Ch. 42

Question 1

osteoporosis

Answer 1

• chronic disease of cellular regulation
• bone loss causes significant decreased density and possible fracture (higher risk)
• decreased bone mass density (BMD)

Question 2

fragility fracture

Answer 2

caused by ostoporosis

Question 3

osteomalacia

Answer 3

bone loss d/t lack of vit D

Question 4

osteopenia

Answer 4

loss of bone mass

Question 5

dowager’s hump

Answer 5

• in the upper thoracic vertebrae
• result of osteoporosis

Question 6

height change with osteoporosis

Answer 6

lose up to 6 inches in height
- kyphosis

Question 7

osteoporosis etiology (causes/risk factors)

Answer 7

genetic
lifestyle
environmental factors
nutrition- lack of vit D and calcium
protein deficiency
caucasian or asian decent
thin built

Question 8

osteoporosis incidence and prevalence

Answer 8

54 million Americans
numbers increase as baby boomers age
females >50 years at higher risk

Question 9

osteoporosis health promotion/ disease prevention

Answer 9

Teach young women appropriate health and lifestyle practices
Nutrition – Vitamin D
Stop smoking
Lose weight
Avoid alcohol
Limit carbonated beverages
Exercise and weight-bearing exercises: walk 30 min 3-5x/week

Question 10

osteoporosis assessment: history

Answer 10

fall risk factors

Question 11

osteoporosis assessment: physical assessment/ s/sx

Answer 11

kyphosis
- think back

Question 12

osteoporosis assessment: psychosocial

Answer 12

body image

Question 13

osteoporosis risk factors (hint: ACCESS)

Answer 13

ACCESS
alcohol
corticosteroid use
calcium low
estrogen low
smoking
sedentary lifestyle

Question 14

osteoporosis after menopause

Answer 14

estrogen drops causing
- dorsal kyphosis
- cervical lordosis
- crush fractures: esp T-8 and below

Question 15

who is at highest risk for osteoporosis

Answer 15

slender
female
caucasian
alcohol users
smokers
steroid users

Question 16

most common fractures d/t osteoporosis

Answer 16

hip and colles’ fractures

Question 17

osteoporosis assessment: lab values

Answer 17

serum calcium
vit D3

Question 18

osteoporosis assessment: imaging

Answer 18

XR of spine and long bones
DXA scan**
QCT scan
vertebral imaging
MRI

Question 19

bone densitometry measures

Answer 19

bone mineral density

Question 20

priority problem for patients with osteoporosis or osteopenia

Answer 20

• potential for fractures d/t weak, porous bone tissue

Question 21

osteoporosis: plan/interventions

Answer 21

nutrition therapy: high vit D and calcium (dairy)
lifestyle changes: no large quantities of alc, walking/swimming exercise (30 min x3 days/week)
drug therapy
- calcium and vit D pills
- bisphosphonates (1st thing in AM empty stomach, full glass of water in upright position (90°) for 30 min- esophagitis irritation, taken 1x/week)
- alenodronate

Question 22

osteoporosis care coordination and transition management

Answer 22

• home care management: falls, throw rugs, good lighting
• self-management education
• health care resources

Question 23

expected outcomes of the patient with/at risk for osteoporosis

Answer 23

• Continues to follow up with DXA screenings as recommended to assess ongoing bone health
• Makes necessary changes in lifestyle to help prevent further bone loss
• Does not experience a fragility fracture due to bone loss

Question 24

osteomalacia

Answer 24

soft bones often develop d/t vit D deficiency

Question 25

primary problems with metabolic bone disease

Answer 25

- strength - risk for fracture - injury prevention - nutritional status

Question 26

metabolic bone disease: interventions

Answer 26

Safety precautions Medications Surgical management Patient teaching Collaborative health care team roles Community resources

Question 27

osteomyelitis

Answer 27

infection in bony tissue - caused by bacteria, virus, fungi (exogenous verses endogenous) bone pain and fever antimicrobial therapy

Question 28

osteomyelitis s/sx

Answer 28

Bone pain: unilateral Fever: >101 Erythema and heat in the area of the infected bone Elevated WBC count ESR may raise later in the disease course

Question 29

osteomyelitis interventions: nonsurgical and surgical

Answer 29

nonsurgical mangement: meds - IV ABT: 1-2 months (central line/PICC to go home) - pain meds: usually opioids - antipyretics: acetaminophen for fever surgical management: when it becomes chronic, open ulcers; surgical debridement

Question 30

DXA scan

Answer 30

done to dx osteoporosis and osteopenia - uses T score

Question 31

T scores

Answer 31

+1- -1: normal -1 to -2.5: indicates low bone mass or osteopenia < -2.5: indicates osteoporosis