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M6 13-005

Exam 16: Other Musculoskeletal Disorders

Osteoporosis disorder that results in a reduction in bone mass which interferes with the mechanical support function of the bone.
Women between the ages of 55 and 65 are at higher risk for post menopausal osteoporosis due to loss of estrogen.
Studies suggest that estrogen deficiency is connected with increased bone reabsorption and sensitivity to parathyroid hormone.
Other factors that contribute to osteoporosis include Immobilization. Use of steroids. High intake of caffeine. Genetics (small bone structure). Environmental (limited exercise).
Individuals most at risk for osteoporosis are small-framed, non-obese, menopausal, white females who smoke.
Other risk factors associated with osteoporosis are Diet low in calcium throughout life span. Smoking. Excessive protein in diet. Sedentary life style (Culture / Ethnic background).
To Dx Osteoporosis: CBC. Serum calcium. Phosphorous. Alkaline Phosphatase. Creatinine Level. Urinalysis. Liver and thyroid function tests. Radiographic studies. Bone density tests.
osteoporosis Medical management Tx aimed at promoting the ↑ of bone density and retardation of bone loss. Calcium supplements to bring total daily calcium intake to 1000mg for men and 1500 mg for post menopausal women.
Osteoporosis: Subjective data Questioning patient about lifestyle practices. Questioning patient about any complaints of pain (low thoracic and lumbar) that worsens with sitting, standing, coughing, sneezing, and straining.
Osteoporosis: objective data Assessing patient for dowager's hump (spinal deformity and height loss). Assessing patient for gait impairment associated with inability to maintain erect posture. Presence of lordosis, scoliosis, and kyphosis.
Osteoporosis: Medical Therapy Estrogen therapy to prevent fractures. Alendronate (Fosamax): bone resorption inhibitor. Risendronate (Actonel): bone resorption inhibitor.
Alendronate (Fosamax): bone resorption inhibitor. Absorbs calcium phosphate crystal in bone and treats symptoms of Osteoporosis.
Risendronate (Actonel): bone resorption inhibitor. Inhibits calcium phosphate crystal in bone and inhibits bone resorption without inhibiting bone formation or mineralization.
Nursing Management of osteoporosis: Management aimed at preventing further bone loss and fractures.
Healthy lifestyle measures to reduce the risk of developing osteoporosis. Ensure an adequate daily intake of calcium and vitamin D. Exercise regularly. Avoid smoking. ↓ coffee intake. ↓ excess protein in the diet. Engage in regular moderate activity such as walking, bike riding, or swimming at least 3 days a week.
Osteomyelitis Local or generalized infection of the bone and bone marrow that can occur from bacteria introduced through trauma or surgery.
Osteomyelitis: Causes If bacteria travels by bloodstream from another site to a bone. Staphylococci. Bacteria invade bone and degeneration of bone tissue occurs. Chronic osteomyelitis causes bone tissue to be weakened and predisposed to spontaneous fractures.
Osteomyelitis: Clinical Manifestations subject to contractures if positioned incorrectly. Possible for new infection to develop months or years after initial infection is diagnosed.
Osteomyelitis: Subjective data Complete history of injuries, surgical procedures, and diseases. Patient complains of persistent, severe, and increasing bone pain and tenderness. Regional muscle spasms. History of allergies from long exposure to antibiotics.
Osteomyelitis: Objective Data Assess wound drainage for color, amount, and presence of odor. Assess vital signs (with infection would see temperature elevation, tachycardia, and tachypnea). Assess for edema, especially in joints with limited mobility.
Osteomyelitis: Diagnosis Complete history. Physical examination. Radiographic studies. CBC (leukocytosis may be present). ESR. Cultures of blood and drainage (if present).
Osteomyelitis: Medical management Intravenous antibiotic therapy (usually broad spectrum such as Keflin). Parenteral antibiotics necessary for several weeks. Bed rest. Surgery may be possible to remove fragment of necrotic bone.
Fibromyalgia: Musculoskeletal chronic pain syndrome of unknown etiology that causes pain in the muscles, bones, or joints. Associated with soft tissue tenderness at multiple sites.
Fibromyalgia: Clinical Manifestations Characterized by generalized achiness (usually neck and lower back). Stiffness that is worse in the morning.
Conditions that aggravate several factor Cold or humid weather. Physical or mental fatigue. Excess physical activity. Anxiety of stress.
Additional problems that accompany FMS Irritable bowel syndrome. Tension headaches. Paresthesia of upper extremities with normal nerve conduction studies. Sensation of edematous hands with no visible signs of edema. Dysfunctional or nonrestorative sleep.
Fibromyalgia: Objective data Periodic limb movement (especially at night). Persistent need to move the lower extremities (day and night). Assessment of sleep deprivation. Assessment of patient's ability to complete self-care activities.
Fibromyalgia: Diagnostic Tests No specific lab or radiographic tests diagnose FMS. Blood chemistry screening, CBC, and ESR may be normal. Sleep study if histories of specific types of sleep disturbances; usually are normal.
Fibromyalgia: Medical Management Treatment approach aimed at education and reassurance. Patient told that this is not a psychotic disturbance. Patient told that symptoms are not uncommon in general population.
Fibromyalgia: Meds Treatment with pharmacological agents (Tricyclic antidepressants) is helpful: Antidepressant results. Anti-inflammatory features. Central skeletal muscle relaxation effects. Pain inhibition through suppressing serotonergic and noradrenergic pathways
Created by: jtzuetrong



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