Chapter 49: Disorders of Musculoskeletal Function: Developmental and Metabolic Disorders, Activity Intolerance, and Fatigue

What are bone formation and breakdown balanced to?

Replacing damaged bone and maintaining the amount and density of bone

A nursing instructor is teaching students about metabolic bone diseases. She realizes a need for further instruction when one student states: "Osteopenia is a condition common to all metabolic bone diseases." "Osteopenia is not a diagnosis." "Osteopenia is a condition that is only common in the elderly." "Osteopenia can be caused by osteoporosis."

"Osteopenia is a condition that is only common in the elderly."

A client with osteomalacia asks, "How can I be deficient in vitamin D?" Which of the following is the nurse's best response? "Tell me about your typical daily food intake." "You do not go out in the sun enough." "You should ask your doctor." "You must be deficient in phosphate."

"Tell me about your typical daily food intake."

How do osteoblasts control bone remodeling?

-laying down new bone -secreting a compound (RANK ligand) that controls the osteoclasts

When do bones stop growing?

18-23 years old

Amount of physical activity a person can perform without injury or excessive exertion Activity tolerance, activity intolerance, or fatigue?

Activity tolerance

Rapid onset with increased activity, relieved with rest, associated with other dx, decreased with condition Acute or chronic fatigue?

Acute

Who would osteomalacia be commonly seen in?

An elderly female who doesn't get a lot of sunshine

How does osteomalacia manifest?

Bone pain, tenderness, fractures

Why would a 70 year old man be prone to osteoporosis?

Bones are broken down more than they are reformed (osteoclast > osteoblast activity)

Why would a hyperthyroid alcoholic be prone to osteoporosis?

Calcium reabsorption issues (hyperthyroid) + less osteoblastic activity (alcohol)

Which disorder is a chromosomal abnormality? Dysplasia of the hip Osteogenesis imperfecta Congenital clubfoot

Congenital clubfoot

Which disorder is fixed with progressive casts? Dysplasia of the hip Osteogenesis imperfecta Congenital clubfoot

Congenital clubfoot

What causes osteopenia?

Decrease in bone formation - not enough osteoblasts Inadequate bone mineralization - disease process Excessive bone deossification - too much osteoclasts

In contrast to osteoporosis, osteomalacia causes which outcome, without the loss of bone matrix? Stress fractures Calcium excretion Bone cortex thinning Defective mineralization

Defective mineralization

In Paget's disease, new bone is Not formed Disorganized Damaged

Disorganized

Which disorder can be fixed with surgery? Dysplasia of the hip Osteogenesis imperfecta Congenital clubfoot

Dysplasia of the hip

Why a postmenopausal woman be prone to osteoporosis?

Estrogen production decreases, which decreases stimulation of osteoblastic activity

How are bone variations corrected?

Exercise, braces, and PT

Osteopenia is a disease. T or F?

False

In Paget's disease, signs and symptoms include fractures headache hypertension mosaic pattern of bone kyphosis pain swelling warm skin cool skin shuffling gait waddling gait sweating vertigo

Fractures, headache, mosaic pattern, kyphosis, pain, warm skin, waddling gait, vertigo

How is osteogenesis imperfecta diagnosed?

Hearing deformities, shorter limbs, discovered in infants

Which form of structural scoliosis has an unknown cause? Congenital Neuromuscular Idiopathic

Idiopathic

Osteopenia

Imbalance between bone formation and bone breakdown

How is dysplasia of the hip diagnosed?

It's checked for at birth. There are uneven creases of the buttocks and thighs

Which form of structural scoliosis is caused by an issue in the brain? Congenital Neuromuscular Idiopathic

Neuromuscular

Why would an olympic figure skater who takes steroids be prone to osteoporosis?

Osteoblastic activity is reduced from steroids

In Paget's disease, what activity is too high?

Osteoclastic

Which disorder occurs when bones break easily? Dysplasia of the hip Osteogenesis imperfecta Congenital clubfoot

Osteogenesis imperfecta

Why would a man with a lung tumor that secretes PTH be prone to osteoporosis?

PTH causes more calcium to be drawn out of the bone

Which type of scoliosis is easily correctable with exercising? Structural Postural

Postural

How is osteoporosis dx?

Screening of women of a certain age

osteoporosis

a decreased bone mineral density that causes porous bone that is weaker than normal bone

Not having sufficient physical or psychological energy reserves to endure or complete required or desired activities Activity tolerance, activity intolerance, or fatigue?

activity intolerance

There should be a _____ between breaking down bones and building up bones

balance

Osteogenesis imperfecta is caused by mutation in what gene?

brittle bone disease from mutation in the collagen gene

Osteomalacia is caused by an entire loss of bone change in bone structure

change in bone structure

Associated with medical conditions, treatment focuses on symptom management, encouragement, and listening to pts Acute or chronic fatigue?

chronic fatigue

Which form of structural scoliosis is formed in utero? Congenital Neuromuscular Idiopathic

congenital

What are some of the s/sx of osteoporosis?

decrease in height, change in spine curvature, more disposition to breaks

Which disorder causes a hip out of socket? Dysplasia of the hip Osteogenesis imperfecta Congenital clubfoot

dysplasia of the hip

A subjective, normal or abnormal response to day to day activities Activity tolerance, activity intolerance, or fatigue?

fatigue

In a client diagnosed with osteomalacia, what would be recommended to aid with improvement of the condition?

increasing dietary consumption of vitamin d

Causes of osteomalacia include insufficient Calcium absorption Trauma incident Decreased phosphate Increased vitamin D

insufficient calcium decreased phosphate

Bone building cells

osteoblasts

Bone breaking cells

osteoclasts

What is osteomalacia?

softening of the bone

Why does osteomalacia happen?

the mineralization process is broken, so the bone becomes soft and rigid

What are the manifestations of osteogenesis imperfecta? Select all that apply. Triangular appearance to face Thick bones in lower extremities Blue or gray sclera Thick skin Scoliosis

triangular appearance ot the face, scoliosis, blue or gray sclera

The nurse suspects idiopathic scoliosis in a client based on which assessment finding?

uneven shoulders or iliac crest