MS - Osteoporosis & Osteomyelitis

Question 1

osteoporosis

Answer 1

*chronic deterioration of bone tissue and density > increases risk for fractures, most common bone disease, public health concern (aging population)

Question 2

osteoporosis: risk factors

Answer 2

primary

• genetics: age/gender, race (caucasian or asian), family history, smaller body frame (<58kg)
• nutrition: low calcium; low vit D intake, high potassium intake, inadequate calories
• lifestyle: sedentary lifestyle, cigarette smoking, excessive alcohol consumption

secondary

• medications: corticosteroid therapy for more than 3 months, antiepileptic, heparin therapy, thyroid hormones
• disease pathology: premature menopause, malabsorptive issues, chronic liver disease, inflammatory bowel disease, rheumatoid arthritis, hyperthyroidism, hyperparathyroidism, previous fracture

Question 3

osteoporosis: pathophysiology

Answer 3

• bone is living, growing tissue
• bone remodeling: osteoclasts break it down with acid & enzymes; osteoblasts rebuild by synthesis & mineralization
• osteopenia (bone loss): osteoclastic activity is greater than osteoblastic activity = decreased bone mineral density (BMD) and greater risk for fractures
• bone mineral density (BMD): decrease in BMD = decreased calcitonin levels (calcitonin decreases osteoclastic activity); decreased estrogen (results in inhibition of bone formation); increase in parathyroid hormone (increases osteoclastic activity and bone turnover) = more porous, brittle, and fragile bones, greater risk for fractures

Question 4

osteoporosis: management

Answer 4

BMD measurement

• dual-energy x-ray absorptiometry (DEXA) scan
• reports T scores of the standard deviations above or below mean of healthy young individual
• low BMD, but not classified as osteoporosis is osteopenia (precursor)

Question 5

osteoporosis: management pt 2

Answer 5

*treatment
prevention > lifestyle changes
*medications
slow progression of bone loss; calcium 1200mg/day; vit D assists calcium absorption 800-1000IU > fortified milk, cereals, egg yolks, saltwater fish, liver; sunlight: 15mins/day for vit D and calcium absorption

Question 6

osteoporosis: management pt 3

Answer 6

*bisphosphonates (-dronates)
alendronate (Fosamax), ibandronate (Bonvia), risedronate (Actonel), Zoledronate (Reclast)/zoledronic acid
stops resorption by inhibiting osteoclastic activity, thereby absorbing calcium phosphate in bone
route: PO tablet
side effects: can cause GI disturbances, dysphagia, and inflammation of esophagus
-instruct client to take sitting upright and stay upright for 30 minutes after ingestion of tablet
*Calcitonin
decreases osteoclastic activity in bone
route: intranasal spray or SQ injection
side effects: can cause rhinitis if given intranasally
assess for hypersensitivity
educate client that flushing and warmth following injection are transient and usually last about 1hr

Question 7

osteoporosis: nursing management

Answer 7

*assess/analyze
"Dowager's hump"
loss of height
back pain
pain w activity
restricted movement
fear of falling
previous fall fracture
*interventions
assess pain, nutrition, activity, fall risk, admin Rx meds, teach med regime & healthy weight

Question 8

osteomyelitis

Answer 8

infection of the bone
can be caused via the bloodstream or through an infected adjacent tissue
*hematogenous
infectious spread via bloodstream; acute cases common in children (85% of all cases)
*non-hematogenous
open to fracture and/or trauma to bone; common with adults open surgical fx or trauma (2-16% of all cases)

acute=evolves over days or weeks
chronic=lasts months or days
diabetes and foot puncture most common chronic osteomyelitis

Question 9

osteomyelitis: pathophysiology

Answer 9

• invasion of the bone and surrounding tissue by bacterial pathogens
• leads to inflammation and increase in vascularity that results in edema
• day to weeks later, thrombus occurs which leads to ischemia and slow necrosis
• necrosis = delayed and superimposed infection or abscess highly probable
• more inflammation and development of sinus tracts between bone and skin

Question 10

osteomyelitis: medical management

Answer 10

*labs
WBC elevation
ESR elevation
CRP elevation first 7 days
blood cultures + (50% cases)
x-rays for chronic 
bone biopsy
*medications
IV antibiotics 4-6 weeks
broad spectrum until susceptibility known
home CVAD
pain management - opioids
*complications
sepsis - amputation
cancer
*surgical intervention
debridement or amputation

Question 11

osteomyelitis: nursing management

Answer 11

*assess/analyze
fever (high)
pain - constant, localized, pulsating 
site tender, swelling, erythema, warmth
irritable, malaise, lethargy
limited ROM
non-weight bearing
poor perfusion
*interventions
assess VS, pain, wound, neurovascular, labs
admin IV abx & analgesics
do thermal therapy, ROM activities
educate pain management, abx therapy, & nutrition therapy