The Skeletal system, Integumentary system, and eyes & ears - PowerPoint Presentation

Slide1

The Skeletal system, Integumentary system, and eyes & ears

Week 9

Chapters 20, 38, & 40

Slide2

The Skeletal System

Slide3

Calcium

One of the body’s most important minerals

Responsible for:

Muscle contraction

Nerve conduction

Bone formation

Slide4

Blood Calcium levels are Controlled by three hormones

Calcitriol

– a form of vitamin D that facilitates calcium absorption from the digestive tract

Increases blood calcium levels

Parathyroid Hormone (PTH)

– secreted by the parathyroid gland

Stimulates osteoclasts

Accelerates bone

resorption

- breaking down of the bone

Calcium increases in the blood and can be used elsewhere in the body

Calcitonin

– secreted by the Thyroid gland

Stimulates bone deposition - building

Removes calcium from the blood

Slide5

Vitamin DEnzymes in the kidneys metabolize Vitamin D to its active form-

Calcitriol

Primary function of calcitriol is to increase calcium absorption from the GI tract

Dietary calcium is absorbed better in the presence of active vitamin D

Many foods are fortified with vitamin D

Slide6

Parathyroid Hormones

38-

6

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Hypocalcemia

Causes:

Vitamin D deficiency

Thyroid tumors

Renal dialysis

hypoparathyroidism

Symptoms:

Spastic muscle contractions (including

paresthesia

)

Tetany

– inability of muscles to relax - classic sign is

Carpopedal

spasm- picture page 654 in book

Treatment—calcium and vitamin D

38-

7

Slide8

Common calcium supplements

Calcium chloride

Calcium lactate

Calcium gluconate

Slide9

Vitamin D supplements (active form)

Calcitriol

(

Rocaltrol

)

Calcitriol

(Vitamin D3)

Slide10

Degenerative Bone Disease

Paget’s disease:

Hyperactive bone metabolism

Thick and weak bones

Osteoporosis:

most common metabolic bone disease

Decreased bone mass:

Increased bone

resorption

Decreased mineral deposition

Increased mineral excretion

Responsible for approximately 1.5 million fractures annually

Usually asymptomatic until bone becomes brittle and fractures

Several factors leave patient prone to osteoporosis

38-

10

Slide11

Risk Factors for Osteoporosis

Postmenopause

- most common risk factor is onset of menopause

High alcohol or caffeine consumption

Anorexia nervosa

Tobacco use

Physical inactivity

Testosterone deficiency, particularly in elderly men

Lack of adequate vitamin D or calcium in the diet

Drugs that lower calcium levels in the blood

(corticosteroids, some anti-

convulsants

,

immunosuppressants

)

Slide12

Treatments

Calcitonin

Bisphosphonates

Calcium supplements

Vitamin D supplements

Slide13

Calcitonin (Fortical, Miacalcin

)

Hormonal agent (Class), extracted from Salmon

Nasal spray or SQ injection

SE nasal irritation; N/V

MOA: Increases bone density

USE: Reduces risk of vertebral fractures, to treat osteoporosis

Slide14

Bisphosphonates

MOA: Inhibit bone resorption by suppressing osteoclast activity

This increases bone density

Profile Drugs:

Alendronate (Fosamax)

Ibandronate

(Boniva)

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BisphosphonatesSide effects: nausea, vomiting, abdominal pain, back pain and esophageal irritation

Patient must sit upright for 30 min following administration

These drugs are poorly absorbed and interact with several foods (milk, orange juice, fortified water)so they need to be

taken on an empty stomach with plain water

Slide16

Question OneA client with osteoporosis is started on alendronate sodium (Fosamax). The client should be instructed to do which of the following? (Select all that apply)

1. Take medication in the morning after arising and before eating

2. Chew tablets to increase bioavailability

3. Drink a full glass of water with each tablet

4. Take Fosamax with an antacid if heartburn occurs

5. Avoid lying down after taking this medication

Slide17

Question TwoThe nurse recognized that calcitonin-salmon (Miacalcin

) may be given to a client with

hypercalcemia

to:

1. Increase renal reabsorption of calcium

2. Decrease intestinal absorption of calcium

3. Increase parathyroid response to

hypercalcemia

4. Decrease bone

resorption

of calcium

Slide18

Question ThreeIf calcium levels decrease below normal, which hormone would be released to compensate?

