osteopororis

Question 1

osteopenic changes

Answer 1

• Osteopenic changes refers to the lower than normal bone density as well as lower bone mass in the vertebrae.
• Metabolic bone disease that results from osteoclastic bone resorption not compensated by osteoblastic bone fracture causing bones to become weak and more at risk for fractures.\
• Chronic disease resulting in bone loss due to low bone density

Question 2

generalized osteoporosis
primary
secondary

Answer 2

• a bit longer and more complex
• multiple structures
• causes: anemic states, drugs (steroids/heparin), dietary deficiency (scurvy, malnutrition, calcium
• both primary and secondary fall under this.Primary occurs in postmenopausal woman and in **70-80 year old men. Secondary results from past medical conditions. Prolonged mobility from spinal cord damage
• ***long term corticosteroid use

Question 3

regional osteoporosis

Answer 3

• *Also caused localized
• *Affects 1 bone or area
• *Traumatic fracture
• Characterized by arthralgia which migrates between the weight bearing joints of the lower limbs
• Causes: immobilization and disuse, reflex sympathetic dystrophy syndrome, transient regional osteoporosis (transient regional osteoporosis of the hip, regional migratory osteoporosis
• ***Decreased mobility for longer than 8-12 weeks can result from this type

Question 4

modifiable risk factors for osteoporosis

Answer 4

smoking
-more than 2 - 3 drinks alcohol
little to no exercise
High volume intake of carbonated drinks

Question 5

nonmodifiable risk factors

Answer 5

gender
small framed/thin
menopause
**Protein deficiency
**estrogen 
**Chronic low calcium or vitamin d

Question 6

physcial assessment findings for pt. with osteoporosis

Answer 6

• pain (more specifically back pain- occurs from lifting or bending)
• Receding gums and bone loss in jaw
• decreased grip strength
• weak and brittle nails
• hair loss
• kyphosis: humpback
• decreased height

Question 7

diagnostic test for osteporosis

Answer 7

• Doctor will order bone density scan - measures bone mineral density
• BMD assessment by a DXA (dual energy xray absorptiometry) - measures bone mineral density
• Ct- can measure volume of bone density and strength of vertebral spine

Question 8

lab results for osteoporosis

Answer 8

serum calcium

vitamin d levels

Question 9

serum calcium

Answer 9

• Helps **build bones and keep you healthy and help build strong bones
• Insufficient calcium leads to hyperparathyroidism increasing the rate of bone remodelling to maintain normal levels

Question 10

vitamin d levels

Answer 10

• Helps build bones and keep you healthy and help build strong bones
• Helps build stronger bones for woman post menopause
• Deficient affects ability to absorb calcium

Question 11

Flomax dosages

Answer 11

Starting dosage 10 mg once daily or 70 mg tablet or oral solution weekly

Question 12

flomax nursing considerations

Answer 12

• Take first thing in morning with water
• 30 mins prior to eating
• assess serum calcium and vitamin d
• may lead to muscle pain
• avoid laying down for 30 mins

Question 13

calcium w/ vit d dose

Answer 13

1000mg w/ Vitamin D 800 international units daily

Question 14

calcium w/ vit d nursing considerations

Answer 14

• Encourage increased fluids to avoid urinary calculi
• monitor lab values
• continuous cardiac monitoring

Question 15

raloxifene dose

Answer 15

60 mg daily

Question 16

raloxifene nursing considerations

Answer 16

• Heart problems-irregular heart beat
• do not breastfeed
• high blood pressure
• higher risk for cancer if smoker

Question 17

priority problem for pt. with osteoporosis

Answer 17

Acute pain due to fracture (particularly spine or hip) and muscle spasm, impaired mobility, imbalanced nutrition

• Risk for fractures
• Preventing falls

Question 18

M.S. receives a prescription for alendronate (Fosamax) 70mg/week. Which instructions are appropriate as you provide patient teaching to M.S. about this drug? (Select All that Apply)

a. “Take the medication with 8 ounces of water immediately upon arising.”
b. “You can take this medication with your morning coffee and orange juice.”
c. “You can eat your breakfast along with this medication.”
d. “You need to sit or stand upright for at least 30 minutes after taking this medication.”
e. “If you experience any severe abdominal pain, vomiting, or jaw pain, notify your doctor immediately.”

Answer 18

a
d
e

Question 19

nonpharmcological interventions to prevent further bone loss and relieve back pain

Answer 19

• Increase intake of calcium and vitamin d,
• weight bearing exercises (regular walking)
• muscle strengthening
• fall prevention
• limit alcohol
• quit smoking

Question 20

increasing calcium intake

Answer 20

• Calcium supplements
• vitamin d supplements
• calcium rich foods : sardines, salmon,**dark leafy greens (have vitamin k- helps bone healing) like kale, beans, broccoli, cabbage, oranges, papayas, eggs

Question 21

M.S. ‘s was told her blood calcium was normal. She asks, “If I have enough calcium in my blood, I couldn’t have osteoporosis could I?’ How would you respond and why?

Answer 21

It is possible to have a calcium blood within range and still have increasing bone loss. There are other factors that impact your bone density. A factor for you could be what you are post menopausal which leads to deficiency in estrogen which is closely linked with osteoporosis.

• If bone cant store it, it goes in blood
• Hypercalcemic

Question 22

M.S. seems overwhelmed and says “I cannot possibly stop smoking and lose weight and exercise all at the same time.”

What information might you provide to M.S. to help her make these modifications?

Answer 22

• leaning off of smoking through patches
• dietitian
• smoking cessation programs

Question 23

referrals

Answer 23

Fall risk
Smoking concern
Send to PT and dietitian