musculoskeletal system + BONE DISEASES Flashcards
What are the pertinent hormones of the musculoskeletal system
+ Growth hormone
+ parathyroid hormone
+ androgens
+ estrogens
+ glucocorticoids
+ calcitonin
+ thyroxine
+ insulin
What are the pertinent minerals of the musculoskeletal system
+ Calcium
+ vitamin D
+ phosphorus
Cells that destroy bone
Osteoclasts
Cells that build bone
Osteoblasts
How many bones are in the human body
206
Physiological changes of aging in the bones
+ Gradual progressive loss of bone mass
+ vertebral collapse
+ Fragility
+ fractures / prone to fractures
+ loss of height
+ kyphosis
+ lots of flexibility
+ pain
+ osteoporosis
Physiological changes of aging in the muscles
+ Fibrosis from increased collagen
+ muscle atrophy and wasting
+ tendons lose elasticity 
+ Loss of strength and flexibility
+ Weakness, fatigue, stumbling, falls
+ Diminished agility
Physiological changes of aging in the joints
+ Cartilage deterioration – progressive
+ thinning intravertebral discs
+ diminished range of motion
+ pain due to nerve compression
Three types of joints
1– diarthrosis: freely moving - wrists, hips
2– synarthrosis: fibrous immovable joints – skull
3– amphiarthrosis: cartilaginous, limited movement – vertebral joints and symphysis pubis
Musculoskeletal assessment for older people
+ Patient history: nutrition health family
+ Skeletal system – physical assessment including assessing for issues related to osteoporosis
+ muscular system: range of motion, atrophy, symmetry, and all the other regular stuff
+ psychosocial: body image affected by pain, deformity, stress
+ current health assessment of common symptoms: pain, body alignment, inflammatory diseases, altered sensation – paresthesias (burning tingling numbness)
+ FRAX - fracture risk assessment tool, joint function (arthritic joints)
+ Assessing To see if assistive devices for movement & stability are needed
What is Osteomyelitis 
Infection of the bone
Who is at risk for osteomyelitis
“BACTERIA + OPPORTUNITY”
+ Older adults
+ IV drug users, dialysis patients, long-term indwelling catheter patients
+ malnourished
+ obesity
+ impaired immune system
+ chronic illness
+ stage four PI: wounds to the bone
+ long-term corticosteroid for immuno suppressant use
+30 days post surgery, 1 year post implant
Diagnostic tests for osteomyelitis
+ WBC
+ ESR
+ CBC
+ C-reactive protein
+ bone culture
+ bone biopsy
+ x/MRI
What bacteria usually causes osteomyelitis
+ Staphylococcus aureus / MRSA
+ Also caused by enterococci, streptococci, pseudomonas
What is the medical treatment for osteomyelitis
+ Heavy antibiotics for long periods of time
+ remove catheters as soon as possible
+ aseptic wound care
+ project management of soft tissue infections
+ bone debridement
What is osteoporosis, Who is at risk
+ Rate of bone resorption by osteoclasts is greater than rate of bone formation by osteoblasts - resulting in diminished bone mass - mainly in older people
+ Small Caucasian women are highest at risk
+ men over 60
+ smoking/drinking
+ poor diet – lacking vitamin D and calcium
+ post menopause
+ low BMI
+ Sedentary lifestyle, and activity
What areas of the body are affected by osteoporosis
+ spine
+ hips
+ wrists
Nursing interventions for someone at risk for osteoporosis
+ Encourage walking three times per week, weight-bearing exercises
+ good body mechanics and posture
+ lots of sunshine
What medication is taken for osteoporosis? What is core drug knowledge for the drug?
+ Fosamax / alendronate
+ Bone resorption inhibitor, biphosphonate
+ Treatment and prevention of postmenopausal osteoporosis, treatment of osteoporosis in men
+ Adverse reactions:
- MAJOR GI AFFECTS, a fib, erythema, blurred vision, abdominal distention/pain, constipation and diarrhea, dyspepsia, esophagitis, gastritis, nausea/vomiting
- Musculoskeletal pain, headache, asthma exacerbation

What tests are performed to diagnose osteoporosis
+ DEXA– Dual energy x-ray absorptiometry
+ BMD – bone mineral density test
+ FRAX - fracture risk assessment tool
+ X-rays
What is most important to teach patience about Fosamax medication
+ Can burn a hole in esophagus
+ must be taken with full glass of water and no food
+ patient must NOT lie down for 30 minutes after taking!!!!
What is osteomalacia
Inadequate mineralization of bone due to deficiency of vitamin D
+ RICKETS (children) - bowed legs
What is important to assess when diagnosing osteomalacia
+ Family history
+ vitamin D and calcium deficiency
Risk factors for osteomalacia
+ Decreased vitamin D from poor nutrition and lack of sun exposure
+ decreased calcium from lactose intolerance and malnutrition
+ renal insufficiency
+ skeletal calcium drained from bone cyst and fibrosis
+ hyperthyroidism
What part of the body is mainly affected by osteomalacia
Leg bones, weight bearing bones
How do you diagnose osteomalacia
+ X-ray
+ serum calcium, phosphate, elevated ALP, creatinine, excretion of calcium
+ bone biopsy
Signs and symptoms of osteomalacia
+ Bone pain
+ muscle weakness
+ bowed legs
+ skewed gait
How do you treat Osteomalacia
+ Find causative issue: kidney disease, supplementation, exposure to light, dietary
+ braces, surgery
Who is at risk for osteomalacia
+ Elderly
+ homebound
+ poor
+ malnourished
