Chapter 18 MusculoSkeletal Diseases Flashcards
Risk factors for osteoarthritis include
Advancing age which is the strongest factor. Joint trauma, obesity, overuse, familial tendency
This is caused by gradual loss of cartilage at a joint articulation, with resulting development of bony spurs and cysts at the joint margins.
Osteoarthritis, also known as degenerative joint disease.
The joints most commonly affected by osteoarthritis are?
The hands, knees, hips, spine, and feet.
This is the most common symptom which is stiffening of the joint after prolonged inactivity and is called?
Gel phenomenon. The stiffness quickly subsides with movement, usually within 5 to 30 minutes. As further joint deterioration occurs, pain and aching become the predominant symptoms.
As osteoarthritis progresses a grating or creaking noise can be noted with range of motion and this is called?
Crepitus
Patients with osteoarthritis must be educated about what?
The importance of pain control to maintain a steady level of activity. Decreases in activity can lead to muscle atrophy and further loss of functional ability. In addition patients who are deconditioned have a higher risk of fall which can lead to further pain and disability.
This is a reduction in bone mass and strength.
Osteoporosis
Adults reach peak bone mass at about age what?
30
The cycle of bone remodeling takes about how many months?
Four months
What is important in the regulation of normal bone remodeling?
Sex hormones
At what age for men and women do these sex hormones begin to decrease that assist with bone remodeling?
Menopause in women and about age 80 in men
This proceeds osteoporosis and is a bone mineral density loss that is from one standard deviation up to 2.4 standard deviations below normal.
Osteopenia
The patient with a BMD the that reveals greater than 2.5 standard deviations below normal has osteoporosis.
This type of osteoporosis is the most common and is related to factors involving the bone itself.
Primary osteoporosis
This type of osteoporosis is found in which another medical condition is causing the osteoporosis.
Secondary osteoporosis
Primary osteoporosis is divided into type one and type two. This one occurs in both genders age 70 or older as total bone production begins to wane. Cortical bone, which provides strength to the skeleton is lost. Hip fractures are common manifestation.
Type two osteoporosis
This type of osteoporosis is related to estrogen deficiency and is seen in women ages 51 to 75. In this type that trabecular bone in the vertebrae, hips, and wrist become week.
Type one osteoporosis
Some common medical conditions that cause secondary osteoporosis are?
Parathyroid disease, Cushing’s disease, hypogonadism, alcohol abuse, liver disease, hyperthyroidism, etc.
Risk factors for osteoporosis include?
Female gender, increased age, white race, thin body frame, alcohol use, cigarette smoking, excess caffeine, and a diet low in calcium.
Bone mass density should be assessed at least once in all women after age what? And for what age men?
65 for women and age 70 for men
Nurses should suggest Patients discuss DEXA scan with their primary care providers if any of the following are present.
History of a fracture in a patient age 40 or older, family history, cigarette smoker, low BMI, dorsal kyphosis, loss of height
The goal of treatment for osteoporosis is?
To increase bone mass density to prevent hip fracture. For each SD decrement in bone mass density, hip fracture risk increases about twofold.
Management Of osteoporosis includes a diet rich in?
Calcium and vitamin D.
Patients with osteoporosis should be encouraged to?
Quit smoking, drink only in moderation, try to prevent falls. Patients taking PPI such as protonic Nexium and Prilosec should take calcium citrate, which is more easily absorbed in the presence of these agents. Weight-bearing exercise such as walking or low impact aerobics and vigorous water Exercise.
This medication was commonly used for the prevention of osteoporosis in women, although, with a high risk of thromboembolic events and breast-cancer it is less often used. contraindicated in patients with a history of CAD,thromboembolic the start of any type and breast-cancer.
Estrogen
This anti-resorptive medication given for osteoporosis can be associated with atypical femoral fracture with prolonged use. Use with caution in patients with dental or G.I. problems. It works well for both men and women. Can be given daily, weekly or monthly or every three months. Consider stopping after five years.
Biphosphonate (Fosamax, boniva, reclast and actonel) reclast Is contraindicated in patients with present or past history of atrial fibrillation
This anti-resorptive drug for osteoporosis works on the estrogen receptor, it can be used in patients with a history of breast cancer. It is contraindicated in patients with a history of thromboembolic disease.
Evista
This antiresorptive drug comes in a nasal spray that can be used for osteoporosis of the spine.
Calcitonin or miacalcin
This drug for osteoporosis is a rank-ligand inhibitor that stimulates bone growth and decreases bone reabsorption. It comes in an injection form. Prolonged use maybe associated with spontaneous bone fracture and delayed bone healing. Not effective at preventing fractures with multiple myeloma.
Prolix
Stimulates bone growth in individuals both men and women at high risk for fracture because of severe disease. Daily sub Q injections for two years, then followed with biophosphonate therapy. Countraindicated in people with history of radiation to the skeleton.
Parathyroid hormone (forteo)
This drug decreases urinary excretion of calcium thus slowing bone loss. It can be used in patients with concomitant hypertension
Hydrochlorothiazide (maxide, dyazide)
Nursing assessment To determine risk of osteoporosis includes?
