Exam 2 Flashcards
What are some risk factors for Osteoporosis?
Greater than 65 years old female gender low bodyweight white/Asian ethnicity Current cigarette smoker in active lifestyle family history diet low in calcium or vitamin D excessive alcohol use Postmenopausal Long term corticosteroid/Dilantin use
This type of fracture is due to a disease like Osteoporosis?
Pathological fracture
___[1]___ break down bone tissue for use in remodeling. ___[2]___ build bone tissue.
1-Osteoclasts
2-Osteoblasts
___[1]___ Osteoporosis is when the disease is gotten through natural means.
___[2]___ Osteoporosis is when the disease is gotten through unnatural means like alcohol/corticosteroid use.
1-Primary
2-Secondary
What do these Clinical Manifestations indicate? Kyphosis short stature Pain Unexplained fractures Anxiety/Fear Isolation
As a Nurse, what can you emphasize to help with this disease?
- osteoporosis
- Nutrition (⇧Ca/VitD/Mg), Exercise (Except High Impact), and Drug Therapy.
2 Surgical Interventions for Osteoporosis?
And what do they entail?
- Vertebroplasty: Bone cement is injected into collapsed vertebrae. (Stabilizes; Does not Correct)
- Kyphoplasty: Air bladder is inserted into collapsed vertebra to correct height and then bone cement injected. (Stabilizes/Corrects)
Walking __[1]__ mins [2]-___ times per week helps strengthen bone.
1: 30 min
2: 3-5
What drug therapy is used to treat Osteoporosis?
Estrogen/hormone replacement calcium/Vit D calcitonin Testex Evista (Estrogen Receptor Modulator) Boniva (Biophosphonate) Actonel (Biophosphonate) Fosamax (Biphosphonate)
_____ affects 1-2% of the total Population, affects 3X more women than men, and most frequently occurs between 30-60 years of age (Or 2-5 or 9-12 years old).
-Rheumatoid arthritis
_______ Lines the joint cavity and is the joint space and the fluid contained there.
Synovium
What is the Pathological process of RA?
- Autoimmune
- Inflammation of Synovium
- RBC’s flow into inflamed space where it accumulates
- Pannus Forms (Sheet of Inflamed Granulated Tissue)
What is JRA and what are the 3 Types?
-Juvenile rheumatoid arthritis
➢Pauciarticular:
Affects the knees, ankles, and elbows; more frequent in females
➢Systemic:
characterized by high fever, polyarthritis, rheumatoid rash, joints and internal organs; affects males and females equally
➢Polyarticular:
Involves five or more joints (usually small joints in the fingers and hands may also involve ankles, knees, feet, hips and neck.
Clinical Manifestations of JRA?
➢Limping ➢Favoring a particular joint ➢c/o pain ➢Uneven growth in a limb ➢Swelling in large joints (knee) ➢Loss of motion and stiffness ➢Fever ➢Rash ➢Lymphadenopathy ➢Hepatomegaly ➢Splenomegaly ➢Main Complication – interference with growth and dev’t
______ ________Can Occur in 10-15% of Patients with RA, which results in ⇣Lacrimal/Salivary gland secretion.
Sjogrens Syndrome
Laboratory Manifestations for RA
- Rheumatoid Factor +if RA & -if OA
- ⇡ESR: indicates Inflammation
- ⇣Albumin
Diagnostics for RA?
- X-Ray (Joint changes)
- CT scan (Cervical Spine involvement)
- Athrocentesis
Drugs used to treat RA?
Disease-Modifying Antirheumatic Drugs (DMARDS)
(ex: Methotrexate, Sulfasalazine, Leflunomide, Penicillamine)
NSAIDS
Corticosteroids
Immunosuppresives
(ex: Imuran, Cytoxan, Cellcept)
Nursing Interventions for RA include?
---Pain Relief--- •Rest •Proper positioning •Ice/heat •Adequate nutrition – avoid obesity •Promotion of self care •In acute exacerbation w/joint pain and swelling in hands Hot packs or heated paraffin wax application before exercise will decrease Joint Pain
—Alternatives—
•Hypnosis
•Acupuncture
•Stress management
As a Nurse, what are some Teaching topics for RA?
➢Balance activity with rest ➢Pace yourself ➢Set priorities ➢Delegate responsibilities ➢Plan ahead ➢Children; ongoing PT; Camp
In this disease, urate crystals deposit in the joints and other tissues causing inflammation.
What’s the difference between Primary and Secondary?
- Gout
- Primary: Uric Acid Production Exceeds Normal excretion by kidneys (40-50yo M/Post-mena W)
- Secondary: Uric Acid levels normal but excretion is ⇣
Clinical Manifestations of Gout?
- Swelling inflammation painful joints
- Tophi – hard irregularly shaped nodules in the skin
- Low grade fever
- Malaise
- Headache
- Pruritis
- Renal stones; Depends on type of gout
- Big toe typically affected
RN Interventions for Gout?
- Low purine diet (Avoid;Sardines, Mussels,Venison, Kidney/liver, Goose)
- 2000ml/day fluid
- Decrease weight if needed
- Avoid alcohol and starvation diets
- BR during acute attack; elevate extremity
- Protect affected joint
- Provide hot-cold
Drug interventions for Gout?
•For Acute gout
➢colchicine, Zyloprim, Uloric
➢NSAIDS (ibuprofen, indocin)
•For Chronic – promote excretion of uric acid
➢Zyloprim/Allopurinol
➢Probenecid
(Avoid ASA; causes Uric Acid Retention)
This Disease is a progressive joint deterioration of the articular cartilage that affects weight bearing joints. It is not a result of inflammation, and it is not systemic.
Osteoarthritis