Ch. 42 Flashcards
osteoporosis
- chronic disease of cellular regulation
- bone loss causes significant decreased density and possible fracture (higher risk)
- decreased bone mass density (BMD)
fragility fracture
caused by ostoporosis
osteomalacia
bone loss d/t lack of vit D
osteopenia
loss of bone mass
dowager’s hump
- in the upper thoracic vertebrae
- result of osteoporosis
height change with osteoporosis
lose up to 6 inches in height
- kyphosis
osteoporosis etiology (causes/risk factors)
genetic
lifestyle
environmental factors
nutrition- lack of vit D and calcium
protein deficiency
caucasian or asian decent
thin built
osteoporosis incidence and prevalence
54 million Americans
numbers increase as baby boomers age
females >50 years at higher risk
osteoporosis health promotion/ disease prevention
Teach young women appropriate health and lifestyle practices
Nutrition – Vitamin D
Stop smoking
Lose weight
Avoid alcohol
Limit carbonated beverages
Exercise and weight-bearing exercises: walk 30 min 3-5x/week
osteoporosis assessment: history
fall risk factors
osteoporosis assessment: physical assessment/ s/sx
kyphosis
- think back
osteoporosis assessment: psychosocial
body image
osteoporosis risk factors (hint: ACCESS)
ACCESS
alcohol
corticosteroid use
calcium low
estrogen low
smoking
sedentary lifestyle
osteoporosis after menopause
estrogen drops causing
- dorsal kyphosis
- cervical lordosis
- crush fractures: esp T-8 and below
who is at highest risk for osteoporosis
slender
female
caucasian
alcohol users
smokers
steroid users
most common fractures d/t osteoporosis
hip and colles’ fractures
osteoporosis assessment: lab values
serum calcium
vit D3
osteoporosis assessment: imaging
XR of spine and long bones
DXA scan**
QCT scan
vertebral imaging
MRI
bone densitometry measures
bone mineral density
priority problem for patients with osteoporosis or osteopenia
- potential for fractures d/t weak, porous bone tissue
osteoporosis: plan/interventions
nutrition therapy: high vit D and calcium (dairy)
lifestyle changes: no large quantities of alc, walking/swimming exercise (30 min x3 days/week)
drug therapy
- calcium and vit D pills
- bisphosphonates (1st thing in AM empty stomach, full glass of water in upright position (90°) for 30 min- esophagitis irritation, taken 1x/week)
- alenodronate
osteoporosis care coordination and transition management
- home care management: falls, throw rugs, good lighting
- self-management education
- health care resources
expected outcomes of the patient with/at risk for osteoporosis
- Continues to follow up with DXA screenings as recommended to assess ongoing bone health
- Makes necessary changes in lifestyle to help prevent further bone loss
- Does not experience a fragility fracture due to bone loss
osteomalacia
soft bones often develop d/t vit D deficiency
primary problems with metabolic bone disease
- strength
- risk for fracture
- injury prevention
- nutritional status
metabolic bone disease: interventions
Safety precautions
Medications
Surgical management
Patient teaching
Collaborative health care team roles
Community resources
osteomyelitis
infection in bony tissue
- caused by bacteria, virus, fungi
(exogenous verses endogenous)
bone pain and fever
antimicrobial therapy
osteomyelitis s/sx
Bone pain: unilateral
Fever: >101
Erythema and heat in the area of the infected bone
Elevated WBC count
ESR may raise later in the disease course
osteomyelitis interventions: nonsurgical and surgical
nonsurgical mangement: meds
- IV ABT: 1-2 months (central line/PICC to go home)
- pain meds: usually opioids
- antipyretics: acetaminophen for fever
surgical management: when it becomes chronic, open ulcers; surgical debridement
DXA scan
done to dx osteoporosis and osteopenia
- uses T score
T scores
+1- -1: normal
-1 to -2.5: indicates low bone mass or osteopenia
< -2.5: indicates osteoporosis
