
which is a widely used self-report measure designed to assess an individual's confidence or fear of falling.
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Functional Consequences Affecting Musculoskeletal Wellness
FES-I ( Falls Efficacy Scale-International): What is it used to evaluate?
The scale is used to evaluate the perceived balance and mobility-related concerns of older adults and their confidence in performing daily activities without falling.
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Functional Consequences Affecting Musculoskeletal Wellness
FES-I ( Falls Efficacy Scale-International): What is the minimum score? What is the maximum score?
Minimum score: 16 ○ No fear of falling
Maximum score: 64 ○ Severe concern of falling
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Functional Consequences Affecting Musculoskeletal Wellness
FES-I ( Falls Efficacy Scale-International):
What is a low concern score? What is moderate? What is high?
● Low concern: 16-19;
Moderate concern: 20-27;
High concern: 28-64
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Validated instruments for fall risk include:
MAHC 10 Fall Risk Assessment:
Hendrich II: health care setting
TUG: home/community setting
174
Validated instruments for fall risk include:
MAHC 10 Fall Risk Assessment: Where is it used?
used in the home setting
175
Validated instruments for fall risk include:
MAHC 10 Fall Risk Assessment:
What score indicates a risk for falls?
score > 4 indicates risk for falls.
176
Validated instruments for fall risk include:
Hendrich II:
Where is it used?
What score indicates a risk for falls?
health care setting
score > 5 indicates high risk for falls.
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Validated instruments for fall risk include:
TUG:
Where is it used?
What score indicates a risk for falls?
TUG: home/community setting
score of > 12 seconds indicates risk for falls
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Slide 27 and slide 28
179
Which statement related to musculoskeletal function and the older adult population is true?
A. There is a greater decline in muscle strength in the upper extremities
B. Diminished muscle strength is attributed primarily to age-related loss of muscle mass
C. Older adults experience muscle fatigue after longer periods of exercise than do younger adults
D. Lifelong patterns of exercise and activity have little effect on muscle strength
B. Diminished muscle strength is attributed primarily to age-related loss of muscle mass
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Diminished muscle strength is attributed primarily to age-related loss of muscle mass
At what age does muscle strength gradually decline?
Beginning at about the age of 40 years, muscle strength declines gradually, resulting in an overall decrease of 30% to 50% by the age of 80 years
181
Diminished muscle strength is attributed primarily to age-related loss of muscle mass
Where does greater decline in muscle strength occur?
With a greater decline in muscle strength in the lower extremities than in the upper extremities
182
Pathologic Condition Affecting Musculoskeletal Function: Osteoarthritis
What is it?
Osteoarthritis: degenerative inflammatory disease affecting joints and attached muscles, tendons, and ligaments (localized) -----(RA –systemic)
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Pathologic Condition Affecting Musculoskeletal Function: Osteoarthritis
Presentation?
Presentation:
initial symptoms pain with joint movement (could be asymmetrical at first) swelling (*no redness) and limited movement of joints -
Bony appearance of joints,
Crepitus (a grating sound on movement),
Range of motion deficit,
overall Muscle weakness.
Heberden’s and Bouchard nodes.
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Pathologic Condition Affecting Musculoskeletal Function: Osteoarthritis
When is stiffness worse?
Stiffness in OA is worse right after the patient rests and decreases with joint movement.
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Pathologic Condition Affecting Musculoskeletal Function: Osteoarthritis
Affects what joints?
osteoarthritis affects several joints rather than a single one.
Weight-bearing joints are most affected, the common sites being the knees, hips, vertebrae, and fingers.
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Pathologic Condition Affecting Musculoskeletal Function: Osteoarthritis
Risk factors?
Female (estrogen reduction w/menopause)
Trauma,
genetics,
low vitamin D and C levels,
obesity, and age-related changes,
individuals whose work involves repetitive movements and lifting/professional sports.
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Pathologic Condition Affecting Musculoskeletal Function: Osteoarthritis
What is used to manage symptoms and improve overall quality of life?
While it might seem counterintuitive, regular physical activity and movement can be beneficial for managing the symptoms and improving the overall quality of life for people with OA.
