Mr. Jones comes in with findings of bone demeniralizaiton with loss of calcium and phosphorus salts. Which of the following best describes the disease or disorder associated with these findings?
Where are the most common sites for osteoporosis to occur?
Hip, wrist, and vertebral column
What puts a patient at subsequent risk for fractures after being diagnosed with Osteoporosis?
Fragile Bones
Lecture
A nurse is assessing three patients and is aware of the risk factors for Osteoporosis. Of the following, which could the nurse expect to have osteoporosis based on the risk factors concerning Osteoporosis?
1. An african-american full framed woman who smokes seldomly.
2. A 25 year old Caucasian who exercises often and smokes seldomly.
3. A 55 year old Asian who seldomly exercises, is a frequent smoker, and stays home watching television all day.
3.
The 55 year old is at risk most based on risk factors.
Slides 5 & 6
A nurse is conducting health
screening for osteoporosis. which of the following clients is at greatest risk of developing this disorder?
1.A 25-year-old woman who jogs
2.A 36-year-old man who has asthma
3.A 70-year-old man who consumes excess
alcohol
4.A sedentary 65-year old woman
who smokes cigarettes
Answer is 4
Age, being woman is a risk factor,
smoking cigrette is also a risk
factor. She has the greatest risk
Slide 7
How much calcium should a pt. with osteoporosis consume daily?
1,200 mg of daily calcium
Mr. Bumblebee is 70 years old, is having trouble seeing, aches in his neck, back pain after lifting, wobbling when he walks, a temp of 98.7, and appears to be hunched over when he walks. What clinical findings indicate he may have Osteoporosis?
Back pains from lifting.
Problems with balance.
Kyphosis(Hunchback)
Slide 12
Which of the following labs are important to consider with Osteoporosis. Select all that apply.
1. Serum Calcium
2. Glucose Levels
3. PTT
4. Urine Calcium
5. Vit. D
6.Alkaline Phosphate
7. Phosphorous
8. Sodium
1, 4, 5, 6, 7,
Slide 13
What are preventative measures concerning Osteoporosis?
A diet rich in Calcium & Vit. D
Regular Wt. Bearing Exercise
Calcium & Vit. D Supplement
What is the best medication to give a pt. with a degenerative bone disease such as Osteoporosis? It is considered first line medication.
Calcium and Vit. D (Caltrate, Citrate)
What are the S/E of Calcium and Vit. D Meds?
Abdominal Distention and Constipation
What is the best nursing intervention for a pt. who has osteoporosis and is complaining of abdominal pain, and hasn't had a Bowel Movement in 3 days.
1. Document the findings.
2. Administer a stool softener per Doctor's Orders
3. Ensure the patient that the discomfort will go away.
4. Increase the amount of Calcium given.
2. Administer a stool softner per Doctor's Orders b/c constipation is expected as a side effect when administering calcium and vit. D.
Mr. Tommy was admitted to the hospital for back pain, unstable balance, and complaints of pain when palpating his hip. The doctor adminsitered 5 mg of Alendronate PO once daily. What is the best reasoning for the doctor's dosage and frequency of this med?
Prevention of Osteoporosis is 5 mg Daily
Treatment of Osteoporosis is 10 mg once Daily
Drug Guide. p. 131
What is the generic name for Alendronate?
Fosamax
What is the brand name for risdronate? What is it's action?
Actonel; It increases bone mass and decreses bone loss by inhibiting oseoclast function.
Slide 18
When administering any of the Biophosphates such on boniva, risdronate, actone, etc..what should the nurse consider during her administration the meds?
To inform her pt. that oral pills need to be taken on an empty stomach with a full glass of water.
They must sit upright for 30-60 minutes.
When administering Calcitonin(Miacalcin) to a pt. with osteoporosis, what should the nurse be very aware of?
To never give a pt. Calcitonin with a seafood allergy.
Slide 19
What is the action of Selective Receptor Modulator, Raloxifene? What is it's brand name?
