low bone density It occurs when the rate of bone resorption osteoclast cells exceeds the rate of bone formation osteoblast cells resulting in fragile bone tissue subsequent fractures ID: 913893
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Slide1
Osteoporosis
Slide2Key Points
Osteoporosis is the most common metabolic bone disorder resulting in
low bone
density. It occurs when the rate of bone resorption (osteoclast cells) exceeds the rate of bone formation (osteoblast cells) resulting in fragile bone tissue subsequent fractures.Osteopenia (precursor to osteoporosis), refers to low bone mineral density for what is expected for the person’s age and sex.Peak bone mineral density: age of 30 to 35 years. After that, bone density decreases, rapidly in postmenopausal women due to estrogen loss.Fragile, thin bone tissue is susceptible to fracture.
Slide3Risk Factors
Age
60Postmenopausal estrogen deficiencyFamily HxThin, lean body buildHx of low calcium intake with suboptimal levels of vitamin DHx of smokingHx of high alcohol intakeLack of physical activity/prolonged immobility
Slide4Secondary osteoporosis
Hyperparathyroidism
.
Long-term corticosteroid use (for example, asthma).Long-term immobility (for example, spinal cord injury).
Slide5Diagnostic Procedures and Nursing Interventions
Radiographs
of the spine and long bones reveal low bone density and fractures.
Dual energy x-ray absorptiometry (DEXA) is used to screen for early changes in bone density. This painless test measures bone mineral density in the wrist, hip, and vertebral column.Serum calcium, vitamin D, phosphorus, and alkaline phosphatase levels are drawn to rule out other metabolic bone diseases (Paget’s disease or osteomalacia).
Slide6Assessment
Monitor for signs and symptoms.
Thoracic kyphosis
Reduced height (postmenopausal)Acute back pain after lifting or bending (worse with activity, relieved by rest)Restricted movementFracturesFear of falling
Slide7NANDA Nursing Diagnoses
Impaired
mobility
Imbalanced nutrition: Less than body requirementRisk for fallsIneffective health maintenance
Slide8Nursing Intervention
Slide9Nursing Intervention
Instruct the client and family regarding dietary calcium food
sources (Seeds, cheese, yogurt, sardine & salmon, beans & lentils,
almonds) .Provide information regarding calcium supplementation (take with food).Instruct the client of the need for adequate amounts of protein, magnesium, vitamin K for bone formation.Reinforce the need for exposure to vitamin D (sunlight, fortified milk).Assess the home environment for safety (remove throw rugs, adequate lighting, clear walkways).Reinforce the use of safety equipment and assistive devices.Instruct the client to avoid inclement weather (ice or slippery surfaces).
Slide10Nursing Intervention
Clearly mark thresholds, doorways, and steps.
Prevention
Teach the importance of regular, weight-bearing exercises.Introduce the importance of calcium intake to children to improve peak bone mass. Strong adult skeletons are built during childhood.
Slide11Complications and Nursing Implications
Fractures
are the leading complication of osteoporosis.
Early recognition and treatment is essential. The nurse should review risk factors for osteoporosis and falls, assess the client’s dietary intake of calcium, reinforce daily exercise including weight-bearing activities, and ensure proper screening with a DEXA scan.
Slide12Test yourself
Which of the following clients is at the greatest risk for osteoporosis?
A. 40-year-old man who has asthma
B. 30-year-old female who jogs dailyC. 65-year-old female who smokes cigarettes and is sedentaryD. 65-year-old male who drinks alcohol excessively
Slide13In providing dietary instructions to a client to minimize the risk of osteoporosis, the nurse
should recommend
which of the following foods?
A. BreadB. YogurtC. ChickenD. Rice
Slide14oSTEOARTHRITIS
Slide15Key Points
Osteoarthritis (OA) is a disorder characterized by progressive deterioration
of the
articular cartilage. It is a non-inflammatory (unless localized), non-systemic disease.It is a process where new tissue is produced as a result of cartilage destruction within the joint. The destruction outweighs the production. The cartilage and bone beneath the cartilage erode and osteophytes (bone spurs) form, resulting in narrowed joint spacesThe changes within the joint lead to pain, immobility, muscle spasms, and potential inflammation.
Slide16Risk Factors
Age
Decreased muscle strength
ObesityPossible genetic linkEarly in the disease process of OA, it may be difficult to distinguish from rheumatoid arthritis (RA).
Slide17Diagnostic Procedures and Nursing Interventions
ESR
and high-sensitivity C-reactive
protein may be slightly elevated related to secondary synovitis.X ray can determine structural changes within the joint.CT imaging scan may be used to determine vertebral involvement
Slide18Assessment
Joint
pain and stiffness that resolves with rest or inactivity (chief report)
Pain with joint palpation or ROM (observe for muscle atrophy, loss of function, client limp when walking, and restricted activity due to pain)Crepitus in one or more of the affected jointsEnlarged joint related to bone hypertrophy
Heberden’s
nodes enlarged at the distal
interphalangeal
(DIP)
joints
Inflammation resulting from secondary
synovitis
, indicating advanced disease
Slide19Assess/Monitor
Pain
: Level (0-10), location, characteristics, quality, and severity
Degree of functional limitationLevels of pain and fatigue after activityROMProper functional/joint alignmentHome barriersAbility to perform activities of daily living (ADLs)
Slide20NANDA Nursing Diagnoses
Chronic
pain
Impaired physical mobilityActivity intoleranceSelf care deficitDisturbed body image
Slide21Nursing Interventions
Conservative
therapy includes:
Balance rest with activity.Use bracing or splints.Apply thermal therapies (heat or cold).Analgesic therapy.AcetaminophenNSAIDSTopical salicylatesIntra-articular injections of glucocorticoids (treat localized inflammation)
Slide22Nursing Interventions
When all other conservative measures fail, the client may choose to undergo
joint replacement
surgery to relieve the pain and improve mobility and quality of life.Osteotomy; remove damaged cartilage and correct the deformity.Instruct the client on the use of analgesics and NSAIDS prior to activity and around the clock as needed.Balance rest with activity.Instruct the client on proper body mechanics.
