unit c musculoskeletal_chpt__46 part ii voice and no underline
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Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Osteoporosis Bone Loses Density Bone cells are decalcified Fractures Occur
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Osteoporosis Risk Factors Caucasian/Asian Postmenopausal Women Sedentary Lifestyle Decreased Calcium Intake Lack of Vitamin D Excessive Alcohol Use Cigarette Smoking
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Osteoporosis Risk Factors Excessive Caffeine Intake Petite Body Build Postmenopausal women Inactive older adults
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Osteoporosis Signs and Symptoms
◆Dowager’s Hump◆Kyphosis ◆Height Decreases ◆Back Pain ◆Fracture
http://www.google.com/imgres?imgurl=http://4.bp.blogspot.com/_
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Osteoporosis Diagnostic Tests
Computed Tomography Ultrasound Serum Calcium, Vitamin D levels Serum Phosphorus DXA (Dual-energy x-ray absorptiometry) (Tool to measure bone density) (Widely used today)
Serum Alkaline Phosphatase (elevation confirms bone damage
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Osteoporosis Therapeutic Interventions
Reduce Risk Factors Medication
◆Calcium Supplements◆Vitamin D◆Fosamax, Boniva, and Actonel are bisphosphonates, a
group of drugs that inhibit reabsorption of bone
◆Evista mimics estrogen in some parts of the body while blocking it in others
◆Forteo increases the number of osteocytes
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Osteoporosis Nursing Care Education
◆Diet• Increase Calcium
◆Exercise◆Fall Prevention
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Paget's Disease (osteitis deformans) Increased Bone Loss results in large
disorganized bone deposits throughout entire body
No Obvious Symptoms Usually, but pain is a major symptom in many patients.
X-ray, Bone Scan Calcitonin (calcimar) (thyroid hormone drug that is often
effective in initiating a remission)( Blood calcium regulator that shrinks osteoclasts)
Relieve Pain, Teach, Promote Life Quality
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Bone Cancer Primary Malignant Tumors
◆Osteosarcoma or just sarcoma• Most Common• 50% Occur in Distal Femur in Young Men• Metastasizes to Lung Within 2 Years
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Bone Cancer Primary Malignant Tumors
◆Ewing’s Sarcoma• Most Malignant
◆Chondrosarcoma• Cancer of Cartilaginous Cells• Better Prognosis
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Primary Bone Cancer Therapeutic Interventions
◆Surgery, Chemotherapy, Radiation
Nursing Care◆Postoperative Care◆Supportive
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Metastatic Bone Disease Bone-seeking Cancers
◆Prostate, Breast, Lung, Thyroid
Pathological Fractures Severe Pain Therapeutic Interventions
◆Radiation
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Metastatic Bone Disease Nursing Care
◆Supportive care as with other Cancers
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Gout Pathophysiology
◆Systemic Connective Tissue Disorder ◆Uric Acid Build up ◆Usually have hyperuricemia ◆Urate Crystals Deposited in Joints/connective
Tissues◆Severe Inflammation
Is classified as a metabolic disorder
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Causes and Types Primary - Inherited Problem With Purine
Metabolism ◆Uric acid production is greater than the
kidneys’ ability to excrete it.
Secondary – Another Health Problem◆Secondary to renal insufficiency or medication
such as diuretic therapy or chemotherapy
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Signs and Symptoms Acute
◆Swollen, Red, Hot, Painful Inflamed Joints ◆Great Toe
Chronic Gout◆Urate Deposits Under Skin ◆Renal Stones
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Diagnostic Tests Serum Uric Acid Joint Fluid – Uric Acid Crystals
http://www.joshuakaye.com/images/gout.jpg
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Therapeutic Interventions Medication
◆Colchicine (drug used to reduce the inflammatory response) may be given until pain subsides or nausea, vomiting, diarrhea, or intestinal cramping occur.