1. calcitonin

2. PTH

3. TRH

4. TSH

Slide19

Arthritic and Joint DisordersChapters 20

Slide20

Arthritic Disorders

Osteoarthritis

Degenerative joint disease

Excessive wear and tear of weight-bearing joints

Rheumatoid arthritis

Degenerative joint disease

Systemic autoimmune disorder

Disfigurement and inflammation of multiple joints ( often red, warm, and limits in ROM)

Gout

Metabolic disorder

Slide21

OsteoarthritisGoal: reduction of pain and inflammation

Analgesics and anti-inflammatory drugs

Cox – 2 inhibitors

Topical medications

NSAIDs

hyaluronate (Hyalgan Euflexxa)

Injection directly into the knee joint

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Rheumatoid Arthritis

Analgesics and anti-inflammatories

Glucocorticoids

Immunosuppressants

Methotrexate (Rheumatrex)

Disease-modifying antirheumatic drugs (DMARDs):

hydroxychloroquine (Plaquenil), gold salts, sulfasalazine (Azulfidine), D-penicillamine (Cuprimine)

Slide23

Gout

Gout is an inflammatory disease caused by uric acid crystal formations in the joints and soft tissue.

Some foods with high purine content precipitate gouty attacks.

Processed, high sodium foods (i.e. canned meats)

Inflammation of the joint is caused by phagocytes trying to remove the uric acid deposits.

20-

23

Slide24

Acute Gouty Arthritis

Uric acid crystals accumulate quickly in the joints

Red, swollen, inflamed tissue

Sudden attacks often occur at night

Triggered by diet, injury, or other stresses

Often occurs in big toes, heels, ankles, wrists, fingers, knees, elbows

Slide25

Medications for the Treatment of Gout

Goals:

Termination of acute attacks

By relieving the acute inflammatory response

Prevention of future attacks

Reducing uric acid levels

NSAIDs are the drugs of choice for treating pain and inflammation

Indomethacine

(Indocin) - NSAID that is widely used for gout

Slide26

Medications for treatment of Acute Gout

Class: Anti-Gout

MOA: alters the phagocytes’ ability to attack the uric acid crystals.

SE: causes nausea, vomiting, diarrhea, thrombocytopenia, and hematuria.

NC: diarrhea will show effectiveness

Colchicine (

Colcrys

)

20-

26

Slide27

Medications Useful in Treating Gout

Two major classes of drugs used in long-term prophylaxis of gout:

Hypouricemic

agents

a

llopurinol (

Zyloprim

)

f

ebuxostat

(

Uloric

)

Uricosuric

agentsProbenecid

20-

27

Slide28

Medications for the Treatment of Gout

Uric acid inhibiting drugs; Hypo-

uricemics

MOA:

Block the accumulation of uric acid in the blood

Block the accumulation of uric acid crystals in the joints

USE: prophylaxis for gout, doesn’t stop acute attacks

Glucocorticoids

Useful for short-term, single joint gout

Delivered intra-

articularly

Slide29

Question OneA nurse is caring for a client who is beginning a new prescription for

etanercept

(Enbrel) for rheumatoid arthritis. Based on the route of administration of

etanercept

, which of the following should the nurse plan to monitor?

1. The client’s vein for thrombophlebitis during IV administration

2. The client’s subcutaneous site for redness following injection

3. The client’s oral mucosa for ulceration after oral administration

4. The client’s skin for irritation following removal of transdermal patch

Slide30

Question TwoChoose the reasons why

a

llopurinol is useful in treating gout.

1. blocks the accumulation of uric acid in the blood

2. decreases the uric acid clearance from the blood

3. blocks the accumulation of uric acid crystals in the joints

4. alters the formation of uric acid

Slide31

Question ThreeA nurse is providing teaching to a client who is to start Colchicine (

Colgout

) for acute gouty arthritis. The nurse should advise the client to do which of the following? (Select all that apply)

1. decrease fluid intake

2. avoid alcohol use

3. take the medication on a empty stomach to increase absorption

4. notify the provider of bleeding, bruising, or sore throat

5. Avoid aspirin or products containing salicylates

Slide32

Question FourSodium

hyaluronate

(

Hyalgan

) is a therapy for patients with moderate osteoarthritis. Which of the following statements about this drug is false?

