Chapter 34: Bone Disorders
What is the purpose of estrogen receptor modulator (agonoist/antagonist)?
-Works as endogenous estrogen in bone, lipid metabolism, and blood coagulation -Decreases bone resorption, which slows bone loss and preserves bone mineral density -Works as an antagonist to estrogen on breast and endometrial tissue -Can decrease plasma levels of cholesterol
What are the nursing administration of calcitonin medication?
-Calcitonin-salmon is administered 1M, subcutaneously, or intranasally. The intranasal route is reserved for clients who have osteoporosis. -Keep the container in an upright position. -Check for Chvostek's or Trousseau's signs to monitor for hypocalcemia. -Monitor bone density scans periodically. CLIENT EDUCATION -Consume a diet high in calcium and vitamin D. -Rotate subcutaneous injection sites to prevent inflammation. -Administer intranasal formulation in a different nostril each day.
What are the contraindications/precautions of Calcium supplements?
-Calcium supplements are contraindicated in clients who have hypercalcemia, renal calculi, hypophosphatemia, digoxin toxicity, and ventricular fibrillation. -Use cautiously in clients who have kidney disease or a decrease in GI function.
What are the nursing administration of Calcium supplements?
-Chewable tablets provide more consistent bioavailability. -Recommended doses of oral calcium vary widely depending on the specific calcium preparation. Instruct the client to follow the prescription. -Prior to administration, warm IV infusions of calcium to body temperature. -Administer IV bolus doses at 0.5 to 2 mL/min CLIENT EDUCATION -Take a calcium supplement at least 1 hr apart from glucocorticoids and tetracyclines and at least 4 hr apart from thyroid hormone. -Take oral calcium with an 8 oz glass of water.
What are the therapeutic uses of Calcium supplements?
-Oral calcium supplements are used for clients who have hypocalcemia or deficiencies of parathyroid hormone, vitamin D, or dietary calcium. -Oral dietary supplements are used for adolescents, older adults, and clients who are postmenopausal, pregnant, or breastfeeding. -IV medications are used for clients who have critically low levels of calcium. -Oral vitamin D supplements can assist with the absorption of dietary calcium. -Calcium and vitamin D supplements used in conjunction with calcitonin or a bisphosphonate can reduce the risk of osteoporosis.
What are the therapeutic uses of estrogen receptor modulator (agonoist/antagonist)?
-Prevent and treat postmenopausal osteoporosis to prevent spinal fractures in female clients. -Protect against breast cancer.
What are the contraindications/percautions of estrogen receptor modulator (agonoist/antagonist)?
-Raloxifene is Pregnancy Risk Category X. -This medication is contraindicated in clients who have a history of venous thrombosis. -The medication should be stopped 72 hrs prior to periods of prolonged immobility (surgery or travel)
What are the nursing administration of Bisphosphonates medication?
-Tablets are prescribed once daily or once a week. The liquid form is prescribed once a week. -Monitor bone density. Clients should have a bone density scan every 12 to 18 months. -Monitor blood calcium. Expected reference range is 9 to 10.5 mg/dL. CLIENT EDUCATION -Take the medication first thing in the morning after getting out of bed. -Take oral medication on an empty stomach, drinking at least 240 mL (8 oz) water with tablets and at least 60 mL (2 oz) water with liquid formulation. -Sit or ambulate for 30 min after taking the medication. -Avoid all calcium-containing foods and liquids or any medications within 2 hr of taking alendronate. -Avoid chewing or sucking on the tablet. -Perform weight-bearing exercises daily (walking 30 to 40 min each day). -Notify the provider of difficulty swallowing, painful swallowing, or new or worsening heartburn. -If a dose is skipped, wait until the next day 30 min before eating breakfast to take the dose. Do not take two tablets on the same day. -For maximum benefit of the medication, consume adequate amounts of calcium and vitamin D.
What are the nursing administration of estrogen receptor modulator (agonoist/antagonist)?
