Week 9 Chapters 20 38 amp 40 The Skeletal System Calcium One of the bodys most important minerals Responsible for Muscle contraction Nerve conduction Bone formation Blood Calcium levels are Controlled by three hormones ID: 777310
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Slide1
The Skeletal system, Integumentary system, and eyes & ears
Week 9
Chapters 20, 38, & 40
Slide2The Skeletal System
Slide3Calcium
One of the body’s most important minerals
Responsible for:
Muscle contraction
Nerve conduction
Bone formation
Slide4Blood 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
Slide5Vitamin 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
Slide6Parathyroid Hormones
38-
6
Slide7Hypocalcemia
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
Slide8Common calcium supplements
Calcium chloride
Calcium lactate
Calcium gluconate
Slide9Vitamin D supplements (active form)
Calcitriol
(
Rocaltrol
)
Calcitriol
(Vitamin D3)
Slide10Degenerative 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
Slide11Risk 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
)
Slide12Treatments
Calcitonin
Bisphosphonates
Calcium supplements
Vitamin D supplements
Slide13Calcitonin (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
Slide14Bisphosphonates
MOA: Inhibit bone resorption by suppressing osteoclast activity
This increases bone density
Profile Drugs:
Alendronate (Fosamax)
Ibandronate
(Boniva)
Slide15BisphosphonatesSide 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
Slide16Question 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
Slide17Question 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
Slide18Question ThreeIf calcium levels decrease below normal, which hormone would be released to compensate?
1. calcitonin
2. PTH
3. TRH
4. TSH
Slide19Arthritic and Joint DisordersChapters 20
Slide20Arthritic 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
Slide21OsteoarthritisGoal: 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
Slide22Rheumatoid Arthritis
Analgesics and anti-inflammatories
Glucocorticoids
Immunosuppressants
Methotrexate (Rheumatrex)
Disease-modifying antirheumatic drugs (DMARDs):
hydroxychloroquine (Plaquenil), gold salts, sulfasalazine (Azulfidine), D-penicillamine (Cuprimine)
Slide23Gout
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
Slide24Acute 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
Slide25Medications 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
Slide26Medications 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
Slide27Medications 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
Slide28Medications 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
Slide29Question 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
Slide30Question 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
Slide31Question 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
Slide32Question 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)
Slide33Integumentary System
Slide34Classifications of skin conditions
Infectious disease
ie
. Athlete’s foot, lice
Inflammatory disorders
ie
. Sunburn, contact dermatitis
Skin cancer
ie
. Squamous cell carcinoma
Slide35Acne
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
Slide36isotretinoin (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
Slide37Eczema 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
Slide38Psoriasis 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
Slide39Question 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
Slide40Glaucoma and Other Eye Disorders
Slide41Forms and Routes
Eye Drop Instillations
Slide42Eye 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.
Slide43General 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
Slide44Slide
44
Anatomy and Physiology of the Eye
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
Slide46Increase 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
Slide47Slide48Glaucoma 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
Slide49Cholinergic 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
Slide50Prostaglandins
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
)
Slide51Beta 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
Slide52Carbonic 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)
Slide53Osmotic 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
)
Slide54Drugs for Other Eye Disorders
Drug classes
Anticholinergics (
mydriatic
drugs)
Cycloplegic
drugs
Corticosteroids and anti-inflammatory agents
Antihistamines
Artificial tear solutions
Slide55Disorders 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
Slide56Drugs 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
Slide57Question 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
Slide58Question 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
Slide59Question 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
Slide60Question 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
Slide61Question 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