Summary NURSING 1 EXAM 1

NURSING 1 EXAM 1 Osteomalacia - Metabolic disease that causes poor & delayed mineralization of the bone cells in mature bones - Main cause is a Vitamin D deficiency Diagnostic procedures for Osteomalacia Serum calcium, phosphate, vitamin D, BUN, creatinine, bone densitometry x-rays Symptoms of Osteomalacia Generalized skeletal pain & tenderness without a history of injury (hips are the most common site) Reluctant to ambulate Low back pain Pain in the ribs, feet, & other areas Waddling gait At risk for Osteomalacia Diet deficient in vitamin D, low endogenous production of vitamin D (lack of sunlight exposure), malabsorption, renal tubule disease, anticonvulsant therapy, liver, pancreatic, and biliary system disease Treatment for Osteomalacia Prevention - sunlight exposure & vitamin D supplements Diagnosed - ergocalciferol and calcium is prescribed Paget's disease Chronic bone disorder that begins with an increase in bone absorption, in compensating for this bone formation increases along with bone remodeling leading to deformities and fractures. Symptoms of Paget's disease *Check for family occurrence (disease is genetic) and history of previous fractures. *Most common symptom is pain in the hips and pelvis which is often described as deep aching that worsens with weight bearing. *Deficits in hearing, vision, swallowing, speech, movement of eye and facial muscles, and balance. *Bowing of the long bones of the arms and legs. *The skull is often enlarged with the bone becoming soft and thick. *Advanced cases may see kyphosis or scoliosis, skin over affected areas may be warm to touch Diagnostic procedures for Paget's disease Increase in serum alkaline phosphate (ALP) is the first indicator, x-ray, bone scan Treatment of Paget's disease NO CURE so focus is aimed at symptom management, limiting disability, and complication prevention. . Physical therapy (weight-bearing exercises) Pharmacological therapy: Calcitonin, Bisphosphonates, Analgesics Worst cases: Surgery Bisphosphonates: Alendronate (Fosamax) Dose: 40 mg once daily for three months MUST be taken on an empty stomach with 6 to 8 ounces of water It may be taken any time during the day, as long as there is no food for 30 minutes after the dose Do NOT lie down for at least 30 minutes after taking the dose Osteomyelitis Occurs when an infection has invaded the bone area. Patients at risk for Osteomyelitis Associated with patients who have diabetes of vascular problems Malnourished patients Elderly patients Overweight patients Injection/needle drug use Poor blood supply Recent trauma Symptoms of Osteomyelitis Fever Malaise Swelling &/or tenderness of the affected area Purulent drainage from the affected site Pain in the affected area Tachycardia Diagnostic procedures for Osteomyelitis Bone biopsy/culture Bone scan Bone x-ray CBC (elevated WBC's) Needle aspiration of the affected area CRP (will be elevated) ESR (will be elevated) Treatment of Osteomyelitis IV antibiotic therapy for 4-6 weeks (type depends on culture) Pain medication Wound debridement Nursing Interventions with Osteomyelitis