week 5 Flashcards
dietary risk factors for osteoporosis
low calcium
low vitamin D & protein
excess alcohol, caffeine, & phosphorus
osteoporosis manifestations
kyphosis
back pain
shortened height
fractures
calcium supplement teaching
take w food in DIVIDED DOSES w 8oz water
less than 500 mg & Mg / vitamin D increase absorption
*monitor for consitpation & hypercalcemia
bisphophonates
alendronate
ibandronate
risedronate
zoledronic acid
**reduces osteoclast activity
alendronate teaching
empty stomach w 8 oz water before breakfast
remain upright/ambulate for 30 min after (esophagitis)
monitor bone density
report dysphagia or heartburn
Raloxifene
decreases osteoclasts & imporves bone density
DVT precaution
monitor liver
stop 72 hours before prolonged bed rest
method of diagnosing osteoporosis
DEXA scan - measures bone mineral density
calcitonin
increases calcium excretion, but helps decrease calcium levels
*monitor for hypocalcemia
hypocalcemia manifestations
tetany = involunatery muscle movements
paresthesia
muscle cramps
osteoporosis
calcium foods
dairy - milk & cheese
almonds
broccoli
kale
fortified grains
osteoporosis patient teachings
spend time in the sun
weight bearing exercise
frequent ambulation - 30 min 4x/wk
limit caffeine & smoking
rubber mats in showers
well lit halls
*NO THROW RUGS
s/s of osteoarthritis
crepitus - crunch sound
joint pain & stiffness
joint effusion
back pain
node formation - herberdens & bouchards
*pain that INCREASES W ACTIVITY
relief at rest
tests to diagnose Rheumatoid arthritis
erythrocyte sedimentation rate (ESR)
C- reactive protein (CRP)
synovial fluid aspiration
rheumatoid factor (RF)
range for c-reactive protein
0.3 to 1.3
pharmacology for osteoporosis
NSAID’s
steroids - Prednisone
Glucosamine
intra-articular injections
hyaluronic acid
glucocorticoids
weak opiod used for osteoarthritis
TRAMADOL
side effects of glucosamine
for osteoporosis
*headache, gi upset, drowsiness
adverse effects of glucosamine
rash
increased bleeding
rheumatoid arthritis
autoimmune disorder that attacks joints
s/s of rheumatoid arthritis
pain AT REST
relief w activity
*systemic symptoms = low grade fever, fatigue, & anorexia
morning stiffness
fatigue
swelling in small joints
*swans neck
*boutonniere deformity
nursing considerations for rheumatoid arthritis
do not elevate knees w pillow at night
low impact exercise (swimming, stationary bike, light walk)
warm shower or bath before bed (alternate hot &cold therapy)
meds used for rheumatoid arthritis
NSAIDs
steroids - prednisone
methotrexate
methotrexate considerations
*for rheumatoid arthritis– to stop body from attacking itself– immunosupression
folic acid to decrease risk of toxicity
no pregnancy – 3 mo after period
bleed risk - no razors
thrombocytopenia
flu vaccines okay but no live vaccines
immunocompromised - no crowds
hydroxychloroquine considerations
*immunosuppressant given to decrease inflammation & fatigue
adverse effects
*vision damage - appointment every 6 to 12 mo
NOT NEEDED FOR OSTEOPOROSIS VITAMINS (calcium & vitamin d)
range for serum uric acid
3.5 to 7.2
gout
inflammatory disease cause bu hyperuricemia & purine metabolism
serum uric acid level > 7
*inflammed BIG TOE
foods high in purine
meat :
seafood;
alcohol
whole grains
legumes
teaching to prevent gout
lose weight
increase fluid intake
avoid purine foods
gout meds
***not for pain
allopurinol (prevention)
colchicine (acute attack)
medication used for pain relief w gout
Naproxen = nsaid or ibuprofen
allopurinol teaching
prevention of gout
RASH = deadly
increase fluids
take w water
months to work
contraindicated in liver & kidney disease
hyper vs hypo - calcemia
hyper = renal stones, nausea, vomiting, & constipation
hypo = twitching, tetany, & muscle spasms
adverse effects of alendronate
jaw pain
blurred vision
muscle pain
raloxifene adverse effects
calf tenderness
DVT risk
*prevents osteoporosis
