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MED. SURG 2 > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

Risk Factors 1

A
  • > 65 y/o
  • female gender
  • low body weight
  • cigarette smoking
  • nontraumatic fracture
  • inactive lifestyle
  • family hx of osteoporosis
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2
Q

Risk factors 2

A
  • diet low in calcium or vit. D
  • excessive alcohol ( >2 drinks a day)
  • postmenopausal
  • White and Asian American descent
  • low testosterone in men
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3
Q

Risk Factors 3

A

many drugs can interfere w/ bone metabolism
- Corticosteroids: increases bone loss and stimulates breakdown
- Antiseizure drugs (valproate [Depakote], phenytoin [Dilantin])
- aluminum- containing antacids
- certain cancer tx
-

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4
Q

Corticosteroids

A

long-term use is a major contributor to osteoporosis

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5
Q

Antiseizure drugs

A

can affect bone marrow

celebrex (phosphenytoin)

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6
Q

When should a DEXA scan be performed

A

65 or older for women

not much benefit for men

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7
Q

DEXA Scan

Osteoporosis vs Osteopenia

A

Osteoporosis = BMD > or equal to -2.5 standard deviations below a young adult BMD.

Osteopenia = BMD > / equal to -1.0 but less than -2.5 standard deviations below a young adult BMD

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8
Q

bone biopsy

A

can be done to differentiate between osteoporosis and osteomalacia

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9
Q

Bone Mineral Density (BMD)

A
  • normal = >1.0
  • osteopenia = -1.0 to < -2.5
  • osteoporosis = < -2.5
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10
Q

Osteopenia

A

more than normal bone loss but not yet osteoporosis

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11
Q

Appropriate Diagnostics

A

H&P: -hip, vertebra, or wrist fracture

  • back pain
  • loss of height
  • spinal deformities (kyphosis/ stooped posture)

Quantitative US: -sound waves to evaluate bone mass
-may see increased use due to cost effectiveness

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12
Q

Diagnostics cont.

A

Serum calcium, phosphorus, and alkaline phosphatase may be normal.

alkaline phosphatase may be elevated after fracture

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13
Q

Blood Tests

A

many used to screen for disease processes that may contribute to osteoporosis

  • calcium
  • liver function (ALT, AST)
  • high TSH (hypothyroidism)
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14
Q

Gold Standard

A

DEXA scan

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15
Q

CBC

A

anemia, sickle cell disease, alcohol abuse (with liver function tests)

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16
Q

Serum chemistry levels

A
  • Ca: underlying disease states. Hypercalcemia may reflect underlying malignancy or hyperparathyroidism. Hypocalcemia can contribute to osteoporosis
  • creatinine levels may decrease w/ increasing PTH levels or may be elevated in patients with myeloma
  • Mg important in calcium homeostasis. Decrease in Mg may affect absorption and metabolism
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17
Q

Calcium Homeostasis

A

calcium level in blood balanced by:
1. PTH- secreted by the parathyroid gland.
If calcium level is low PTH raises calcium level by stimulating osteoclasts to breakdown bone.
Increases calcium resorption from kidneys.

  1. calcitonin
    secreted by thyroid gland.
    If serum calcium too high, calcitonin moves calcium into bones.
    Decreases calcium reabsorption.
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18
Q

Two major hormones involved with Calcium

A

Two antagonistic hormones;

  • PTH
  • Calcitonin
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19
Q

Calcium- Phosphorus

Relationship

A

When Calcium is high(> 11.0), phosphorus is low (<3.0)

When phosphorus is high ( > 4.5), calcium is low (< 9.0)

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20
Q

Ca and Phosphorus levels

A 
Calcium= 9.0 - 11.0
Phosphorus= 3.0 - 4.5
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21
Q

Phosphates

A

used to treat;

  • hypophosphatemia
  • hypercalcemia

require doctor care

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22
Q

Osteoporosis

“silent thief”

A 
chronic, progressive metabolic bone disease
-porous bone
-low bone mass
-structural deterioration of bone tissue
-increased bone fragility
-
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23
Q

