lecture notes

Metabolic bone disorders Madeline Calderon  Remember:  Metabolic bone diseases are disorders of bone strength usually caused by abnormalities of minerals (such as calcium or phosphorus), vitamin D, bone mass or bone structure, with osteoporosis being the most common.  Teach: Osteoporosis, which literally means porous bone, is a disease in which the density and quality of bone are reduced. As bones become more porous and fragile, the risk of fracture is greatly increased. The loss of bone occurs silently and progressively. Often there are no symptoms until the first fracture occurs. CONTROLABLE RISK FACTORS Not getting enough calcium and vitamin D. Not eating enough fruits and vegetables. Getting too much protein, sodium and caffeine. Having an inactive lifestyle. Smoking. Drinking too much alcohol. Losing weight. UNCONTROLABLE RISK FACTORS Being over age 50. Being female. Menopause. Family history of osteoporosis. Low body weight/being small and thin. Broken bones or height loss. UNDERSTAND: Our bones are living tissue and constantly changing. From the moment of birth until young adulthood, bones are developing and strengthening. Our bones are at their most dense in our early 20s  tEACH:  Osteoporosis may be undetectable on routine x-rays until there has been significant demineralization, resulting in radiolucency of bones. Osteoporosis is dx using the dexa scan , and is analized and reported using t-scores. The major goals for patients include: A diet rich in calcium and vitamin D throughout life, with an increased calcium intake during adolescence and the middle years, protects against skeletal demineralization.  The recommended adequate intake level of calcium for men 50 to 70 years is 1000 mg daily, and for women aged 51 and older and men aged 71 and older is 1200 mg daily. Regular weight-bearing exercise promotes bone formation. Recommendations include 20 to 30 minutes of aerobic, bone-stressing exercise  daily.Weight training stimulates an increase in BMD.  In addition, exercise improves balance, reducing the incidence of falls and fractures ANALYZE: Pharmacologic Therapy Calcium and vitamin D may be taken to prevent osteoporosis or may be taken as supplements to drugs prescribed to prevent or treat osteoporosis. These types of drugs include bisphosphonates, estrogen agonist/antagonists, and receptor activator of nuclear factor kappa-B ligand (RANKL) inhibitors Fracture Management Fractures of the hip that occur as a consequence of osteoporosis are managed surgically by joint replacement or by closed or open reduction with internal fixation. Osteoporotic compression fractures of the vertebrae are managed conservatively.  TEACH: EVALUATE: TEACH:   Paget Disease of the Bone:?     PAGET DISEASE (OSTEITIS DEFORMANS) IS A DISORDER OF LOCALIZED RAPID BONE TURNOVER, MOST COMMONLY AFFECTING THE SKULL, FEMUR, TIBIA, PELVIC BONES, AND VERTEBRAE.?      STRUCTURAL BOWING OF THE LEGS CAUSES MALALIGNMENT OF THE HIP, KNEE, AND ANKLE JOINTS, WHICH CONTRIBUTES TO THE DEVELOPMENT OF ARTHRITIS AND BACK AND JOINT PAIN are manifestations of Paget Disease.  Osteomalacia: Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone. As a result, the skeleton softens and weakens, causing pain, tenderness to touch, bowing of the bones, and pathologic fractures. On physical examination, skeletal deformities  give patients an unusual appearance and a waddling gait. These patients may be uncomfortable with their appearance and are at risk for falls and pathologic fractures, particularly of the distal radius and the proximal femur Create an individual diet, lifestyle and treatment plan to improve bone health. Which client would the nurse identify as having the greatest risk for osteoporosis? A   A 40-year-old overweight African American woman B  A16-year-old male with a history of asthma C  A small-framed, thin 45-year-old white woman D  A 20-year-old male athlete with repeated injuries Which of the following is the most important nursing diagnosis for an elderly patient diagnosed with osteoporosis? A  Deficient knowledge about osteoporosis and the treatment regimen B Acute pain related to fracture and muscle spasm C Risk for constipation related to immobility D Risk for injury related to fractures due to osteoporosis What clinical manifestation would the nurse expect to find in a client who has had osteoporosis for several years? A Bone spurs B Diarrhea C Increased heel pain D Decreased height The nurse teaches the client with a high risk for osteoporosis about risk-lowering strategies, including which action? A Increase fiber in the diet B Walk or perform weight-bearing exercises outdoors C Reduce stress D Decrease the intake of vitamin A and D A nurse is planning discharge teaching regarding exercise for a client at risk for osteoporosis. Which of the following exercises would be appropriate? A  Yoga B  Walking C  Bicycling D  Swimming