NUR 312 - Week 3 - ch. 41, 41, gid 2, gid 26, gid 27

Bisphosphonates side effects

- GI: N/V/D, abdom pain - Esophageal: GERD, ulcers - Musculoskeletal pain: bone, muscle, joints - H/A - HypoCa++ !!!! - ONJ (osteonecrosis of the jaw; 0.12% chlorhexidine rinse) - Might increase risk of esophageal cancer - Possible increased risk of THIGH bone fractures

Osteomyelitis nursing considerations

- supportive (high risk for injury r/t NV impairment) - pain management - maintenance of IV access - cast care (immobilization) - nutrition - quiet play on bed rest

individual risk factors for tissue disruption are associated with underlying health conditions...

-Health conditions associated with poor peripheral perfusion, malnutrition, obesity, fluid deficit or excess, impaired physical mobility, and immunosuppression increase the risk of tissue disruption. -In addition, exposure to chemical irritants, radiation, excessively hot or cold temperatures, and mechanical damage may cause a loss of tissue integrity. - Individuals who have undergone medical treatments, surgical procedures, or invasive procedures have disruptions to skin and tissue integrity as a result of those procedures.

RANKL Inhibitor indications

-Monoclonal antibody that increases BMD and reduces the porosity of cortical bone by inhibiting the effects of TNF on osteoclasts, inhibiting their activity -Treatment of osteoporosis in men and women who are postmenopausal at high risk of fracture; also indicated for women with osteoporosis and breast cancer receiving aromatase inhibitors and for men with osteoporosis and prostate cancer receiving gonadotropin-reducing hormones

Carpal tunnel syndrome symptoms

-Numbness/tingling in thumb, index, and middle finger -Positive phalen (dorsum of hands placed together) -Positive tinel (tapping wrist) -Weakness with abducting thumb

Malignant Bone Tumors

-Osteogenic sarcoma -Chondrosarcoma -Ewing's sarcoma -Multiple myeloma -Bone metastases

Osteomyelitis Pathophysiology

-Pathogen in bone causes inflammatory response -Abscesses form (lifts periosteum off underlying bone) -Pressure from abscess causes decreased blood supply to bone - necrosis -Osteoblasts form new bone

Estrogen Agonist/Antagonist indication

-Promotes estrogenic effects on bone, preserving BMD, with concomitant antiestrogenic effects on the uterus and breasts -Prevention and treatment of osteoporosis in women who are postmenopausal, particularly those with breast cancer -May also reduce the risk of breast cancer in patients at risk

fracture manifestations

-Unnatural alignment, swelling, muscle spasm, tenderness, pain, impaired sensation, and decreased mobility -Often transient numbness due to nerve trauma

Benign Bone Tumors

-osteoma -chondroma -osteochondroma -osteoclastoma Often asymptomatic and may be discovered on routine x-ray or as a cause of pathologic fracture

Paget's disease of bone pathophysiology

1. disordered bone remodeling with increase osteoclast bone resorption -> increased abnormal trabecular bone formation -> larger, weaker, less compact bones more vascular and prone to fractures 2. lytic phase (increase osteoclast activity) -> mixed phase -> sclerotic phase (increase osteoblast activity)

Bisphosphonates nursing considerations

1. monitor for gastric upset and esophageal 2. vision changes 3. musculoskeletal pain 4. administer with 6 to 8 ounces on empty stomach 5. do not administer with antacids or other medications 6. avoid food and beverages for 60 minutes after administration 7. instruct the client to sit occurs -Adequate calcium and vitamin D intake is needed to assure maximum effect; however, these supplements should not be taken at the same time as the bisphosphonates

Carpal tunnel syndrome

A condition caused by compression of the median nerve in the carpal tunnel and characterized especially by weakness, pain, and disturbances of sensation in the hand and fingers

Osteoporosis

A condition in which the body's bones become weak and break easily.

The Braden scale

A tool for predicting pressure ulcer risk

Estrogen Agonist/Antagonist nursing considerations

Administer PO once daily. May be given in tandem with calcium and vitamin D

Alendronate (Fosamax)

Bisphosphonate - This medication is used to prevent and treat postmenopausal osteoporosis and Paget's Disease. - Alendronate must be taken first thing in the morning on an empty stomach. - The pt must be instructed to wait at least 30 minutes after taking Alendronate before eating, drinking, or taking other medications.