-Take medication with or without food once per day. -Monitor bone density. Clients should undergo a bone density scan every 12 to 18 months. -Monitor blood calcium. Expected reference range is 9 to 10.5 mg/dL. -Monitor liver function tests. Raloxifene levels can increase in clients who have hepatic impairment. CLIENT EDUCATION -For maximum benefit of the medication, consume adequate amounts of calcium (from dairy products) and vitamin D (from egg yolks). Inadequate amounts of dietary calcium and vitamin D cause release of parathyroid hormone, which stimulates calcium release from the bone -Perform weight-bearing exercises daily (walking 30 to 40 min each day).
What are the contraindications/percautions of calcitonin medication?
-This medication is Pregnancy Risk Category C. -The medication is contraindicated in clients who have hypersensitivity to the medication or fish protein. Perform an allergy skin test prior to administration if the client is at risk. -Use cautiously with children, clients who are lactating, and clients who have kidney disease. -Intranasal spray is only approved for treatment of postmenopausal osteoporosis.
What are the interactions of calcitonin medication?
Concurrent use with lithium can decrease blood lithium levels. NURSING ACTIONS -Monitor lithium levels closely.
What are the interactions of Bisphosphonates medication?
Alendronate absorption decreases when taken with calcium, iron, magnesium supplements, antacids, orange juice, and caffeine NURSING ACTIONS -Wait at least 2 hr after administration to administer antacids or supplements. CLIENT EDUCATION -Take the medication on an empty stomach with at least 240 mL (8 oz) water.
What are the interactions of Calcium supplements?
Concurrent use of glucocorticoids reduces absorption of calcium. NURSING ACTIONS -Give at least 1 hr apart. Concurrent use of calcium decreases absorption of tetracyclines and thyroid hormone. NURSING ACTIONS -Ensure 1 hr between administration of tetracyclines and calcium and at least 4 hr between the administration of thyroid hormone and calcium. Concurrent administration of thiazide diuretics increases risk of hypercalcemia. NURSING ACTIONS -Assess for hypercalcemia. -Avoid concurrent use. Spinach, rhubarb, beets, bran, and whole grains can decrease calcium absorption. NURSING ACTIONS -Do not administer calcium with foods that decrease absorption. -Instruct clients to avoid consuming these foods at the same time as taking calcium. IV calcium precipitates with phosphates, carbonates, sulfates, and tartrates. NURSING ACTIONS -Do not mix parenteral calcium with compounds that cause precipitation. Concurrent use of digoxin and parenteral calcium can lead to severe bradycardia. NURSING ACTIONS -IV injection of calcium must be given slowly with careful monitoring of client cardiac status.
What are the interactions of estrogen receptor modulator (agonoist/antagonist)?
Concurrent use with estrogen hormone therapy is discouraged.
What are the nursing evaluation of medication effectiveness of Calcium supplements?
Depending on therapeutic intent, effectiveness is evidenced by blood calcium level within expected reference range: 9 to 10.5 mg/dL.
What are the nursing evaluation of medication effectiveness of calcitonin medication?
Depending on therapeutic intent, effectiveness is evidenced by the following. -Increase in bone density -Blood calcium level within the expected reference range of 9 to 10.5 mg/dL
What are the nursing evaluation of medication effectiveness of estrogen receptor modulator (agonoist/antagonist)?
Depending on therapeutic intent, effectiveness is evidenced by the following. -Increase in bone density -No fractures
What are the nursing evaluation of medication effectivensss of Bisphosphonates medication?
Depending on therapeutic intent, effectiveness is evidenced by the following. -Increase in bone density -No fractures
What is the purpose of calcitonin medication?
EXPECTED PHARMACOLOGICAL ACTION -Decreases bone resorption by inhibiting the activity of osteoclasts in osteoporosis. -Increases renal calcium excretion by inhibiting tubular resorption THERAPEUTIC USES -Treats (but does not prevent) postmenopausal osteoporosis, moderate to severe Paget's disease, hypercalcemia caused by hyperparathyroidism, and cancer
What is the purpose of Bisphosphonates medication?
EXPECTED PHARMACOLOGICAL ACTION Bisphosphonates decrease the number and action of osteoclasts, and inhibit bone resorption THERAPEUTIC USES -Prophylaxis and treatment of postmenopausal osteoporosis -For male clients who have osteoporosis -Prophylaxis and treatment of osteoporosis produced by long-term glucocorticoid use -For Clients who have Paget's disease of the bone
What are the complications of Bisphosphonates medication?
