Unit one exam - Adult Health two Flashcards
Osteoporosis
what is it? a cellular in which bone loss cause significant decreased density and possible fracture
what causes it? it is known to involve imbalance osteoblast, osteoclast activity
what are the different kinds? primary (type 1 and type 2)
Type 1 estrogen deficiency from the bone Type 2 result from kidneys losing the ability to process vitamin D and lastly Secondary
What does it look like? fragility fractures (hip), increased loss of bone mass, increased bone fragility and increased risk of fractures
what are the etiology and genetic risk?
nutrition deficiency of calcium and vitamin D/ protein deficiency/ Hormone deficiency testosterone or estrogen
how to diagnose it? Lab assessment data is a increased serum calcium, Vitamin D decreased and bone turnover marker not commonly tested
some imaging assessment data is an X-ray of spine and long bones, DXA only as a screening tool, QCT measures volume of bone density, Vertebral imaging, and MRI
fragility fracture
caused by osteoporosis also called a bone attack
Osteomalacia
Bone loss related to the lack of vitamin D
Osteopenia
Loss of bone mass occurs when the osteoclasts are greater than the osteoclastic activity
what are the risk factors of Osteoporosis?
Non modifiable is Family History, age and gender, ethnicity, other chronic diseases and current low bone mass in children
Modifiable
poor nutrition, body weight, substance abuse, and sedentary lifestyle
what does access the pneumonic for osteoporosis stand for
Alcohol use, corticosteroid use, calcium low, estrogen low, smoking, sedentary lifestyle
what would you assess In a patients with osteoporosis
do a complete health history assessment of risk factors and fall risk factors
what is done for a psychosocial assessment of osteoporosis?
Body image, Negative association with women, less independence, Insomnia & Depression, fear of falling
What are the physical assessment and signs and symptoms of osteoporosis
Loss of height as vertebral bodies collapse, progressive curvature of spine ( lordosis, kyphosis, protrusion of abdomen, knees hips flex), low back pain, fractures of forearm spine and hip
Lordosis
excessive inward curvature of the spine
Kyphosis
Outward curvature of the thoracic spine
what is the pharmacological treatment for Osteoporosis
Calcium, Vitamin D, Biophosphonates (dronate), RANKL inhibitor(-mab)
what is the non pharmacological treatment of Osteoporosis
Dietary Management/Nutrition therapy, Lifestyle changes
what you should know about calcium before you take it
take with a meal or within one hour after a meal, adults greater than the age of 5 should take 1000-2000 mg of calcium a day
Adverse effects include hypercalcemia, lethargy, drowsiness, headache, anorexia, nausea, vomiting, increased urination or thirst
Contradicted with people with atrial fibrillation
do not administer with digoxin or calcium channel blockers
What should you know about Vitamin D in relation to treating Osteoporosis
can be taken in combination with calcium
Side effects: nausea, vomiting, poor appetite, weight loss, disorientation, kidney damage and stones
what are the vitamin D levels supposed to look like?
25-80 ng/mL
what should the patient know when prescribed vitamin D and calcium
Increase fluid intake to prevent kidney stones
What should you know about biophosphonates?
AE: nausea, vomiting, abdominal pain, esophageal irritation,
Pt education: take on an empty stomach take on a weekly basis as this can still be as effective as taking the dose daily
what should you know about RANKL inhibitors?
approved for osteoporosis when other lines of treatment are not effective
subcutaneous,
AE: musculoskeletal pain, back pain, general weakness, dyspnea, fatigue
Patient education: this can lower your calcium levels
Diabetes Mellitus
What is it? chronic disorder caused by impaired metabolism vascular complications and neurologic complications
what does It look like? elevated blood glucose level (hyperglycemia)or Decreased glucose level (hypoglycemia)
what causes it? absence of insulin production for type 1 and type 2 is the adequate production of insulin can be a genetic risk
what are the attributes? Polydipsia, polyuria, polyphagia
how do we diagnose it? Glycosolated hemoglobin (A1C) and FBG
what are the nursing interventions for Diabetes Mellitus? preventing injury from hypoglycemia, embracing surgical recovery, preventing injury from peripheral neuropathy, reducing the risk for kidney disease and preventing complications
what is the most important exercise for osteoporosis
walking for 30 minutes 5 times a week
what are the nursing interventions for Osteoporosis
Nutrition therapy, Lifestyle Changes, and drug therapy
what is an example of insulin resistance?
increased waist band size
what are the chronic complications of diabetes mellitus (macrovascular)
coronary heart disease, cerebral vascular disease, peripheral vascular disease
Metabolic Syndrome
precursor to diabetes
what does it look like? visceral obesity, hypertension, Hyperglycemia, elevated triglycerides, low LDL cholesterol
what are the microvascular complications of diabetes mellitus
Nephropathy, Neuropathy, retinopathy
what are some of the additional risk factors of type 2 DM
smoking, physical inactivity, obesity, hypertension, high blood fat and cholesterol levels.
what is the value for FBG for diabetic patients
> 126 mg/dL
What abnormal level means FBG of impaired fasting
100-126 mg/dL
what is the level for Hemoglobin A1C for normal
4%-6%
abnormal range for A1C of Prediabetes
5.4%-6.4% prediabetes
what does greater than 6.5% A1C mean
Diabetes
what is the level of A1c for poor diabetic control
> 8%
what is the reading of HgA1C based upon
in the 3 months or 90 days
when is the HgA1c recommended for diabetic patients
quarterly
what are the pharmacological treatment options for diabetic patients
Insulin, Glucagon, Hypoglycemic, lipid lowering agents (-statins)
what is a surgical procedure for diabetic patients
Pancreas Transplant
what are the signs of hyperglycemia
Hot and dry (dehydrated, kaussmal respirations (fast and deep), mental status altered, tachycardia, Nausea, and vomiting
greater than >250 mg/dL positive for ketones
what are the signs of hypoglycemia
cold and clammy
sweaty, anxious, nervous, irritable, hunger, palpitations, coma,
60-70 mg/dL moderate hypoglycemia
<50 mg/dL severe hypoglycemia
what are the nursing diagnoses related to Diabetes Mellitus
Deficient knowledge, impaired skin integrity, risk for infection, risk for injury, risk for deficient fluid volume, disturbed sensory perception, ineffective coping