Etiology and Pathophysiology

A

bone resorption exceeds bone deposition

most commonly in spine, hips, and wrists

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24
Q

Resorption

A

loss of bone

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25
Q

Osteoporosis

-Clinical manifestations

A

“silent killer”

  • usual first signs are; back pain, spontaneous fractures
  • loss of height
  • easy fracture
26
Q

Physiology of bone growth

A

Bone is living tissue undergoing change
- about 10% of skeleton is broken down each year

OsteoClasts- break down (Crush) areas of old/ damaged bone

OsteoBlasts- Build new bone in those areas

osteocytes maintain and monitor mineral content

27
Q

Etiology and Pathophysiology

A

wedging and fractures of vertebrae produce gradual loss of height and a humped back known as dowager’s hump/ kyphosis

usual first signs are back pain or spont. fractures

28
Q

Biphosphonate

A
  • take on an empty stomach
  • upright for 30 min. after taking med.
  • give with full glass of water

remember: tell patient to go for a walk after taking

29
Q

Recommended exercise

A

low-impact weight bearing exercise

  • walking
  • hiking
  • weight training
  • dancing
30
Q

Collaborative Care

Focus

A 
Proper nutrition 
Ca supplements
Exercise
Prevention of fract. 
Drug therapy
Vertbroplasty
Kyphoplasty
31
Q

Vertbroplasty

Kyphoplasty

A

Vertebroplasty- bone cement is injected into collapsed vertebra to stabilize it. Does not correct deformity

Kyphoplasty- air bubble inserted into collapsed vertebra and inflated to regain vertebral body height

32
Q

Collab. Care

-Nutrition

A 
milk
cheese
ice cream
yogurt
salmon ----
sea food----
broccoli----
spinach
33
Q

Collab. Care

-supplements

A

Calcium- lower doses now recommended. Do not take with biphosphonate

  1. -1500 mg/day post menopausal women
    - 1000 g/day premenopausal or postmenopausal taking estrogen
  2. Supp. vit. D recommended
    - 800 units to 1000
    - 20 min. of sunlight daily
  3. Calcitonin promotes bone building
    - inhibits osteoclastic bone resorption, interacts w/ active osteoclasts
    - Salmon Calcitonin (Calcimar): IM, subq, intranasal
    - when calcitonin is used, Ca supp. necessary to prevent hyperparathyroidism.
34
Q

Vit. D

A

20 min a day in sunlight is recommended

older adults need 400 - 800 IU

35
Q

Drug Therapy

A

Biphosphonates inhibit osteoclast- mediated bone resorption

36
Q

Biphosphonate “nates”

A
  • etidronate (Didronel)
  • alendronate (Fosomax)
  • pamidronate (Aredia)
  • can hurt jaw and cause cancer
  • should not take mannitol while on this med.***
37
Q

Calcium recommendation

A

1500 mg/day

prevents future loss

does not build new bone

38
Q

Prevention of Fractures

A
  • install grab bars
  • sit to shower
  • make shower less slippery
  • raise your toilet seat
  • make last step stand out
  • reduce clutter
  • keep items within reach
  • use a step stool
39
Q

Drug Therapy cont.

A
  • selective estrogen receptor modulators: raloxifene (Evista)
  • teriparatide (Forteo): portion of parathyroid hormone. First drug to stimulate new bone formation**
40
Q

Hip Fracture Risks in older adults

A

-falls
-poor balance
-limited shock
absorbers (fat, muscles, bulk)
-gati
-decreased vision and hearing
-slow reflexes
-hypotension
-medication use
-loose rugs
-furry friends

41
Q

Hip Fracture Assessment Findings (clinical manifestations)

A
  • external leg/foot rotation
  • shortening of affected leg
  • muscle spasm
  • severe pain and tenderness
42
Q