To reduce the risk of osteoporosis by preserving BMD w/o estrogenic effects of the uterus. ; Evista
Slide 20
Mr. T has clinical findings of Spontaneious Vertebral fracture related to osteoporosis. What would be the best Nursing Diagnosis?
Deficient knowledge about the osteoporosis process.
The objective would be to promote understanding of osteoporosis and the treatment.
Slide 22
Mr. T is also complaining of pain and the nurse has a diagnosis of acute pain related to fracture and muscle spasm. What would be interventions that could help alleviate his pain?
Lie in a firm, non-sagging mattress.
Local heat and back rubs
Good posture and body mechanics
When caring for a pt. who is at risk for injury what are some nursing interventions to prevent injury?
Avoid sudden bending jarring and strenous lifting.
Wt. Bearing Activity.
Provide Safe Environment
Isometric Exercise
True or False
Men develop Parkinson's Disease more often that women
True.
Slide 27
Which of the following are signs of Parkinson's Disease? Select All That Apply?
1. Rigidity and trembling of head and extremities.
2. Shuffling gait with short steps.
3. Reduced appetite
4. Fragile Bones
5. Reduced arm swinging.
1, 2, 5
Slide 27
What are the causes of Parkinson's Disease? Select all that apply.
1. Genetics
2. Viral Infections
3. Consumption of alcohol
4. Head Trauma
5. Chronic use of antipsychotic medications
6. Multiple Sexual Partners
1, 2, 4, 5
Slide 28
What is an anticholinergic medication
used to treat Parkinson’s Disease?
A.Benztropine mesylate (Cogentin)
B.Diphenhydramine hydrochloride (Benadryl)
C.Orphenadrine citrate (Banflex)
D.Phenindamine hydrochloride
(Neo-Synephrine)
A
•Benztropine mesylate (Cogentin) is an
anticholinergic medication used to control of
tremor and rigidity and counteracts the
action of acetylcholine with Parkinson’s disease. Diphenhydramine hydrochloride
(Neo-Synephrine) are antihistamines that may reduce tremors.
Med-Surg DVD Rom
Is the following statement True or False?
Parkinson’s disease is a slowly
progressing neurologic movement disorder that eventually leads to disability.
True
Parkinson’s disease is a slowly
progressing neurologic movement disorder that eventually leads to disability.
Which of the following are autonomic changes related to Parkinson's Disease? Select all that apply.
1. Orthostatic hypotension
2. Constipation
3. Depression
4. Osteoporosis
5. Uncontrolled Sweating
6. Delirium
1, 2, 5
The other choices are Psychiatric Changes related to Parkinson's Disease.
Slide 31
What are some mental changes that occur with Parkinson's Disease?
Cognitive, Perceptual, Memory
Slide 32
If a pt. has tremor, postural changes, and rigidity can the pt. be considered as having Parkinson's Disease?
Yes the presence of two or more cardinal symptoms is acceptable for diagnosis of Parkinson's Disease.
What would be an appropriate drug in order to manage Parkinson's? What is it's action?
Levodopa (Larodopa)
Converting to dopamine in the basal ganglia, producing symptoms releif
What are some adverse effects of Levodopa?
Confusion, hallucinations, depression and sleep alteration.
Slide 34
What should the nurse assess for on a pt. who has a diagnosis of Parkinson's Disesase?
Functional abilities, quality of speech, tremors, mental function, forward posture, slowness of movement, and swallowing deficits.
Slide 35
What is active assistance?
An exercise carred by the patient with help of assistance.
What is resistive exercise?
An active exercise carried out by the pt working against resistance.
What is isometric or muscle setting?
Contracting and relaxing muscle while keep apart in a fixed position.
What's important to remember when using a transfer board?
One end of the transfer board is placed under the buttocks and the other end chair is placed.
When preparing for ambulation what should the nurse consider?
Exercise is important
Push up or pull up exercise
How often should muscle contraction and relaxation be done when preparing for ambulation?
10 to 15 times hourly.
What should the distance be between the axillae and arm pieces on the crutches be?
