Ch 71 Osteoporosis

Question 0

What are some health promotion and disease prevention techniques for a client with osteoporosis?

Answer 0

Ensure the clients diet includes adequate amounts of calcium & vit D
Encourage the client to take a calcium supplement with vit D if dietary intake is inadequate (lactose intolerant)
Encourage the client to limit the use of carbonated beverages, which may cause calcium loss.
Encourage the client to expose areas of skin to sun 5-30 min twice a wk./ exposure to sun for any length of time should include wearing sunscreen to avoid a sunburn.
Encourage the client to express pros& cons of hormone replacement therapy postmenopausally with her provider
Encourage the client to engage in weight bearing exercises (walking, lifting weight)

Question 1

Give a overview of osteoporosis.

Answer 1

Osteoporosis is a common chronic metabolic BONE DISORDER, resulting in low bone density.
Osteoporosis occurs when the rate of bone reabsorption ( osteoclast cells) exceeds the rate of bone tissue and subsequent fractures.
Osteopenia, the precursor to osteoporosis refers to low bone material density relative to the clients age and sex.
Bone mineral density peaks between the ages of 18-30. After peak years, bone density decreases with a significant increase in the rate of loss in post menopausal women due to estrogen loss.

Question 2

What are the risk factors for developing osteoporosis?

Answer 2

Female gender, family history, & thin lean body build are precursors to low bone density.
A woman over 60 with postmenopausal estrogen deficiency/low levels of calcitonin OR is a male with low testosterone; increased bone loss may occur.
Hx of low calcitonin intake with suboptimal levels of vit D decreases bone formation.
Hx of smoking and high alcohol intake (3 or more drinks per day) causes decreased bone formation & increased bone absorption)

Question 3

What causes excretion of calcium on the urine?

Answer 3

Excess caffeine consumption

Question 4

What does inadequate intake of calcium and vitamin D in the diet stimulate?

Answer 4

It stimulates the parathyroid hormone to be released and triggers calcium to be pulled from the bone.

Question 5

What are more risk factors for developing osteoporosis?

Answer 5

Excess caffeine consumption
Inadequate intake of calcium and vit D
lack of physical activity/ prolonged immobility place the client at risk for,osteoporosis because bones need the stress of wt. bearing activity for bone rebuilding and maintenance

Question 6

What medical conditions does secondary osteoporosis result from?

Answer 6

Hyperparathyroidism
Long term corticosteroid use (asthma, systemic lupus erythematous)
Long term anticonvulsant med use ( phenytoin [Dilantin] & phenobarbital affect the absorption and metabolism of calcium)
Long term lack of weight bearing ( spinal cord injury)

Question 7

What are clinical manifestations of osteoporosis?

Answer 7

Reduced height ( postmenopausal)
Acute back pain after lifting or bending(worse with activity, relieved by rest)
Restriction in movement and spinal deformity
Hx of fractures (wrist, femur, thoracic spine)
Thoracic ( kyphosis) of the Dorsal spine
Pain upon palatial over affected area

Question 8

What laboratory test; tests the diagnosis of osteoporosis?

Answer 8

Serum calcium, Vit D, phosphorus, & alkaline phosphatase levels are drawn to rule out other metabolic bone diseases ( Paget’s disease or osteomalacia)
Thyroid tests and serum protein level also are checked to rule out hyperthyroidism

Question 9

What diagnostic procedures diagnose osteoporosis?

Answer 9

Radiographs
Radiographs of the spine and long bones reveal low bone density and fractures.

Dual X- Ray absorptiometry (DXA)

Peripheral quantitative ultrasound ( pQUS)

Quantatative computed tomography (QCT)

Question 10

What is DXA used 4?

Answer 10

A DXA scan is used to screen for early changes in bone density and is usually done on the hip or spine.
A peripheral DXA scan is used to assess the bone density of the heel, forearm, or finger.
DXA uses 2 beams of radiation. Findings are analyzed by a computer and interpreted by a radiologist. Clients receive a score that relates their amount of bone density to other ppl in their age group and gender.
The pt will lie on table while a scan of the selected area is done.

Question 11

What is peripheral quantative ultrasound?

Answer 11

pQUS is an ultrasound usually of the heel, tibia, & patella.
pQUS mis an inexpensive, portable, and low risk method to determine osteoporosis and assessing for risk of fracture, especially in men over age 70 years.

Question 12

What is quantative computed tomography used for?

Answer 12

A QCT is used to measure bone density, especially in the vertebral column.

Question 13

What should the nurse educate the client on regarding bone formation?

Answer 13

Instruct the client on the need for adequate amounts of protein, magnesium, vit K, and other trace minerals needed for bone formation?

Question 14

What meds can slow or prevent osteoporosis?

Answer 14

Meds such as calcium and vit D can slow, or prevent osteoporosis. A combination of several of these meds may b used in place of just one.

Question 15

What is the therapeutic intent of thyroid hormones-
calcitonin human,calcitonin salmon ( Miacalcin, Fortical)?

Used for osteoporosis

Answer 15

Decreases bone reabsorption by inhibiting osteoclast activity for prevention & treatment of osteoporosis, hypercalcemia, and Pagent’s disease of the bone.

Nursing considerations;
Calcitonin human can only be administered subcutaneously
Calcitonin salmon can b administered subcutaneously, IM and intranasally.

Question 16

What is the therapeutic intent of Teriparatide ( Forteo)?

