Unit c musculoskeletal_chpt__46 part ii voice and no underline
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Transcript of 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
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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
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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
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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/_
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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)
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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
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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.
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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)
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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
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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
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Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Osteogenesis Imperfecta Therapeutic Interventions
◆No treatment◆Fracture care
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Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Osteogenesis Imperfecta Nursing Care
◆Careful handling ◆Teaching (patient and caregivers may feel
guilty when fracture occurs)◆Support groups
• Osteogensis Imperfecta Foundation
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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
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Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Polymyositis Nursing Care
◆Supportive Care◆Education
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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
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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
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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
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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
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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
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Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Joints Affected By Osteoarthritis
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Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Causes Unknown Risk Factors
◆Aging◆Obesity◆Excessive “Wear and Tear” on Synovial Joints
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Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
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
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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
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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
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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
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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
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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