Esophagitis, esophageal ulceration (oral formulations) NURSING ACTIONS -Instruct the client to sit upright or ambulate for 30 min after taking this medication orally. -Clients taking ibandronate must remain upright and not ingest food or other medications for 1 hr after taking the medication orally. -Instruct the client to take tablets with at least 240 mL (S oz) water and liquid formulation with at least 60 mL (2 oz). -Discontinue the medication and contact the provider for difficulty swallowing or new heartburn. GI disturbances all bis hos honates -Abdominal pain, nausea, diarrhea, constipation NURSING ACTION -Notify provider for GI problems that prevent adequate intake. Musculoskeletal pain CLIENT EDUCATION -Take a mild analgesic. -Notify the provider if pain persists. Alternate medication can be prescribed. Visual disturbances -Blurred vision and eye pain CLIENT EDUCATION -Watch for manifestations and report them to the provider. Medication should be discontinued. Bisphosphonate-related osteonecrosis of the jaw -With IV infusion NURSING ACTIONS -See dentist prior to beginning treatment. Avoid dental work during administration of medication. Kidney toxicity with IV infusion NURSING ACTIONS -Monitor kidney function and hydration status.
What are the complications of Calcium supplements?
Hypercalcemia Calcium level greater than 10.5 mg/dL FINDINGS: Initially, tachycardia and elevated blood pressure eventually leading to bradycardia and hypotension. Other findings include muscle weakness, hypotonia, constipation, nausea, vomiting, abdominal pain, lethargy, and confusion. NURSING ACTIONS -Monitor blood calcium levels to maintain between 9 and 10.5 mg/dL. -Infuse 0.9% sodium chloride IV. -Medications used to reverse hypercalcemia include IV furosemide, and calcium chelators (plicamycin). Medications used to prevent hypercalcemia include bisphosphonates (alendronate and oral inorganic phosphates). CLIENT EDUCATION -Monitor for manifestations and report them to the provider.
What are the complications of estrogen receptor modulator (agonoist/antagonist)?
Increased risk for pulmonary embolism and deep-vein thrombosis (DVT) NURSING ACTIONS -Medication should be stopped prior to scheduled immobilization (surgery). Medication can be resumed when the client is fully mobile. -Monitor for manifestations of DVI' (red, swollen extremity). -Discourage long periods of sitting and inactivity. Hot flashes CLIENT EDUCATION: The medication can exacerbate hot flashes.
What is the purpose of Calcium supplements?
Maintenance of musculoskeletal, neurologic, and cardiovascular function
What are the contraindications/percautions of Bisphosphonates medication?
Most bisphosphonates are Pregnancy Risk Category D. Ibandronate and etidronate are Pregnancy Risk Category C. -Zoledronate has been associated with an increase in stillbirths and a decreased survivability of neonates. -These medications are contraindicated for clients Who have dysphagia, esophageal stricture, esophageal disorders, serious kidney impairment, and hypocalcemia. This medication should not be administered to clients who cannot sit upright or stand for at least 30 min after medication administration. -Use cautiously for clients who are lactating, and in clients who have upper GI disorders, infection, and liver impairment. -Older adults are at slight risk for femoral fractures, which can occur without trauma while taking bisphosphonates.
What are the complications of calcitonin medication?
Nausea CLIENT EDUCATION -Nausea is usually self-limiting. Nasal dryness and irritation with intranasal route NURSING ACTION -Inspect nasal mucosa periodically for ulceration. CLIENT EDUCATION -Alternate nostrils daily.
Name some Bisphosphonates medications?
SELECT PROTOTYPE MEDICATION: Alendronate
Name some calcitonin medication?
SELECT PROTOTYPE MEDICATION: Calcitonin-salmon
Name some Calcium supplements?
SELECT PROTOTYPE MEDICATION: Calcium citrate OTHER MEDICATIONS -Calcium carbonate -Calcium acetate
Name selective estrogen receptor modulator (agonoist/antagonist)?
SELECT PROTOTYPE MEDICATION: Raloxifene for postmenopausal osteoporosis
