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Comprehensive Presentation about OSTEOPOROSIS

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  1. 1. OSTEOPOROSIS<br />
  2. 2. OVERVIEW<br />
  3. 3.
  4. 4.
  5. 5. Osteoporosis<br />Metabolic bone disorder<br />The result is decreased bone mass <br />Bones become porous, brittle, and abnormally vulnerable to fracture<br />
  6. 6. <ul><li>Primary
  7. 7. Secondary to an underlying disease</li></li></ul><li>
  8. 8. Classification of Primary Osteoporosis<br />Idiopathic osteoporosis <br /><ul><li>affects children and adults</li></ul>Type I (or postmenopausal) osteoporosis <br /><ul><li>Usually affects females ages 51 to 75
  9. 9. Related to the loss of estrogen's protective effect on bone
  10. 10. Results in trabecular bone loss and some cortical bone loss
  11. 11. Vertebral and wrist fractures are common. </li></li></ul><li>Type II (or senile) osteoporosis <br /><ul><li>occurs most commonly between ages 70 and 85
  12. 12. Trabecular and cortical bone loss
  13. 13. fractures of the proximal humerus, proximal tibia, femoral neck, and pelvis</li></li></ul><li>
  14. 14. Pathophysiology and etiology<br />
  15. 15.
  16. 16.
  17. 17. The rate of bone resorption increases over the rate of bone formation<br /><ul><li>loss of bone mass</li></ul>Calcium and phosphate salts are lost<br /><ul><li>porous, brittle bones</li></ul>Occurs most commonly in postmenopausal women<br />
  18. 18.
  19. 19. COmplications<br />
  20. 20. Fractures<br /><ul><li>Most common: vertebrae, femoral neck, distal radius</li></ul>Progressive kyphosis<br /><ul><li>loss of height </li></ul>Chronic back pain from compression fracture<br />
  21. 21. Typical loss of height associated with osteoporosis and aging<br />
  22. 22. Clinical manifestations<br />
  23. 23. Asymptomatic until later stages<br />Fracture after minor trauma may be first indication<br />Most frequent fractures associated with osteoporosis include fractures of:<br />distal radius<br />vertebral bodies<br />proximal humerus<br />Pelvis<br />proximal femur (hip)<br />
  24. 24. May have vague complaints related to aging process<br /><ul><li>Stiffness
  25. 25. Pain
  26. 26. Weakness</li></ul>Estrogen deficiency may be noted<br />
  27. 27. Diagnostic evaluation<br />
  28. 28. Differential diagnosis<br /><ul><li>exclude other causes of rarefying bone disease, especially those that affect the spine
  29. 29. metastatic carcinoma, advanced multiple myeloma</li></ul>X-rays <br /><ul><li>show changes only after 30% to 60% loss of bone</li></ul>DEXA<br /><ul><li>Dual-energy X-ray absorptiometry
  30. 30. Shows decreased bone mineral density
  31. 31. T score -2.5 or worse</li></li></ul><li>
  32. 32. Serum and urine calcium levels<br /><ul><li>normal</li></ul>Serum bone GLA-protein<br /><ul><li>Marker for bone turnover
  33. 33. Elevated</li></ul>Bone biopsy <br /><ul><li>Shows thin, porous, otherwise normal bone</li></li></ul><li>Spine Computed Tomography Scan <br /><ul><li>Shows demineralization
  34. 34. Quantitative computed tomography can evaluate bone density
  35. 35. Less available and more expensive than DEXA</li></li></ul><li>MANAGEMENT<br />
  36. 36. GOAL:<br /><ul><li>To control bone loss
  37. 37. prevent additional fractures
  38. 38. control pain
  39. 39. Treatment:
  40. 40. physical therapy program of gentle exercise and activity
  41. 41. drug therapy to slow disease progress
  42. 42. supportive devices
  43. 43. surgery</li></li></ul><li>Medications<br />
  44. 44. Biphosphonates<br /><ul><li>Alendronate, Risedronate
  45. 45. To prevent bone loss and reduce the risk of fractures</li></ul>Calcium and vitamin D supplements <br /><ul><li>To support normal bone metabolism
  46. 46. Raloxifene and calcitonin
  47. 47. To reduce bone resorption
  48. 48. To slow the decline in bone mass</li></li></ul><li>
  49. 49. Supportive devices and surgery<br />
  50. 50. Back brace<br /><ul><li>Supports weakened vertebrae</li></ul>Surgery <br /><ul><li>open reduction and internal fixation
  51. 51. to correct pathologic fractures of the femur
  52. 52. Reduction and Immobilization
  53. 53. with a cast
  54. 54. Required in Colles' fracture
  55. 55. 4 to 10 weeks</li></li></ul><li>Lifestyle modification<br />
  56. 56. Diet<br /><ul><li>Adequate intake of dietary calcium
  57. 57. Decreased alcohol consumption and caffeine use</li></ul>Regular Exercise<br />Smoking cessation<br />
  58. 58. Hormonal and fluoride treatment<br />
  59. 59. Hormone replacement therapy (HRT)<br /><ul><li>with estrogen and progesterone
  60. 60. retard bone loss and prevent the occurrence of fractures
