Unit c musculoskeletal_chpt__46 part ii voice and no underline

Understanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper

Osteoporosis
 Bone Loses Density
 Bone cells are decalcified
 Fractures Occur


Osteoporosis Risk Factors
 Caucasian/Asian Postmenopausal Women
 Sedentary Lifestyle
 Decreased Calcium Intake
 Lack of Vitamin D
 Excessive Alcohol Use
 Cigarette Smoking


Osteoporosis Risk Factors
 Excessive Caffeine Intake
 Petite Body Build
 Postmenopausal women
 Inactive older adults


Osteoporosis
 Signs and Symptoms
◆ Dowager’s Hump
◆ Kyphosis
◆ Height Decreases
◆ Back Pain
◆ Fracture

http://www.google.com/imgres?
imgurl=http://4.bp.blogspot.com/_


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


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


Osteoporosis Nursing Care
 Education
◆ Diet
• Increase Calcium
◆ Exercise
◆ Fall Prevention


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


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


Bone Cancer
 Primary Malignant Tumors
◆ Ewing’s Sarcoma
• Most Malignant
◆ Chondrosarcoma
• Cancer of Cartilaginous Cells
• Better Prognosis


Primary Bone Cancer
 Therapeutic Interventions
◆ Surgery, Chemotherapy, Radiation
 Nursing Care
◆ Postoperative Care
◆ Supportive


Metastatic Bone Disease
 Bone-seeking Cancers
◆ Prostate, Breast, Lung, Thyroid
 Pathological Fractures
 Severe Pain
◆ Radiation


Metastatic Bone Disease
 Nursing Care
◆ Supportive care as with other Cancers


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


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


Signs and Symptoms
 Acute
◆ Swollen, Red, Hot, Painful Inflamed Joints
◆ Great Toe
 Chronic Gout
◆ Urate Deposits Under Skin
◆ Renal Stones


Diagnostic Tests
 Serum Uric Acid
 Joint Fluid – Uric Acid Crystals

http://www.joshuakaye.co
m/images/gout.jpg


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)


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


Osteogenesis Imperfecta
 Congenital abnormality characterized by
skeletal bone fragility
 AKA Brittle Bones disease
 Pathological fractures
 Collagen synthesized abnormally by
fibroblasts and osteoblasts.


 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)


 Signs and Symptoms Con’t
◆ Alterations in muscle tone or development
◆ Blue, purple, grey tint to sclera
◆ Brittle or discolored teeth
◆ Smooth, thin skin


 Diagnosis
◆ History of fractures
◆ Physical
◆ Skin biopsy


◆ No treatment
◆ Fracture care


 Nursing Care
◆ Careful handling
◆ Teaching (patient and caregivers may feel
guilty when fracture occurs)
◆ Support groups
• Osteogensis Imperfecta Foundation


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


Polymyositis
 Nursing Care
◆ Supportive Care
◆ Education


Muscular Dystrophy
 Group of 9 Disorders
 Loss of Muscle Tissue
 Progressive Muscle Weakness
 Genetic
 Skeletal muscle fibers degenerate, atrophy


 Supportive Care
 Prevention of Complications
 Gene Therapy Research
◆ http://www.youtube.com/watch?v=vfeAJxtb-F8


Nursing Diagnoses
 Impaired Physical Mobility
 Ineffective Breathing Pattern
 Self Care Deficits
 Deficient Knowledge


Osteoarthritis
 Degenerative Joint Disease (DJD)
 Common
 Slow progressive degeneration of joint
articular cartilage
 http://video.about.com/arthritis/Arthritis.htm


Pathophysiology
 Articular Cartilage/Joints Bone Ends
Deteriorate
 Joint Space Narrows, Bone Spurs Develop,
Joint Inflamed
 Joint Deformities, Pain, Immobility
 Weight-bearing Joints


Joints Affected By
Osteoarthritis


Causes
 Unknown
 Risk Factors
◆ Aging
◆ Obesity
◆ Excessive “Wear and Tear” on Synovial Joints


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/o
steoarthritis/heberden-
nodes.jpg


Diagnostic Tests
 X-rays
 CT
 MRI
 Synovial Fluid Analysis


 No Cure
 Medication
◆ NSAIDS
 Rest and Exercise
 Heat or Cold
 Weight Control
 http://www.webmd.com/video/injectable-gel-osteoarthritis


 Complementary Therapies
◆ Imagery, Music Therapy, Acupressure,
Acupuncture
 Surgery
◆ Total Joint Replacement


Nursing Diagnoses
 Chronic Pain
 Activity Intolerance
 Chronic Sorrow
 Disturbed Body Image
 Impaired Physical Mobility
 Self-care Deficit
 Ineffective Health Maintenance


Patient Education
 Protect Joints
 Conserve Energy
 The patient with prolonged osteoporosis
may experience fractures

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