Health history, Family history of osteoporosis, and presence of risk factors such as level of exercise, alcohol, caffeine, and smoking. Ask women about previous fractures, menopause, date of last mammogram, and history of gynecological cancer. Assess for kyphosis, gait impairments, and muscle weakness.
Nursing management of patients with osteoporosis include?
Control the pain, relaxation and repositioning techniques, education about the disease, prevention of falls, injuries, and other deformities, stressing importance of smoking cessation and decreasing alcohol, limiting caffeine, and recommending exercise at least every other day for 25 to 30 minutes.
This instrument developed by the World Health Organization can determine the ten year probability of hip, spine, forearm or shoulder fracture on the basis of bone density readings. It helps determine patients who would benefit from aggressive treatment of their osteopenia or osteoporosis.
FRAX
Is a metabolic disease characterized by formation of spongy bone due to an adequate and delayed mineralization.
Osteomalacia
When the thyroid gland is not producing enough thyroxine it is known as?
Hypothyroidism
When the problem with the thyroid gland not producing enough thyroxine occurs at the level of the gland it self it is known as?
Primary hypothyroidism.
If the decrease in hormone function of the thyroid gland occurs because of a problem in the anterior pituitary it is known as?
Secondary hypothyroidism
If the problem of decreased production of hormones by the thyroid gland is caused by the hypothalamus this is called?
Tertiary Hypothyroidism
The most common cause of hypothyroidism in older adults is?
Autoimmune thyroiditis.
Thyroiditis can be brought on by?
Virus, stress, or treatment of certain illnesses, such as Hodgkin’s disease. Previous radiation to the head and neck can render the thyroid nonfunctional, as can oblation of the gland with radioactive iodine or surgery
On occasion, hypothyroidism can be the result of ingesting what?
Lithium, amiodarone, iodine, and kelp
The prevalence of hypothyroidism is higher or lower for women?
Higher for women than in men.
Primary hypothyroidism is characterized by an Elevated level of what hormone and a subnormal serum level of what?
An elevated level of thyroid stimulating hormone otherwise known as TSH, and a subnormal serum free thyroxine T4 level.
Common presenting signs and symptoms of primary hypothyroidism are?
Anorexia, weight loss, unstable gait or balance, arthralgias, muscle aches, weakness, unexplained lipid abnormalities, constipation, depressed affect, mild cognitive impairment. In older adults it’s insidious onset of symptoms are often attributed to getting old.
hypothyroidism in older adults may manifest more serious signs and symptoms than younger adults such as?
Bradycardia, angina, cold intolerance, syncope, muscle cramps, and numbness.
Treatment of hypothyroidism includes replacement of the hormone level thyroxine. Depending on the elevation level of the TSH, the starting dose is usually what?, then on the basis of TSH levels which are checked every eight weeks, the doses titrated up until the TSH is At what level?
25-50mcg/day
TSH of 0.3-3 mlU/L
Nursing assessment for patients with hypothyroidism should include?
Onset and pattern of fatigue, any history of weight or bowel changes, Depression scale, mental status exam,
Nursing management of patients with hypothyroidism include?
Education about the disease process, symptoms, and diagnostic testing that may be needed. Nurses should stress the importance of lifelong therapy and monitoring.
This is excessive secretion of thyroid hormones.
Hyperthyroidism.
This excessive secretion of thyroid hormone is usually associated with an enlarged gland (otherwise known as goiter). In older patients the most common cause is multinodular goiter rather than Graves’ disease which is seen in younger adults.
Hyperthyroidism
Iodine induced hyperthyroidism can be seen with the use of what?
Amiodarone, which is 70% iodine and deposits iodine in the peripheral tissues.
What is commonly seen in the patient with hyperthyroidism as far as their TSH levels and levels of elevated free T4 and T3?
Suppressed TSH and an elevated free T4 and T3
Signs and symptoms of hyperthyroidism include?
Insomnia, increased tremor, bowel movements, weakness, hair loss, heat intolerance, tachycardia, weight-loss, and fatigue. 60% of older adults present with this type for thyroidism. AF Is the most common presentation of hyperthyroidism.
Medical management for hyperthyroidism includes?
Radioactive iodine. This therapy is curative and easily tolerated. Beta adrenergic blocker such as propranolol to control the symptoms of palpitations, tachycardia, and heat intolerance. After ablation patients must be monitored closely for signs and symptoms of hypothyroidism or worsened illness.
assessment for patients with hyperthyroidism include?
Assessment of weight loss, and BMI, fatigue, and cardiac symptoms. Other Comorbid states and medications should be noted.
Nursing management of patients with hyperthyroidism include?
education about the illness, diagnostics, and treatment. Many patients will require anti-thyroid medications: propylthiouracil or Tapazole, Before radioactive therapy. Nurses inform patients of the importance of taking these medications prior to Radioactive iodine therapy. Alert patients to potential for Exopthlamus(eye).