  61. 61. decreases bone reabsorption and increases bone mass</li></ul>Fluoride treatments <br /><ul><li>may also offer preventive benefit</li></li></ul><li>
  62. 62. NURSING MANAGEMENT<br />
  63. 63. Nursing diagnoses<br />
  64. 64. Chronic pain<br />Disturbed body image<br />Dressing or grooming self-care deficit<br />Imbalanced nutrition: Less than body requirements<br />Impaired physical mobility<br />Risk for impaired skin integrity<br />Risk for injury<br />
  65. 65. Key outcomes<br />
  66. 66. The patient will:<br />experience increased comfort and decreased pain<br />express positive feelings about herself<br />perform activities of daily living (ADLs) within the confines of the disease<br />maintain adequate dietary intake<br />
  67. 67. maintain joint mobility and range of motion (ROM)<br />exhibit intact skin integrity<br />demonstrate measures to prevent injury<br />
  68. 68. Nursing interventions<br />
  69. 69. Design plan of care<br /><ul><li>to consider the patient's fragility</li></ul>Concentrate on careful positioning, ambulation, prescribed exercises<br />Provide emotional support and reassurance <br /><ul><li>to help the patient cope with limited mobility
  70. 70. Give her opportunities to voice her feelings
  71. 71. If possible, arrange for her to interact with others who have similar problems</li></li></ul><li>Include the patient and her family in all phases of care<br />Answer questions as honestly as you can<br />Encourage the patient to perform as much self-care as her immobility and pain allow<br />Allow her adequate time to perform these activities at her own pace<br />Check the patient's skin daily for redness, warmth, and new sites of pain, which may indicate new fractures.<br />
  72. 72. Provide the patient with activities that involve mild exercise<br /><ul><li>help her to walk several times daily</li></ul>As appropriate, perform passive ROM exercises, or encourage her to perform active exercises<br />Make sure she attends scheduled physical therapy session<br />Impose safety precautions<br /><ul><li>Keep bed rails up</li></li></ul><li><ul><li>Move the patient gently and carefully at all times
  73. 73. Discuss with ancillary facility personnel how easily an osteoporotic patient's bones can fracture</li></ul>Provide a balanced diet rich in nutrients that support skeletal metabolism: vitamin D, calcium, and protein.<br />Administer analgesics and heat to relieve pain as ordered<br /><ul><li>Assess the patient's response</li></li></ul><li>Patient teaching<br />
  74. 74. Explain all treatments, tests, and procedures<br />Make sure the patient and her family clearly understand the prescribed drug regimen<br /><ul><li>Tell them how to recognize significant adverse reactions
  75. 75. Report them immediately</li></ul>Teach the patient taking estrogen to perform breast self-examination<br /><ul><li>Perform this examination at least once a month
  76. 76. Report lumps right away</li></li></ul><li><ul><li>Emphasize the need for regular gynecologic examinations
  77. 77. Report abnormal vaginal bleeding promptly</li></ul>If the patient takes a calcium supplement, encourage liberal fluid intake <br /><ul><li>to help maintain adequate urine output and thereby avoid renal calculi, hypercalcemia, and hypercalciuria</li></ul>Report new pain sites immediately, especially after trauma<br />Sleep on a firm mattress and avoid excessive bed rest<br />
  78. 78. Teach the patient how to use a back brace properly, if appropriate<br />Thoroughly explain osteoporosis to the patient and her family<br /><ul><li>If they don't understand the disease process, they may feel needless guilt, thinking that they could have acted to prevent bone fractures</li></ul>Demonstrate proper body mechanics<br /><ul><li>Stoop before lifting anything
  79. 79. Avoid twisting movements and prolonged bending</li></li></ul><li>
  80. 80.
  81. 81. Install safety devices (grab bars, railings) at home<br />Eat a diet rich in calcium<br />Explain that type II osteoporosis may be prevented by adequate dietary calcium intake and regular exercise<br />Hormonal and fluoride treatments also may help prevent osteoporosis<br />Explain that secondary osteoporosis may be prevented by:<br />
  82. 82. effectively treating underlying disease<br />early mobilization after surgery or trauma<br />decreased alcohol consumption<br />careful observation for signs of malabsorption<br />prompt treatment of hyperthyroidism<br />Reinforce the patient's efforts to adapt, and show her how her condition is improving or stabilizing<br />Refer her to an occupational therapist or a home health nurse to help her cope with ADLs<br />
  83. 83.<br /><br /><br />THANK YOU!Have a nice day : )<br />- RDG<br />