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Pathologic Condition Affecting Musculoskeletal Function: Osteoarthritis
Noninflammatory joint disease (osteoarthritis)---different from RA --
With OA we have :
lack of synovial inflammation
absence of systemic manifestations
normal synovial fluid
189
Pathologic Condition Affecting Musculoskeletal Function: Osteoarthritis
How does this happen?
Cartilage thins --> underlying bone (subchordal bone) is no longer protected
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Pathologic Condition Affecting Musculoskeletal Function: Osteoarthritis
Cartilage thins --> underlying bone (subchordal bone) is no longer protected
How does this happen?
Disequilibrium between destructive and synthesis elements lead to a lack of homeostasis necessary to maintain cartilage, causing joint damage
191
Pathologic Condition Affecting Musculoskeletal Function:
RA: what is the process of inflammation?
The process of inflammation is very Different from RA –in RA synovial membrane becomes inflamed and thickened, fluid builds up and joints erode and degrade.
192
Pathologic Condition Affecting Musculoskeletal Function: How does RA differ from OA?
Rheumatoid arthritis is a chronic inflammatory disorder that can affect more than just joints.
In OA --Inflammation is limited to a joint.
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Pathologic Condition Affecting Musculoskeletal Function:
What is important to know about pain of OA?
*OA is a condition long thought to be characterized by damage to the cartilage and bone; however, as with many other pain diagnoses, there is frequently little correlation between damage seen on radiographs and the amount of pain that patients experience,” according to an article published online in The Journal of Family Practice.
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Nursing Treatment Focus -OA
For pain?
For pain –Thermal Tx (Heat/Cold)
NSAID’s (Aleve, Advil)
Diclofenac,
Acetaminophen (Tylenol)
capsaicin cream (Zostrix)
Diclofenac Sodium (Voltaren Gel)*
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Nursing Treatment Focus -OA
*According to an article published online in The Journal of Family Practice, for patients with OA treatment should be how?
*According to an article published online in The Journal of Family Practice, for patients with OA treatment should be multimodal and include interventions targeted at halting the progression of damage as well as palliation of pain.
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Nursing Treatment Focus -OA
Which medication is likely most beneficial in the setting of acute flare-ups of pain?
Diclofenac,
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Nursing Treatment Focus -OA
What to be aware of for NSAID’s (Aleve, Advil)?
*Renal toxicity, GI bleed
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Nursing Treatment Focus -OA
How much acetaminophen in a day maximum?
Acetaminophen (Tylenol) *No more than 4 g/24h (1 g 6 hours) (Liver damage)
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Nursing Treatment Focus -OA
capsaicin cream (Zostrix): How can it be taken?
capsaicin cream (Zostrix) *can be taken as a combo tx with the above medications * Not to be used with external heat source (heating pad) can cause burns
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Nursing Treatment Focus -OA
Diclofenac Sodium (Voltaren Gel)*; What should be avoided when taking this?
Diclofenac Sodium (Voltaren Gel)*Avoid sun and UV light * should not be used with ASA or oral NSAID’s
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Nursing Treatment Focus -OA
Nursing Focus: self-care health education interventions:
maintain ideal weight, avoid high impact activities, engage in strengthening exercise programs (Tai Chi), sturdy shock absorbing shoes, use orthotics support, use assistive devices as appropriate (walker /cane etc.)
Referral to OT/PT
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Nursing Treatment Focus -OA
All treatment plans for OA should also include:
All treatment plans for OA should also include exercise, weight reduction, and self-management, in addition to pharmacologic interventions, to reduce both the micro-inflammation and the centralized pain component (when present).
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Nursing Treatment Focus -OA
Thermal Heat: Heat therapy
Heat therapy is generally more effective for soothing muscle stiffness and promoting relaxation.
It can be especially helpful for easing the discomfort associated with osteoarthritis in the joints.
Use heat when muscles feel tense, and patient wants to increase blood flow to the affected area
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Nursing Treatment Focus -OA
Thermal treatment: Cold therapy
Cold therapy is more effective for reducing inflammation, swelling, and acute pain.
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Nursing Treatment Focus -OA
Slide 34
