(NUR 211) Unit 2 Study Guide

Osteoporosis NUR 211 Unit 2 Study Guide Revised =chronic condition that results in deterioration of bone tissue and density, increasing a patient’s risk for fractures. It is the most common bone disease in humans and creates a major public health concern for the future. =”Silent Disease” Bone remodeling = the constant replacing of older bone with newer bone Osteoclasts = break down bone by adhering to the surface of bone and secreting acids and enzymes directly into the bone cavity Osteoblasts = rebuild bone by synthesis and mineralization of the new bony matrix within the bone cavity Osteopenia = bone loss; bone resorption is greater than bone rebuilding in a decreased bone mineral density; before osteoporosis Medical Management Diagnosis A. Annual height measurement B. Bone Mineral Density (BMD) testing 1. Women over 65 or men over 70 years 2. Postmenopausal women and men 50-69 with high risk factors a. DEXA = dual-energy x-ray absorptiometry ; precise measurements; highlight areas for future fracture risk Normal BMD within 1 SD of young normal adult, T-score -1.0 or higher Low bone mass or osteopenia BMD between 1 and 2.5 SD’s lower than that of a young normal adult. T-score between 1.0 and -2.5 Osteoporosis BMD more than 2.5 SD’s lower than that of a young normal adult, T-score -2.5 or lower b. Quantitative computed tomography (QCT) = measures volumetric bone density of the spine and hip and can identify cortical and trabecular bones distinctly. Used for research and diagnostic management -NOT screening c. Biochemical Markers = bone-specific alkaline phosphate, osteocalcin, N-telopeptide and C-telopeptide, serum & urine calcium, Vit D, phosphorous, hematocrit, ESR, d. FRAX = calculates a 10 year probability for hip and any one of four major osteoporotic fractures bet 40-89 years. Treatment A. Prevention and early screening B. Weight loss C. Muscle-strengthening exercises and weight-bearing exercises D. Avoid smoking and excessive alcohol intake E. Calcium + Vitamin D supplements Calcium 1,200 mg /day -give with food in divided doses with 6-8 oz of water -can cause GI upset -monitor for constipation & hypercalcemia Vitamin D 800-1000 international units / day -Toxicity can occur: weakness, fatigue, nausea, constipation, kidney stones Milk and milk products Fortified milk & cereals Figs Egg yoks Fish with bones Saltwater fish Greens Liver Red and white beans Sunlight 15 min /day Medications A. Bisphosphonates 1. Fosamax (alendronate) = admin daily or weekly on an empty stomach 30 min before food or meds and remain sitting up for 30 minutes after admin as risk for esophagitis and esophageal ulcers can occur 2. Boniva (ibandronate) = monthly tablet or IV infusion every 3 months – admin on empty stomach and remain sitting up for 30 minutes after admin as risk for esophagitis and esophageal ulcers can occur Manifestations Dowager’s hump (kyphosis) Fear of falling Loss of height (2-3 in) Previous fractures Back pain BMD more than 2.5 SD’s (standard deviations) lower than that of a young adult Pain with activity – relief with rest T-score -2.5 or lower Restriction of movement Hormonal Influences A. Calcitonin (thyroid hormone) – decreases bone resorption by inhibiting osteoclast activity B. Estrogen - replaces estrogen lost due to menopause or surgical removal of ovaries and should be given with progesterone in clients who sill have their uterus. 1. Estrace = assists with bone remodeling and osteoclastic activity; varies methods of admin; risk for MI, stroke, breast and endometrial cancers, PE, DVT. Perform monthly breast exams C. Parathyroid hormone Diet A. Dietary sources such as Vitamin D fortified milk, cereals, egg yolks, saltwater fish, liver, and kale B. Sunlight for 15 min / day C. Supplements of calcium and vitamin D Nursing Diagnosis A. Risk for trauma B. Impaired physical mobility C. Acute / chronic pain D. Nutrition, imbalance: less than body requirements Interventions A. Admin meds B. Encourage activity for ADL’s and exercise: walking is effective C. Assistive devices as applicable D. Safety measures E. Encourage weight reduction F. Vitamin D and calcium supplements Fibromyalgia