Risedronate (Actonel)

Bisphosphonate -Treatment of osteoporosis in men, and in women and men taking corticosteroids

Ibandronate (Boniva)

Bisphosphonate -Treatment of osteoporosis in women who are postmenopausal -IV dosing may be good option for patients either intolerant of PO bisphosphonates or nonadherent to prescribed therapy

Zoledronic acid (Reclast)

Bisphosphonate -Prevention and treatment of osteoporosis in women who are postmenopausal Treatment of osteoporosis in men and in both men and women taking corticosteroids for at least 12 months

skin functions

Body's protective covering; Prevents bacteria & other substances from entering the body; Prevents excess amounts of water from leaving the body; Protects organs from injury; Nerve endings in the skin sense pleasant and unpleasant stimulation. Nerve endings are over the entire body and sense cold, pain, touch, & pressure to protect the body from injury; Skin helps regulate body temperature. Blood vessels dilate (widen) when temp outside body is high. More blood comes to the body surface for cooling during evaporation. When blood vessels constrict (narrow) the body retains heat because less blood reaches the skin

Osteoporosis Pathophysiology

Bone resorption exceeds formation. Results in loss of compact bone Diagnosed with bone density scans Can cause compression fractures of vertebrae, wrist, or hip Can lead to kyphosis and scoliosis

osteoporosis treatment

Calcium/vitamin D supplementation (prophylaxis); bisphosphonates, PTH analogs, SERMs, calcitonin, denosumab (treatment)

Wound cultures

Cultures identify the organisms causing infection. Because some bacteria are present on healthy skin, normal skin flora may be identified in wound cultures along with any pathogenic bacteria.

RANKL Inhibitor

Denosumab (Prolia)

Bisphosphonates

Fosamax: inhibit bone resorption used in osteoporosis. AE: dysphagia, esophageal ulcer. Nursing: take 1st thing in the morning w/o food, 8oz of water, remain upright for 30mins after taking, if dose missed-skip

Unstageable/Unclassified: Full thickness skin or tissue loss—depth unknown

Full thickness tissue loss in which actual depth of the ulcer is completely obscured by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed.

Category/Stage IV: Full thickness tissue loss

Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present. Often includes undermining and tunneling.

Category/Stage III: Full thickness skin loss

Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling.

RANKL Inhibitor nursing considerations

Given once every 6 months SQ Note: when treatment with denosumab is stopped, loss of BMD can be rapid; other drugs should be started to mitigate this response

Functional ability assessment

Health problems and normal aging changes often bring a decline in functional status. Functional ability is especially important in discharge planning and home care.

Osteomyelitis is classified as:

Hematogenous osteomyelitis (i.e., due to bloodborne spread of infection) Contiguous-focus osteomyelitis, from contamination from bone surgery, open fracture, or traumatic injury (e.g., gunshot wound) Osteomyelitis with vascular insufficiency, seen most commonly among patients with diabetes and peripheral vascular disease, most commonly affecting the feet

dislocation treatment

Immediate medical treatment required to preserve function. Splint extremity as its found, apply ice, get help. Movement can damage blood vessels/muscles/and nerves.

closed fracture treatment

Immobilization Closed manipulation, traction, and open reduction Internal and external fixation

Bisphosphonates indication/use

Inhibit osteoclasts, causing decreased bone loss and increased bone mass

Category/Stage I: Non-blanchable erythema

Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area. The area may be painful, firm, soft, warmer or cooler as compared to adjacent tissue. Category I may be difficult to detect in individuals with dark skin tones. May indicate "at risk" persons.

disuse syndrome

Loss in the ability to perform ADL functions as a result of a sedentary lifestyle disability Approximately 14.2% of elders living in the community experience difficulty completing one or more ADLs because of health-related problems. Approximately 21.6% of elders report difficulties with instrumental ADLs (IADLs). The need for assistance in ADLs and IADLs increases with age.

bone tumors

May originate from bone cells, cartilage, fibrous tissue, marrow, or vascular tissue

acute back pain

More than 5 weeks Less than 3 months

osteoporosis symptoms

Most don't know till fracture, sustaining a mild bump, or sneezing. Acute/chronic pain,change in body image. COPD-FROM limited activity. GI upset. Functional abilities maybe limited.

Metabolic Bone Disorders

Osteoporosis Osteomalacia Paget's Disease

most common and most often fatal primary malignant bone tumor?

Osteosarcoma

Category/Stage II: Partial thickness

Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled or sero-sanguinous filled blister.

Osteomyelitis treatment

Pharmacology is 4-6 weeks of IV antibiotic therapy for acute, and 6-8 weeks of oral antibiotic for chronic. Localized wound debridement will be necessary.

Metastatic Bone Disease

Primary malignant tumors occur in prostate, breast, lung, thyroid gland,are bone seeking cancers migrate to bone more than primary cancer.

Suspected Deep Tissue Injury—depth unknown

Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue.

sprain treatment

RICE (rest, ice, compression, elevation)

strain treatment

RICE (rest, ice, compression, elevation)

Estrogen Agonist/Antagonist

Raloxifene (Evista)

osteoporosis assessment

SUBJECTIVE DATA 1. questioning the patient about lifestyle practices and complaints of pain (low thoracic and lumbar) that worsens with sitting, standing, coughing, sneezing, and straining OBJECTIVE DATA 1. assessing the patient for dowager's hump (spinal deformity and height loss that result from repeated spinal vertebral fractures) and increased lordosis, scoliosis, and kyphosis 2. assess gait impairment associated with inability to maintain erect posture

Estrogen Agonist/Antagonist side effects

Side effects include hot flashes and leg cramps Adverse effects include VTE formation

