Key Points for Metabolism & Mobility(1)
docx
keyboard_arrow_up
School
Forsyth Technical Community College *
*We aren’t endorsed by this school
Course
211
Subject
Health Science
Date
Dec 6, 2023
Type
docx
Pages
5
Uploaded by BrigadierAntelopePerson1015
Key Points for Metabolism & Mobility:
Osteoporosis:
Primary & Secondary Causes
Primary – Genetic or environmental factors such as age, decreased calcium intake,
decreased vitamin D, women
Secondary – Medical conditions such as CKD, COPD, Multiple Myeloma, Men, RA,
endocrine, malabsorption. Or chronic medication use.
Asian, white, older than 50, anorexia, bariatric surgery
Clinical Manifestations
Osteopenia is the precursor to osteoporosis – reduced height of 5-7.5cm (2-3in), acute
back pain after lifting or bending (worse with activity, relieved by rest), restriction in
movement and spinal deformity, History of fractures (wrist, femur, thoracic spine),
Thoracic Kyphosis, pain upon palpation over affected area.
Health Promotion & Prevention – Lifestyle Changes & Interventions
Adequate calcium ( milk, leafy greens, OJ, cereal, red/white beans, figs) and vit D (fish,
egg yolk, fortified milk and cereal) intake, exposure to sun, tobacco cessation, limit
alcohol, include weight bearing exercises
.
Osteoporosis: Teaching About Preventive Measures
Instruct regarding calcium and Vit D food sources, inform take supplements with food,
Reinforce need for sun exposure, Encourage weight bearing exercises (30 min 3-5 x per
week), assess home environment for safety, reinforce use of assistive devices, mark
thresholds and doors
Limit caffeine, alcohol, and carbonated beverages, consume adequate amounts of protein, mg, Vit K, avoid slippery
surfaces and wear rubber bottom shoes, Isometric exercises (strengthens core), avoid activities that would increase
body stress (jarring activities, strenuous lifting)
Dietary Measures for Prevention & Maintenance
Adequate calcium ( milk, leafy greens, OJ, cereal, red/white beans, figs) and vit D (fish,
egg yolk, fortified milk and cereal) intake
Osteoporosis: Managing Lower Back Pain
Rest, Nsaids
Diagnostic Test: DXA or DEXA (Same thing)
Screens for early changes in bone density. Usually done on hip or spine.
It’s 2 beams of radiation. Lying flat on x-ray table, remove metallic objects that
might interfere with the scanning procedure
T score – Bone density of young healthy adult
Z score – compares client’s readings with group of age matched clients who serve as a
control
Medications:
Alendronate Effervescent Tablets
Decreases number and actions of osteoclasts, inhibiting bone resorption for prevention
and treatment.
Monitor calcium levels if receiving IV. Prior to starting (if IV) should have dental exam and preventative treatment
to minimize risk for osteonecrosis of the jaw.
Risk for esophagitis and esophageal ulcers. Report early manifestations of indigestion, chest pain, difficulty
swallowing, or bloody emesis to provider immediately.
Take with 8oz of water early morning before eating, remain upright for 30 minutes
Raloxifene
Decreases osteoclast activity resulting in decreasing bone resorption and increasing
bone mineral density. Prevents and treats postmenopausal osteoporosis and breast
cancer
Avoid for clients with hx of DVTs, Monitor LFT, DC use 72 hours before prolonged bedrest.
Report unusual calf pain or tenderness, acute migraine, insomnia, UTI, vaginal burning/itching, take calcium and Vit
D supplements
Teriparatide
Contraindicated for hypercalcemia, hx of bone cancer, radiation, and Paget’s disease
Adv effects – nausea, back pain, arthralgia, and leg cramps
Orthostatic hypotension can occur up to 4 hours after receiving medication
Administer only SQ
Can only be used for 2 years then Bisphosphonates are started
Osteoarthritis:
Risk Factors for Arthritis
Primary - Aging, Genetics
Secondary - joint injury d/t acute or repetitive stress on joints, obesity, metabolic
disorders ( DM, blood disorders such as sickle cell), females
Clinical Manifestations – What Does it Look Like? What Does it Affect?
