Musculoskeletal Flashcards
osteoporosis patho
- chronic metabolic disease in which bone loss causes decreased density and possible fracture
- occurs when osteoclastic activity is greater than osteoblastic activity
osteoporosis risk factors (6)
- older age
- low body weight, thin build
- low calcium/vitamin D intake
- estrogen/androgen deficiency - ex. menopause
- alcohol intake
- lack of physical exercise, prolonged immobility
daily calcium and vitamin D intake
calcium: 1200 mg/day
vit D: 800 mg/day
osteoporosis physical/psychosocial assessment (4)
- Dowager’s hump
- loss of height
- back pain
- fallophobia
labs for osteoporosis
- serum calcium, vitamin D, phosphorus - rule out secondary causes/other bone diseases
how do you diagnose osteoporosis?
- dual x-ray absorptiometry - measures bone mineral density
T score:
• -1 to -2.5 = osteopenia
• < -2.5 = osteoporosis
nutritional therapy for osteoporosis
- calcium and vitamin D intake/supplementation - milk, leafy greens, legumes
- protein, magnesium, vitamin K and other minerals also important
teaching for calcium/vit D supplementation
can cause GI side effects, constipation - take with lots of water
lifestyle changes for osteoporosis
- muscle strengthening and weight bearing exercises - walk 30 mins 3-5 times/week
- smoking cessation
drug therapy for osteoporosis (3)
- calcium/vitamin D - Os-Cal, Citracal
- selective estrogen receptor modulator (SERM) - Raloxifine
- biphosphonates - alendronate (Fosamax)
teaching for biphosphonates
- side effect: esophagitis
- take on empty stomach first thing in the morning w/ full glass of water, remain upright for 30 mins
osteoarthritis patho
- joint pain and loss of function characterized by progressive deterioration and loss of cartilage in the joints
- “wear and tear” of joints
osteoarthritis physical assessment (6)
- chronic joint pain/stiffness
- tenderness with palpation/ROM
- enlarged joints - Heberden’s and Bouchard’s nodes
- joint effusion
- atrophy
- loss of function
goal of osteoarthritis treatment
relieve pain and minimize functional disability
medications for osteoarthritis (6)
- acetaminophen = drug of choice
- NSAIDs
- lidoderm patch
- cortisone injections
- hyalunorate injections (Synvisc)
- muscle relaxants
non-pharmacological treatments for osteoarthritis (4)
- rest and positioning
- hot/cold application
- weight control
- complementary/ alternative therapies
surgery for osteoarthritis
total joint arthroplasty
total hip replacement precautions (4)
- don’t stand or sit for long periods of time
- don’t flex hip more than 90 degrees
- keep abducted - pillow between legs
- avoid internal rotation
post-op care for joint replacement (7)
- prevent dislocation
- monitor for infection
- prevent thromboembolic complications
- assess for bleeding
- assess neurovascular status (6 P’s)
- pain management
- encourage ambulation ASAP
what do you do for a hip fracture before surgery?
immobilize immediately to prevent further damage - ex. Buck’s traction
surgery of choice for hip fracture
open reduction internal fixation (ORIF)
complications after hip fracture repair (7)
- dislocation
- necrosis of femoral beck
- infection of incision or hardware - beware of sepsis!
- delayed healing
- DVT, PE
- compartment syndrome
- skin alterations