Bucks Traction

A

used to pull leg and decrease spasms occurring from the injury

43
Q

Hip Fractures defenition

A

disruption/ break in continuity of the structure of bone

  • fracture of proximal third of femur extending up to 5 cm below lesser trochanter
  • intracapsular fracture (femoral neck)

many develop disabilities requiring long-term care

44
Q

Fractures

A
  • subcapital neck fracute: right under head
  • transcervial neck fracture: in the middle of the neck
  • intertrochanteric fracture: under the neck
  • subtrochanteric fracture: lowest, on the femur bone
  • greater trochanter fracture
  • lesser trochanter fracture
45
Q

Hip Fracture: Initial Assessments

A

wiggle toes, check temp., pulses, sensation, resp. status

past medical Hx

x-ray

46
Q

Pain management

A

analgesics
muscle relaxants
positioning

47
Q

Teaching upmost importance

A
  • Surgery
  • exercise unaffected leg to prevent clots
  • use trapeze bar
  • pt to begin to teach chair transfer
48
Q

Overall goals for hip fracture treatments

A

anatomic realignment of bone fragments

immobilization to maintain realignment

restoration of normal or near-normal function of injured parts

49
Q

Skin traction (Buck’s Traction)

A
  • used for short-term treatment until surgery is possible: used for 24-48 hrs
  • traction weights: 5-10 lbs
  • apposing force pulling
50
Q

Buck’s Traction purpose

A

decrease muscle spasms

immobilize joint or part of body

decrease of fracture or dislocation

treat a pathological joint condition

51
Q

Care for client in TRACTION

A 
T- temperature: extremity infection
R- ropes hang freely
A- alignment
C- circulation check (5 Ps)
T- type & location of fracture
I- increased fluid intake
O- overhead trapeze
N- no weights on bed or floor
52
Q

Surgical Repair

A

Open reduction (ORIF)

  • correction of bone alignment through surgical incision
  • includes internal fixation with use of wires, screws, pins, plates, intramedullary rods, nails
53
Q

Surgical Disadvantages

A
  • infection
  • complications with anesthesia
  • effects of preexisting medical conditions
54
Q

Prior to surgery

A
  • monitor V.S
  • nerovasc. checks
  • maintain proper alignment
  • monitor Buck’s traction if applicable
  • medicate for pain/ muscle spasms
  • pre-op teaching
55
Q

Post-op

A
  • monitor v.s.
  • monitor for bleeding
  • monitor I&Os
  • turn, cough, deep breathe
  • medicate for pain
  • maintain abduction
  • mobilize asap (first day post-op)
  • prevent complications of DVT, infection (osteomyelitis takes 6-8 weeks to remove infection)
56
Q

5 Ps

A 
1- pain
2- paresthesia
3- paralysis
4- pallor
5- pulses
57
Q

Post-op Education

A
  • fall precautions
  • avoid flexing >90 degrees
  • watch for sudden severe pain, lump in buttock, limb shortening, external rotation (dislocation)
  • place large pillow between legs when turning
  • avoid turning on affected side until approved by surgeon
58
Q

Joint Arthroplasty

A

replacement or reconstruction of a joint to decrease pain, improve ROM, decrease deformity

59
Q

Hip Arthroplasty Care

A

for posterior approach hip arthroplasties, do not flex >90

knees must be apart

avoid bending

DVT prophylaxis: **knees and hips pose highest risk
may be on warfarin (Coumadin), rivaroxiban (Xarelto), apixaban (Eliquis),

60
Q

Osteoarthritis

A
  • affects joints mostly
  • weight-bearing joints: hands, knees, hips, spine
  • unsymmetrical
  • does not affect other systems of the body
  • from “wear or tear”
  • inflammation not present: grating of bones, bone breakdown, bone spurs, cartilage/bone spurs floating in bone space
61
Q

RA

A
  • affects joints symmetrically
  • most common: fingers and wrist
  • can also affect neck, shoulders, elbows, ankles, knees, feet
  • systemic: can extend to heart, skin, eyes, mouth, lungs, cause fever, anemia
  • affects women more than men (ages 20-60 yo)
  • inflammation present

MED. SURG 2 (3 decks)

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