◆NSAIDS (nonsteroidal ant inflammatory drugs such as aspirin and ibuprofen) http://www.lyberty.com/encyc/articles/nsaid.html http://www.green-lipped-mussel-oil.com/nsaids.html
◆Allopurinol (Zyloprim) & Probenecid (Benemid)
• Uricosuric drugs (drugs that decrease uric acid)
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Nursing Care Teaching
◆Diet – Avoid Foods High in Purines (end products of nucleoprotein digestion)
• Found in foods such as liver, organ meats, shellfish, and oily fish such as sardines
◆Avoid Aspirin, Diuretics, Alcohol • Alcohol especially beer may provoke an attack.
◆Increase Fluids to reduce the possibility of urate stone formation
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Osteogenesis Imperfecta Congenital abnormality characterized by
skeletal bone fragility AKA Brittle Bones disease Pathological fractures Collagen synthesized abnormally by
fibroblasts and osteoblasts.
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Osteogenesis Imperfecta Signs and Symptoms
◆Fragile bones ◆Triangular shaped face◆Potential hearing loss◆Scoliosis◆Loose joints
http://www.oif.org/site/PageServer (see page 1014 for list of symptoms)
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Osteogenesis Imperfecta Signs and Symptoms Con’t
◆Alterations in muscle tone or development ◆Blue, purple, grey tint to sclera◆Brittle or discolored teeth◆Smooth, thin skin
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Osteogenesis Imperfecta Diagnosis
◆History of fractures◆Physical◆Skin biopsy
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
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Osteogenesis Imperfecta Therapeutic Interventions
◆No treatment◆Fracture care
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
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Osteogenesis Imperfecta Nursing Care
◆Careful handling ◆Teaching (patient and caregivers may feel
guilty when fracture occurs)◆Support groups
• Osteogensis Imperfecta Foundation
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Polymyositis Diffuse Inflammation of Skeletal Muscle
which lead to weakness, atrophy and degeneration
Dermatomyositis – polymyositis with rash Progressive Remissions and Exacerbations Women > Men Treatment: Prednisone
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Polymyositis Nursing Care
◆Supportive Care◆Education
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Muscular Dystrophy Group of 9 Disorders Loss of Muscle Tissue Progressive Muscle Weakness Genetic Skeletal muscle fibers degenerate, atrophy
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Therapeutic Interventions Supportive Care Prevention of Complications Gene Therapy Research
◆ http://www.youtube.com/watch?v=vfeAJxtb-F8
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Nursing Diagnoses Impaired Physical Mobility Ineffective Breathing Pattern Self Care Deficits Deficient Knowledge
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Osteoarthritis Degenerative Joint Disease (DJD) Common Slow progressive degeneration of joint
articular cartilage http://video.about.com/arthritis/Arthritis.htm
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Pathophysiology Articular Cartilage/Joints Bone Ends
Deteriorate Joint Space Narrows, Bone Spurs Develop,
Joint Inflamed Joint Deformities, Pain, Immobility Weight-bearing Joints
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Joints Affected By Osteoarthritis
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
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Causes Unknown Risk Factors
◆Aging◆Obesity◆Excessive “Wear and Tear” on Synovial Joints
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
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Signs and Symptoms Joint Pain
◆Intensifies After Physical Activity
Stiffness Heberden’s and Bouchard’s Nodes
◆Bony Nodes on Joints of Fingers
http://www.healthinplainenglish.com/health/musculoskeletal/osteoarthritis/heberden-nodes.jpg
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Diagnostic Tests X-rays CT MRI Synovial Fluid Analysis
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Therapeutic Interventions No Cure Medication
◆NSAIDS
Rest and Exercise Heat or Cold Weight Control http://www.webmd.com/video/injectable-gel-osteoarthritis
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Therapeutic Interventions Complementary Therapies
◆Imagery, Music Therapy, Acupressure, Acupuncture
Surgery◆Total Joint Replacement
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Nursing Diagnoses Chronic Pain Activity Intolerance Chronic Sorrow Disturbed Body Image Impaired Physical Mobility Self-care Deficit Ineffective Health Maintenance
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Patient Education Protect Joints Conserve Energy The patient with prolonged osteoporosis
may experience fractures