RANKL Inhibitor side effects

Side effects include skin rashes Adverse effects include hypocalcemia, cellulitis, osteonecrosis of the jaw, and atypical femur fracture

Septic (Infectious) Arthritis

Swollen, painful, red, monoarticular arthritis with migratory involvement and assymetrical pattern of involvement

Osteomalacia Pathophysiology

The major defect in osteomalacia is a deficiency of activated vitamin D, which promotes calcium absorption from the gastrointestinal tract and facilitates mineralization of bone. The supply of calcium and phosphate in the extracellular fluid is low and does not move to calcification sites in bones.

osteomalacia

a metabolic bone disease characterized by inadequate mineralization of bone. As a result, the skeleton softens and weakens, causing pain, tenderness to touch, bowing of the bones, and pathologic fractures.

stress fracture

a small crack in the bone that often develops from chronic, excessive impact

Neoplasms

abnormal growths of new tissue that are classified as benign or malignant

Most low back pain is caused by one of many musculoskeletal problems, including..

acute lumbosacral strain, unstable lumbosacral ligaments and weak muscles, intervertebral disc problems, and unequal leg length.

corn

an area of hyperkeratosis (overgrowth of a horny layer of epidermis) produced by internal pressure (the underlying bone is prominent because of a congenital or acquired abnormality, commonly arthritis) or external pressure (ill-fitting shoes). The fifth toe is most frequently involved, but any toe may be involved.

Osteomyelitis

an infection of the bone that results in inflammation, necrosis, and formation of new bone

ABCDEF for moles

asymmetry, border, color, diameter, elevation, feeling

greenstick fracture

bending and incomplete break of a bone; most often seen in children

simple fracture (closed)

bone is broken cleanly; the ends do not penetrate the skin

impacted fracture

broken bone ends are forced into each other

depressed fracture

broken bone portion is pressed inward

contusion

bruise, injury

open fracture

compound fracture; broken bone with an open wound

Carpal tunnel syndrome caused by

compression of the median nerve

skin integrity

condition of the skin

Osteomyelitis symptoms

constant bone pain increased ESR (shows infection) positive would cultures warmth, swelling, redness in extremity leukocytosis

Paget's disease of bone

disorder of localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae.

dislocation

displacement of a bone from its joint

osteoporosis prevention

encourage the women to participate in weight-bearing activities; sun exposure-ok with precautions; this will increase the absorption of vitamin D (important for bones); vitamin E-no relationship to bone density or prevention of osteoporosis

comminuted fracture

fracture in which the bone is splintered or crushed

callus

increased growth of cells in the keratin layer of the epidermis caused by pressure or friction

functional ability

individual's ability to perform the normal daily activities required to meet basic needs; fulfill usual roles in the family, workplace, and community; and maintain health and well-being -cognitive, social, physical, and emotional ability to carry on the normal activities of life

Bursitis

inflammation of a bursa usually caused by a blow or friction

tendonitis

inflammation of tendon sheaths typically caused by overuse

sciatica

inflammation of the sciatic nerve

Fractures types are classified by?

location type

chronic back pain

more than 3 months

oblique fracture

occurs at an angle across the bone

transverse fracture

occurs straight across the bone

compression fracture

occurs when the bone is pressed together (compressed) on itself

Strains

overstretching and tearing a muscle

radiculopathy

pain radiating from disease of the nerve roots

osteoporosis risk factors

post-menopause; calcium intake; activity level

Dermal Ulcer

pressure sore; pressure ulcer

sprain

stretching or tearing of ligaments

comorbidities

the presence of one or more diseases at the same time

mobility

the quality or state of being able to move about freely

osteopenia

thinner than average bone density

fracture

to break (a bone)

factors that influence skin integrity

trauma/injury perfusion immunologic infestations/infections thermal/radiation lesions

decondition

used to describe a loss of physical fitness.

correct way to lift objects

using the strong quadriceps muscles of the thighs, with minimal use of weak back muscles (see Fig. 41-3). With feet placed hip-width apart to provide a wide base of support, the patient should bend the knees, tighten the abdominal muscles, and lift the object close to the body with a smooth motion, avoiding twisting and jarring motions

Bursitis and tendonitis treatment

• Applications of cold and heat • Immobilization of affected part, analgesics, NSAIDs, local steroid injections • Physical therapy or hydrotherapy to help maintain range of motion

Integrating Care for a Person with a Pressure Ulcer

• Establishing the treatment goal • Moist wound healing • Cleansing the wound • Choosing appropriate topical wound care products • Wound debridement • Consideration of adjunct therapy • Pain management • Management of nutrition • Surgical consultation • Patient and staff education • Discharge plan or transfer of care • Documentation of all items in patient's medical record

Carpal tunnel syndrome treatment

• Rest of wrist, wearing splint • NSAIDs • Surgical decompression of the nerve through resection of the carpal tunnel ligament

Osteomyelitis risk factors

• gender (males more likely) • age (acute = young, chronic = elderly) • recent injury (= broken bones) • orthopedic surgery • poor circulation • catheters, central lines, IV drug abuse