Musculoskeletal Disorders: 10 questions Dr. Elliott Flashcards
What is Osteoporosis?
bone breakdown faster than building
A chronic metabolic bone disorder that results in low bone density.
Bone demineralization results in more bone breakdown/resorption (osteoclastic activity) versus bone building (osteoblastic activity).
This results in decreased density of the bone, fragile bones, and increased risk for fractures (hip, wrist, vertebral, etc.)
Relationship between osteopenia and osteoporosis.
What are you going to do when you know a patient has osteopenia?
Osteopenia is the precursor to osteoporosis and refers to low bone density relative the patient’s and sex. (WOMEN)
Bone mineral density peaks between the ages of 18-30.
After the peak years, the is a significant rate of loss in postmenopausal patients due to estrogen loss
Need to teach pt about risks and what it means in term of them developing osteoporosis
Risk factors? osteoporosis
Don’t’ just memorize the risk factors. Make sure you understand them from a nursing perspective. How do you use risk factors in the assessment and when teaching patients?
> 65 years old
Familial history
Thin, lean body build
Low calcium and vitamin D intake
Low estrogen levels
Low testosterone levels
Lack of exercise
Prolonged immobility
More risk factors for osteoporosis?
Tobacco smoke exposure (active or passive)
High alcohol intake (three or more drinks per day)
Limited protein intake
Excess caffeine consumption causes excretion of calcium in the urine.
High phosphorus intake increases the rate of calcium loss.
Drinking more than 40 ounces/day of carbonated beverages increases osteoporosis risk
Clinical manifestations (osteoporosis)
What is your role with clinical manifestations as a registered nurse? As I stated in class, you know them…. So you can assess for them. You also need to teach them to patients/significant others.
Early manifestations:
Back pain
Spontaneous fractures
Occurs most commonly in bones of the spine, hips, and wrists
Reduced height of 2-3 inches
Acute back pain after lifting or bending (relieved by rest)
Kyphosis
If have one vertebral fracture, risk for having a second one within a year
Pain when palpating the affected area
Diagnostic tests- make sure you know “WHY” the tests are ordered for osteoporosis?
Blood tests
-Calcium
-Phosphorus
-Vitamin D
X-rays- can reveal bone density and presence of fractures
helps in process of diagnosis
Bone Density Testing
DEXA
Scan specifically used to determine bone density
recommend an initial bone density
-women over 65
-men over 70
Medicare will pay for this every other year
If younger and have ↑ risks, they need to be test earlier but wont need to be tested again until another 15 yrs
Treatment and management-
Diet—food sources
- Daily calcium intake:
-Dairy products, such as cheese, milk and yogurt - Dark green leafy vegetables:
broccoli and kale - Fish with edible soft bones:
Sardines and canned salmon - Calcium-fortified foods and beverages:
soy products, cereal and fruit juices, and milk substitutes
Lifestyle changes- Keep in mind that there are safety issues with osteoporosis.
Smoking cessation
Limit alcohol and caffeine intake
NO Diuretics ↑ calcium loss in urine
Regular weight-bearing exercise such as walking, tennis and jogging, and strength-training like weight lifting
*Teach importance of safety in home
Treatment & Management/Drug Therapy
Drugs- why are they given, what are significant side/adverse effects. What will you teach?
- Hormone Replacement Therapy- Estrogen and progesterone
–May increase risk of breast cancer, CVD & stroke - Vitamin D supplements
- Bisphosphonates- inhibit bone resorption
-Alendronate (Fosamax) - daily or weekly oral tablet
-Ibandronate (Boniva) - monthly oral tablet or every 3 months intravenous infusion.
-Risk for esophagitis and esophageal ulcers when taken by mouth (report any indigestion, dysphagia, bloody emesis)
-Take early am with 8 oz water & wait 30 minutes before eating
Calcium? how to take
Difficult to absorb in doses greater than 500 mg.
TAKE WITH MEALS OR SNACK
divide doses throughout the day
What is osteoarthritis?
-A degenerative joint disease
-Occurs when the cartilage covering the articular surfaces of the joints becomes damaged.
Most commonly affected:
-Weight-bearing joints (hips and knees)
-Hands
What are the risk factors?
osteoarthritis
Older age- joints changes may be visible on x-ray
Overuse of joints
-What group of individuals fall into this category? (athletes)
Positive family history/Genetics
Obesity: weight-bearing joints
Clinical manifestations
osteoarthritis
Gradual onset (over a period of years)
Pain/Discomfort in the affected joint
Pain with joint palpation or range of motion
-There may be atrophy, loss of function, limp when walking/altered gait, and restricted activity due to pain.
Pain is aggravated by overuse/use of the joint.
**Early morning joint stiffness with inactivity (after rest)
Swelling
Redness and/or Heat
Crepitus(hear sound of bone on bone)
Vertebral radiating pain affected by cervical or lumbar compression of nerve roots.
Back pain (OA of the spine)
Joint effusion (excess joint fluid) that is easily moved from one area of the joint to another area.
May be unilateral (right hip only).
Bone spurs may be present
other symptoms of osteoarthritis
Bouchard’s nodes
-Bony nodules on the proximal interphalangeal joints (PIP)’
Heberden’s nodes
-Bony nodules on the distal interphalangeal joints (DIP)
(inspect and palpate to find these)