1. It is injected directly into the knee joint

2. It coats the articulating cartilage surface

3. Patients should avoid strenuous activity for 48 hours after it is administered

4. It is used prior to treatments with COX-2 inhibitors and

nonsteroidal

anti-inflammatory drugs (NSAIDs)

Slide33

Integumentary System

Slide34

Classifications of skin conditions

Infectious disease

ie

. Athlete’s foot, lice

Inflammatory disorders

ie

. Sunburn, contact dermatitis

Skin cancer

ie

. Squamous cell carcinoma

Slide35

Acne

Common skin disorder of adolescents and young adults

Treatment

Benzoyl Peroxide (

Benzaclin

) – OTC (sometimes combined with antibiotics)

Retinoids

– Vitamin A – like compounds (cause sensitivity to light, don’t use when pregnant)

Antibiotics (tetracycline, doxycycline)

Birth control pills

MOA for

antiacne

drugs

Slow down turnover of skin cells

Inhibit bacterial growth

Slide36

isotretinoin (Accutane)

Treatment - most severe cases, strongest Retinoid

Isotretinoin

(Accutane)

MOA: provides improved resistance to bacterial infection by reducing oil production and the occurrence of clogged

pores

SE: sensitivity to sunlight,

teteragenic

, hepatotoxic

NC: Pregnancy

category X

iPLEDGE

system

Pregnancy test prior to initiation of treatments

Monitor liver enzymes and triglyceride levelsAvoid direct sunlight

Slide37

Eczema and Dermatitis

Eczema-

skin disorder that resembles allergic reaction

Inflammation, itching, rash

Contact dermatitis

Delayed type of allergic reaction

Contact with specific allergens - cosmetic, detergents, jewelry, latex

Inflammation, varying degrees of cracking, bleeding, or small blisters

Treat with Topical Steroids

Best way to treat symptoms of dermatitis

Help relieve inflammation and itching

Available in different levels of potency

Different preparations available - creams, lotions, solutions, gels, pads

Slide38

Psoriasis Disorder

Symptoms - red patches of skin covered with flaky, silver-colored scales (called plaques)

Reason for plaques - extremely fast skin turnover rate

Cause - may be genetic immune reaction

Topical and Systemic Medications for Psoriasis

Emollients- soften and soothe skin

Topical glucocorticoids

Immunosuppressant medications

Slide39

Question OneAn 18 – year – old female client has severe acne. There has been no improvement from the use of various preparations and

isotretinoin

(Accutane) is being prescribed. The nurse evaluates that the client understood medication instructions, if the client stated to do which of the following?

1. Apply a thick layer of

isotretinoin

twice a day

2. Increase exposure to the sun for added benefits

3. Have a pregnancy test prior to beginning therapy and use contraception

4. Have blood drawn for hormonal studies monthly for the first 6 months

Slide40

Glaucoma and Other Eye Disorders

Slide41

Forms and Routes

Eye Drop Instillations

Slide42

Eye Drop InstillationExpose the conjunctiva sac by gently pulling down and having the pt

look

up.

Administer

prescribed # of drops into center of sac without touching

dropper.

Press

the lacrimal duct with cotton or tissue 1-2 min to prevent systemic

absorption.

Client

should keep eye closed 1-2 min after to increase absorption.

Slide43

General Considerations for

Topical Ophthalmic Drug Therapy

Topical application

Check which eye is being medicated

Proper administration

One drop at a time

If more than one drug at about the same time, separate administration by at least 5 minutes

Minimize systemic absorption

Ointments

Slide44

Slide

44

Anatomy and Physiology of the Eye

Slide45

Glaucoma

One of the leading causes of blindness

Causes

Some cases genetic

Nongenetic

factors

Eye injury and disease

Medications

Major risk factors

High blood pressure

Migraine headaches

Refractive illnesses

Old age

Slide46

Increase in Intraocular Pressure (IOP)

Reason is the flow of aqueous humor is blocked

Pressure on optic nerve builds

Can result in blindness

In some cases, can be sudden, but in most cases is a gradual increase in IOP

Two Types

Closed-angle glaucoma

Open-angle glaucoma

Both types result from buildup of aqueous humor

Difference comes from how quickly the increased intraocular pressure develops

Slide47

Slide48

Glaucoma Drug Therapy

2 approaches

Drugs that increase the outflow of aqueous humor at the Canal of

Schlemm

Cholinergic agents (

Miotics

)

Prostaglandins

Drugs that decrease formation of aqueous humor at the

ciliary

body

Beta adrenergic blockers

Carbonic anhydrase inhibitors

Osmotic diuretics

Slide49

Cholinergic Agents (Miotics)

MOA:

Activate cholinergic receptors

This produces a variety of responses in the eye including dilation of the trabecular meshwork so that the canal of