Joint pain and stiffness
(in more than one joint that may improve with rest
), pain with joint
palpation
(observe for muscle atrophy, loss of function, limp when walking, and restricted activity d/t pain)
,
Crepitus,
Heberden’s nodes
(
Proximal, closest to tips of fingers),
Bouchard’s nodes
(
closer to the
body),
(not a symmetrical disease, joint effusion, limping gait, back pain, edema.
Dowager’s Hump
(Cervical Lordosis (hump on back of neck)
Physical Assessment of a Client with Osteoarthritis
Pain level, intensity, location, duration, and aggravating or alleviating factors,
visualization of joints, palpation and ROM, mobility changes, decreased mobility, and
impact on daily activities
Medications:
Glucosamine
Natural substance that aides in repair and maintenance of cartilage. Assists in reducing
inflammation
ADV effects – GI upset, rash, HA, and drowsiness.
Use and dosage based on weight. Do not take if client has HTN, pregnant, or lactating
Celecoxib
Used to relieve pain unrelieved by Tylenol and topical agents, and synovitis
Baseline Liver and Kidney function tests and CBC needed if NSAIDS are given. Topical nsaids can be used.
Monitor Kidney function tests (BUN and Cr).
Nsaids are nephrotoxic, report black tarry stools, indigestion, and SHOB
Take action/Interventions:
Exercise, rest, positioning, heat/cold, weight control
Scoliosis:
Postoperative Care for Scoliosis Repair
Monitor for neurovascular changes, vitals, dressing status, I&)
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
Pain management, IV opioid analgesics, log roll, bracing, early ambulation,
developmentally appropriate emotional support
TSLO brace to be worn as prescribed. Consider developmental age and psychosocial
impact
Pain Reduction
IV opioid – monitor respiratory rate, at risk for falls, delirium, constipation (listen to
bowel sounds)
Assessing pain OPQRST – onset, prevoking factors, quality (intensity),
region/radiation, severity, time and treatment
Herniated Lumbar Disc:
Pain Reduction Techniques & Interventions
Nsaids, Mild opioids, Duloxetine, Tizanidine (muscle spasms), Ziconotide (via pain
pump inserted in spine)
Techniques to prevent low back pain and injury
Positioning (semi-fowler’s with knees bent), supportive shoes, mats at work, proper body mechanics,
topical applications, TENS unit, stretching and strengthening, heat, massage, spinal manipulation,
acupuncture, stress reduction, yoga
Hip Fracture:
Post-Hip Arthroplasty Nursing Care & Patient Education for Discharge
Nursing care – ABCs, frequent vitals, neurovascular assessments, positioning, pain
management. Monitor HGB and HCT,
Monitor for infection, early mobilization, prevent post op complications, positioning,
pain management, discharge needs, Turn cough and deep breath, IS, increase fluid intake
Education - Hip Precautions – do not cross legs, use abduction pillows or wedge, don’t
twist, use of assistive devices, raised toilet seats, use straight back chairs with arms,
externally rotate the toes
Exercise will be uncomfortable but needed for recovery and best overall function
Medication Used After Hip Arthroplasty to Prevent Complications
Warfarin, ASA, Lovenox.
Complications Post Hip Fracture – What would it look like? What would the nurse need
to do?
DVT or PE
Monitor for acute dyspnea, tachycardia, and pleuritic chest pain.
Prophylaxis for DVT stockings, SCDs, foot pump, anticoagulations
Fractures and Immobilization Devices
Bucks traction – pre-op for hip immobilization, prevents soft tissue injury, realigns
bone fragments , decreases muscle spasms and pain, correct or prevent further
deformities.
Identifying type of bone fracture
Spiral – abuse
Greenstick - kids