** used for osteoporosis**

Answer 16

A parathyroid hormone that stimulates osteoblasts to increase new bone formation to increase bone mass.
Stimulates calcium absorption

Nursing considerations**
Administered only SQ
Contraindicated if hypercalcemic
Report leg cramps or bone pain to the provider.

Question 17

Estrogen hormone supplements-
Estrogen( Premarin) estrogen and medroxyprohesterone(Prempro)

** used to treat osteoporosis**

Answer 17

Therapeutic intent
Replaces estrogen lost due to menopause or surgical removal of ovaries.

** nursing considerations**
Instruct client on potential complications, including breast and endometrial cancers & DVT.
reinforce monthly breast self exams
Estrogen should be given along with progesterone in woman who still have their uterus.

Question 18

Name a estrogen agonist/ antagonist.

** used for osteoporosis**

Answer 18

Raloxifene hydrochloride (Evista)

Therapeutic intent
Decreases osteoclast activity, subsequently decreasing bone reabsorption and increasing bone mineral density.
Treats post menopausal osteoporosis as well as breast cancer.

** nursing considerations**
Avoid use in clientS with a hx of DVT
monitor liver function tests
Instruct client on the need for calcium and Vit D supplements
monitor and instruct client to report unusual calf pain or tenderness to the provider.

Question 19

Calcium supplement- calcium carbonate (Os-Cal, Caltrate 600) calcium -citrate (citracal)

** used for osteoporosis**

Answer 19

Therapeutic intent

Supplements calcium that is consumed in food products to promote healthy bones. ( not to slow osteoporosis)

** nursing considerations**

Give with food in divided doses with 6-8 oz of water
Calcium supplements may cause G.I. upset
Monitor for kidney stones

Question 20

What is the therapeutic intent of vitamin D supplements

Answer 20

Increases absorption of calcium from intestinal tract and availability of calcium in the Serum need it for re-mineralization of bone
Needed in individuals who are not exposed to adequate amounts of sunlight or he did not meet it’s daily requirements

Nursing considerations
Vit D is a fat soluble vitamins so toxicity can occur symptoms of toxicity include weakness fatigue nausea constipation and kidney stones

Question 21

Biphosphonates (inhibit bone resorption)

-alendronate (Fosamax), ibandromate ( Boniva), risedromate ( Actonel)

Answer 21

Nursing considerations
Risk for esophagitis and esophageal ulcers report early signs of indigestion chest pain difficulty swallowing blood emesis to provider immediately
Take with 8oz of water in the early morning before eating
Remain right for 30 minutes after taking medication

Question 22

Most hip fractures are due to what?

Answer 22

Repair or joint arthroplasty requires physical therapy for a full recovery

Question 23

What is available for immobilization of the spine after a compression fracture of the spine

Answer 23

Orthotic devices
The devices support and decreases pains
A physical therapist fits the device and teaches him how to apply it .

Teach them
Wit to log roll when getting OOB
ENCOURAGE CLIENT TO USE HEAT PADS AND BACK RUBS TO PROMOTE MUCLE RELAXATION.

Question 24

What are surgical interventions for osteoporosis

Answer 24

Joint repair or John arthroplasty maybe necessary to repair or replace a joint weakened by osteoporosis this is most often on the hip joint
Vertebroplasty or kyphoplasty are minimally invasive procedure performed by a radiologist.
Bone cement is injected into the fractured space of the veteran column with or without balloon inflation. Balloon inflation of the fracture is to contain the cement and add height to the fractured vertebra.

Question 25

What happens when a client undergoes vertebra or kyphoplasty?

Answer 25

Mild sedation is used
Client lies in a supine position for 1-2 hr following procedure
Monitor vital signs for SOB & the puncture site for bleeding
Complete a neurological assessment
Apply cold therapy to the injection site

Question 26

What is the Leading cause of osteoporosis?

Answer 26

Fractures

Question 27

What food are rich in Vit D?

Answer 27

Most fish
Egg yolks
Fortified milk
And cereal

Question 28

What foods are rich in calcium?

Answer 28

Milk products
Green vegetables
Fortified orange juice
Cereals
Red and white beans
Figs

Question 29

A nurse is admitting an older adult client who,has suspected osteoporosis. What is an expected clinical finding.

Answer 29

Loss In height of 2 in (5.1cm)
Body mass index of 21 due to low body weight and thin body build
Kyphosis curve at upper thoracic spine( due to fractures of the vertebra causing the curve)
Hx of lactose intolerance( due to possible lack of calcium intake)

Question 30

A nurse is performing health screenings of clients at a health fair; what clients are at risk of osteoporosis?

Answer 30

1. A 40 yr old client who takes prednisone ( Deltasone) for asthma
   (Prednisone affects the absorption & metabolism of calcium & places the client at risk.
2. A 45yr old who takes phenytoin seizures also affects the absorption and metabolism of calcium & places client at risk.
3. 65yr old with sedentary lifestyle
   4.
   Client who smoked for 50 yrs.

Question 31

A nurse is providing dietary teaching about calcium rich foods to a client with osteoporosis; what foods should the nurse include?

Answer 31

WHITE BEANS
Red beans
Figs 
fortified juice & cereals
Green vegetables 
Milk products

Question 32

When providing care 4 a client who had a vertebroplasty of the thoracic spine, what is an appropriate action of the nurse?

Answer 32

Place the client in a supine position
The client should remain in a supine position with bed flat for,the 1 st 2hr following the procedure to decrease bleeding and swelling following the procedure.