UNIT 7 OSTEOPOROSIS AND OSTEOMYELITIS CHAPTER 45 Flashcards
What is Osteoporosis
a lack of bone density/bone mass due to the lack of consumption or absorption of calcium or lack of estrogen because estrogen keeps calcium in the bones.
ALSO CAUSES OR REFERRED TO AS WEAK BONES
Loss of bone mass which can be caused by multiple factors:
Lack of calcium,
Sexual hormones (estrogen/testosterone)
OR
To keep bones strong, the body destroys old bone cells with osteoclasts. Then makes more bone cells with osteoblasts. Some times these cells do not work as they should.
More common in European American / Asian postmenopausal
women
What are the risk factors of Osteoporosis?
Older age
* Sedentary lifestyle
* Poor health
* Low calcium and vitamin D intake
* Excessive alcohol and caffeine
* Smoking
* Oral steroid use
* History of fractures or falls
*post menopausal women
Assess for these nonmodifiable risk factors:
* Older age (over 50 years of age)
* Menopause or history of total hysterectomy, including removal of ovaries
* Parental history of osteoporosis, especially mother
* Euro-Caucasian or Asian ethnicity
* Eating disorders, such as anorexia nervosa
* Rheumatoid arthritis
* History of low-trauma fracture after age 50 years
Assess for these modifiable risk factors:
* Low body weight, thin build
* Chronic low calcium and/or vitamin D intake
* Estrogen or androgen deficiency
* Current smoking (active or passive)
* High alcohol intake (two or more drinks a day)
* Drug therapy, such as chronic steroid therapy (also see Table 45.2)
* Poor nutrition
* Lack of physical exercise or prolonged decreased mobility
What are the signs and symptoms of Osteoporosis?
*Kyphosis of the spine (dowager’s hump) HUMPBACK
* Loss of height (2-3 inches within 20 years)
* Back pain
* Compression fractures of spine
When performing a musculoskeletal assessment, inspect the vertebral column. The classic “dowager’s hump,” or kyphosis (outward curvature of the thoracic spine causing a “humped back”), is often present (Fig. 45.1). The older patient may state that he or she has Gott en shorter, perhaps as much as 2 to 3 inches (5 to 7.5 cm), within the previous 20 years. Take or delegate the taking of height and weight measurements and compare with previous measurements if they are available (Jarvis, 2020).
The patient may have back pain, which often occurs after lifting, bending, or stooping. The pain may be sharp and acute or persistent (chronic). Pain is worse with activity and is often reduced by rest. Back pain accompanied by tenderness and voluntary restriction of spinal movement suggests one or more compression vertebral fractures (i.e., one of the most common types of osteoporotic or fragility fracture).
- ________ are found within the spongy bone and are responsible for building up the bone matrix. While ________, which are also found in the spongy bone, breakdown the bone matrix.*
A. Osteocytes, osteoclasts
B. Osteoclasts, osteoblasts
C. Osteocytes, osteoblasts
D. Osteoblasts, osteoclasts
D. Osteoblasts, osteoclasts
What food are high in calcium and Vitamin D?
HIGH IN VITAMIN D
Dietary sources of vitamin D include dairy products, eggs, fortified food products, liver, and fay fish (salmon and mackerel).
HIGH IN CALCIUM
Cheese, ice cream, milk, yogurt, rhubarb, spinach, tofu
DARK LEEFY GREENS
How is calcium absorbed in the body?
by vitamin D
The focus of evidence-based osteoporosis prevention is to decrease modifiable risk factors to promote patient safety. For example, teach patients who do not include enough dietary calcium which foods to eat, such as dairy products and dark green leafy vegetables. Teach them to read food labels for sources of calcium content. Explain the importance of sun exposure (but not so much as to get sunburned) and adequate vitamin D in the diet.
Are pt’s who have osteoporosis should registered under falls risks?
A complete health history with the assessment of risk factors is important in the prevention, early detection, and treatment of osteoporosis. Patients who have risk factors for osteoporosis are at increased risk for fractures when falls occur. In some cases, the fracture occurs before the fall. Include a fall risk assessment in the health history, especially for older adults.
What type of exercise should a patient do to prevent osteoporosis?