Slide23Intervention
Encourage the use of thermal applications: heat to alleviate pain, ice for
acute inflammation
.Encourage the use of complementary and alternative therapies, including: acupuncture, hypnosis, magnets,…….Encourage the use of splinting for joint protection and the use of larger joints.Encourage the use of assistive devices to promote independence, including an elevated toilet seat, shower bench, …………..Encourage the use of a daily schedule of activities that will promote independence (high-energy activities in the morning).Encourage a well-balanced diet and ideal body weight. Consult a dietitian to provide
meal-planning for balanced nutrition.
Slide24Rheumatoid Arthritis
Slide25Key points
RA is
a
chronic, systemic, progressive inflammatory disease of the synovial tissue. It is a bilateral systemic inflammatory disease process involving multiple joints. In contrast, osteoarthritis is a unilateral degenerative disease process of a single joint.It is classified as an
autoimmune process
in which antibodies are formed
against synovial
tissues, including:
Synovial membrane.
Articular cartilage.
Joint capsule.
Tendons and ligaments surrounding the joint.
Involvement of the spine, particularly the cervical joints.
Slide26Key points
The natural course of the disease is one of exacerbations and remissions.
Inflammation and tissue damage can cause severe deformities that greatly restrict function
Risk FactorsFemale genderAge 20 to 50 yearsGenetic predispositionEpstein Barr virusStress
Slide27Diagnostic Procedures and Nursing Interventions
Rheumatoid
Factor (RF) antibody
Diagnostic for rheumatoid arthritis = 1:40 to 1:60 (normal ≤ 1:20).High titers correlate with severe disease.Antinuclear Antibody (ANA) Titer (antibody produced against one’s own DNA)A positive ANA titer is associated with RA (normal is negative ANA titer at 1:20 dilution)Erythrocyte Sedimentation Rate (ESR): Elevated20 to 40 mm/hr = mild inflammation.40 to 70 mm/hr = moderate inflammation.70 to 150 mm/hr = severe inflammationArthrocentesis; Synovial
fluid aspiration by
needle With
RA, increased white blood cells (WBCs) and RF are present
.
Slide28Assessments
Clinical
findings depend on the area affected by the
disease process:Pain at rest and with movementMorning stiffnessJoint swellingJoint deformityAnorexia/weight lossFever (generally low grade)FatigueMuscle weakness/atrophyAssess/MonitorPain (character, intensity, effectiveness of relief measures)Functional abilityIndications of infection
Slide29NANDA Nursing Diagnoses
Fatigue
Impaired physical mobility
Chronic painDisturbed body imageRisk for injury
Slide30Nursing Interventions
Apply
heat or cold to affected areas as indicated based on client response.
Morning stiffness (hot shower)Pain (heated paraffin)Edema (cold therapy)Assist with and encourage physical activity to maintain joint mobility (within the capabilities of the client).Teach the client measures to:Maximize functional activity.Minimize pain.Conserve energy (pacing activities, rest periods)
Slide31Nursing Interventions
Provide a safe environment.
Facilitate the use of assistive devices.
Remove unnecessary equipment/supplies.Utilize progressive muscle relaxation.Monitor the client for signs/symptoms of fatigue.Refer the client to support groups as appropriate.Administer medications as prescribed.AnalgesicsAnti-inflammatoriesNSAIDsSteroids, such as prednisoneMonitor for fluid retention, hypertension, and renal dysfunction.
Slide32Nursing Interventions
Immunosuppressants
(may slow the progression of disease)
Disease-modifying anti-rheumatic medications (DMARM)such as hydroxychloroquine, sulfasalazine, minocycline (slow the progression of joint damage from rheumatoid arthritis. Methotrexate (Rheumatrex)Monitor for toxic effects (bone marrow suppression, increased liver enzymes).
Slide33Nursing Interventions
Biological response modifiers: Inhibit the action of tumor necrosis
factor (TNF);
is a cytokine produced primarily by monocytes and macrophages. It is found in synovial cells and macrophages in the tissues. Do not administer if the client has a serious infection.Monitor for injection/infusion reactions.Monitor CBC and the client for signs of infection.Monitor for medication effectiveness (reduced pain, increased mobility).Teach the client regarding signs/symptoms that need to be reported immediately (fever, infection).
Slide34Complications and Nursing Implications
Sjogren’s
syndrome (dry eyes, dry mouth, dry vagina)Joint deformity (tendon rupture, secondary osteoporosis)Vasculitis (ischemic organs)Cervical subluxation (risk of quadriplegia and respiratory compromise)
Slide35