Schlemm

can absorb more aqueous humor

Direct or indirect acting

USE: increase outflow of aqueous humor to reduce IOP in glaucoma

SE/NC: rest and digest is absorbed systemically; hold lacrimal duct and may need a stronger dose for darker eyes

Example

Pilocarpine

(

Isopto

Carptine)- direct actingDemecarium bromide (Humorsol)-indirect acting

Slide50

Prostaglandins

MOA: Increase aqueous humor outflow by reducing congestion in trabecular meshwork

USE: reduces IOP in glaucoma

Major SE of prostaglandins-

cause hyperpigmentation of the eye

Can be irritating to the eyes

NC:

Give at HS to decrease irritation

Instruct

pt

eye color may change

Latanoprost

(

Xalatan

)

Slide51

Beta Blockers

Most commonly

used

class of drugs to treat glaucoma

Exact

mechanism of action

not understood

Reduce intraocular pressure without the ocular symptoms seen with cholinergic agents

Example

Timolol

(

Timoptic

)

Adverse Effects

Systemic side effects (uncommon b/c doses are usually too low for drug to enter systemic circulationBronchoconstrictionReduced heart rate and blood pressure

Slide52

Carbonic Anhydrase Inhibitors

Used

as a second choice if beta blockers not effective

MOA: Inhibit the enzyme, carbonic anhydrase

Results in a decrease in production of aqueous humor

SE: Cross Allergy to Sulfas

Example

a

cetazolamide (Diamox)

Slide53

Osmotic Diuretics

Used

when a quick loss of intraocular pressure is required

Eye surgery

Acute closed-angle glaucoma

MOA: Reduce plasma volume very quickly

AE: HA, dizziness, F/E imbalances

NC: many drug interactions

Example

Mannitol (

Osmitrol

)

Slide54

Drugs for Other Eye Disorders

Drug classes

Anticholinergics (

mydriatic

drugs)

Cycloplegic

drugs

Corticosteroids and anti-inflammatory agents

Antihistamines

Artificial tear solutions

Slide55

Disorders of the ear

Otitis – inflammation of the ear most often in outer and middle ear

external otitis – swimmer’s ear

otitis media – inflammation of middle ear (occur most often with upper resp. infections, allergies, or auditory tube irritation)

otitis

interna

– inflammation of inner ear – most difficult to treat

mastoiditis

– inflammation of mastoid sinus – causes hearing loss if left untreated

Slide56

Drugs for Disorders of the Ear

Antibacterials

for otitis media 

Antihistamine-decongestants

To reduce nasal and middle ear congestion in OM

Ceruminolytics

Drugs to loosen and remove impacted

cerumen

from the ear canal

Irrigation with hydrogen peroxide and water

Debrox

Slide57

Question OneA client is receiving

pilocarpine

(

Isopto

Carpine

) for the treatment of glaucoma. Which symptoms, if experienced by the client, does the nurse attribute to systemic absorption?

1. Diaphoresis

2. Constipation

3. Tachycardia

4. Hypertension

Slide58

Question TwoThe nurse is providing care to a client taking

methazolamide

(

N

eptazane

), a carbonic anhydrase inhibitor for glaucoma. The nurse should include monitoring for which electrolyte imbalances when implementing the plan of care? Select all that apply.

1. Hyperkalemia

2. Hypokalemia

3.

Hypocalcemia

4.

Hypercalcemia

5. Hypernatremia

Slide59

Question ThreeThe parent of a 2 year old child exhibits correct administration technique for

otic

solutions by which action in a return demonstration?

1. The child’s pinna is pulled down and back before administering the medication

2. The child’s pinna is pulled up and back before administering the medication

3. The dropper is placed into the child’s ear canal for instilling the medication

4. The child’s head is tilted towards the affected side for medication instillation

Slide60

Question FourThe nurse is observing a client give a return demonstration of the administration of eye drops. Which client actions indicate a need for further teaching? Select all that apply.

1. The client pulls the lower lid of the eye

d

own, forming a sac.

2. The client instills the medication into the

conjunctival

sac.

3. The client cleanses the eyelid with cotton balls moistened with warm tap water

4. The client cleanses the eye from inner canthus to outer canthus

5. The client promotes drainage of the medication toward the inner canthus

Slide61

Question FiveThe nurse is monitoring a client with open-angle glaucoma who is receiving

timolol

(

Timoptic

) for treatment. The nurse should expect the

timolol

to exert which action that leads to the therapeutic response?

1. A decrease in the outflow of aqueous humor

2. An increase in the outflow of the aqueous humor

3. A decrease in aqueous humor production

4. An increase in aqueous humor production