In addition to exercises for muscle strengthening, a general weight- bearing exercise program should be implemented. Teach patients that walking for 30 minutes three to five times a week is the single most effective exercise for osteoporosis prevention. Remind them to avoid any activity that would cause jarring of the body, such as jogging and horseback riding. These activities can cause compression fractures of the vertebral column.
Health promotion or Osteoporosis
In addition to nutrition and exercise, other lifestyle changes may be needed. Teach the patient to avoid tobacco in any form, especially active or passive cigarette smoking (NOF, 2018). Remind women not to consume more than one alcoholic drink per day (5 ounces each); instruct men not to have more than two alcoholic drinks per day.
In collaboration with the primary health care provider, the physical therapist may prescribe exercises for strengthening the abdominal and back muscles for those at risk for vertebral fractures. These exercises improve posture and support for the spine. Abdominal muscle tightening, deep breathing, and pectoral stretching are stressed to increase lung capacity.
Exercises for the extremity muscles include muscle-tightening, resistive, and range-of-motion (ROM) exercises to improve mobility. Muscle strengthening also helps to prevent falls and promote balance. Swimming and yoga provides overall muscle exercise.
Patient teaching for drug therapy for Biphosphanates
DRUGS
- Alendronate
- Ibandronate
- Risedronate
- Pamidronate (IV)
- Zoledronie acid (IV)
*Teach patients to take drug on an empty stomach first thing in the morning with a full glass of water to help prevent esophagitis, esophageal ulcers, and gastric ulcers.
*Remind patients to take drug 30 minutes before food, drink, and other drugs to prevent interactions.
*Instruct the patient to remain upright, sitting or standing, for 30 minutes after taking the drug to help prevent esophagitis (esophageal inflammation).
*Instruct the patient to have a dental examination before starting the drug because it can cause jaw and maxillary osteonecrosis, particular if oral hygiene is poor.
*Do not give the drug to patients who are sensitive to aspirin because bronchoconstriction may occur.
*For IV drug, infuse over 15-30 min to prevent rare complications such as atrial fibrillation.
*For IV drugs, check the patient’s serum creatinine before and after administering the medication because it can cause renal insufficiency or acute kidney injury.
- A patient is prescribed Alendronate (Fosamax) at 0800 for the treatment of osteoporosis. As the nurse you know you must administer this medication:*
A. on an empty stomach with a full glass of water and keep the patient upright for 30 minutes.
B. right after breakfast and to lay the patient flat (as tolerated) for 30 minutes.
C. with food but to avoid giving this medication with dairy products.
D. on an empty stomach with a full glass of juice or milk.
A. on an empty stomach with a full glass of water and keep the patient upright for 30 minutes.
The answer is A. Alendronate (Fosamax) is a bisphosphonate which is known for causing GI upset, especially inflammation of the esophagus. These medications should be taken with a full glass of water in morning on empty stomach with NO other medication. The patient should sit up for 30 minutes (60 minutes with Boniva) after taking the medication, and not eat anything for 1 hour after taking (helps the body absorb more of the medicine.)
The nurse is discussing osteoporosis with a group of women. Which factor will the nurse identify as a nonmodifiable risk factor?
1. Calcium deficiency.
2. Tobacco use.
3. Female gender.
4. High alcohol intake.
- Female gender.
Which foods should the nurse recommend to a client when discussing sources of dietary calcium?
1. Yogurt and dark-green, leafy vegetables.
2. Oranges and citrus fruits.
3. Bananas and dried apricots.
4. Wheat bread and bran.
- Yogurt and dark-green, leafy vegetables.
The female client diagnosed with osteoporosis tells the nurse she is going to perform swim aerobics for 30 minutes every day. Which response is most appropriate by the nurse?
1. Praise the client for committing to do this activity.
2. Explain to the client walking 30 minutes a day is a better activity.
3. Encourage the client to swim every other day instead of daily.
4. Discuss with the client how sedentary activities help prevent osteoporosis.
- Explain to the client walking 30 minutes a day is a better activity.
Which signs/symptoms indicate to the nurse the client has developed osteoporosis?
1. The client has lost one (2) inches in height.
2. The client has lost 12 pounds in the last year.
3. The client’s hands are painful to the touch.
4. The client’s serum uric acid level is elevated.
- The client has lost (2) inches in height.