Two or three fingerwidths in the axilla space.
What position should the elbows be in when the client is walking?
The elbows should be slightly flexed, 20 to 30 degrees, when the client is walking.
Slide 89
What side should the nurse stand on when ambulating with the client.
1. Behind the pt.
2. Lead the pt. by hand.
3. On the affected side
4. On the unaffected side
The affected side, when ambulating with the client.
Slide 90
When the nurse is assisting the client with ambulation what should the nurse tell the pt. about how to distance themselves with the crutches.
1. 2-4 inches diagonally in front of the foot.
2. 6-10 inches diagonally in front of the foot
3. 6-12 inches straight in front of the foot.
4. 8-12 inches straight in front of the foot.
2.
Slide 90
Your pt. is trying to sit with crutches, what should the nurse tell the pt about sitting with crutches?
Place the unaffected leg against the front of the chair.
Move the crutches to the affected side
Grasp the arm of the chair with the hand on the unaffected side
Flex the knee of the unaffected leg to lower self into the chair while placing the affected leg straight out in front.
Slide 91
When sitting with crutches is it acceptable for the pt. to grasp the arm of the chair with the hand on the affected side or unaffected side.
Unaffeced.
Slide 91
When going up the stairs with crutches which leg goes up first? The unaffected or affected leg?
The unaffected leg goes up first.
The pt moves the affected leg and the crutches up
When ambulating down the stairs which legs goes first?
The pt. moves the crutches and the affected leg down.
The pt moves the unaffected leg down.
Describe Two-Point Gait
¡Used
with partial weight-bearing limitations and with bilateral lower extremity
prostheses
¡The
crutch on the affected side and the unaffected foot are advanced at the same
time.
Describe Three Point Gait
¡Used
for partial weight-bearing or no weight-bearing on the affected leg; requires
that the client have strength and balance
¡Both
crutches and the foot of the affected extremity are advanced together, followed
by the foot of the unaffected extremity.
Four Point Gait
¡Used
for partial weight-bearing or no weight-bearing on the affected leg; requires
that the client have strength and balance
¡Both
crutches and the foot of the affected extremity are advanced together, followed
by the foot of the unaffected extremity.
Swing to gait
¡Used
when there is adequate muscle power and balance in the arms and legs
¡Both
crutches are advanced together, then both legs are lifted and placed down on a
spot behind the crutches. The feet and crutches form a tripod.
When using a cane what position should the client elbow be flexed at?
15-30 Degree Angle
When using a cane the nurse should ¡Instruct the client to hold the cane 4 to
6 inches to the side of the foot.
True or False
True
¢Instruct
the client to hold the cane in the hand on the unaffected side so that the cane
and weaker leg can work together with each step.
¢True or False
Instruct the client to move the cane at the same time as the affected leg.
True
A
nurse
has given a client instructions about crutch safety. the nurse determines that
the client needs reinforcement of information if the client states:
1.That
he or she will not use someone else's crutches
2.That
crutch tips will not slip even when wet
3.The
need to have spare crutches and tips available
4.That
crutch tips should be inspected periodically for wear
Answer
2
Crutch
tips should remain dry. Water could cause the client to slip by decreasing the
surface friction of the rubber tip on the floor. If crutch tips get wet, the
client should dry them with a cloth or paper towel. The client should use only
crutches measured for the client. The tips should be inspected for wear, and
spare crutches and tips should be available if needed.
When ambulating with a walker forward should the affected foot or unaffected foot move first?
The affected foot.
Slide 98
Pronation
Rotation of the forearm so the palm hand is down
Dorsiflexion
Movement that flexes or bends the hand back toward the body or the foot toward the leg.
Supination
Rotation of the forearm so that the palm of the hand is up
Flexion
Bending of a joint so that the angle of the oint diminishes.
Opposition
Touching the thumb to each fingerti on same hand.
Eversion
Movement that turns the sole of the foot outward.
A nurse performs radial deviation on a pt for ROM exercises, describe the ROM exercise.
Move hand sideways so that side of hand on which thumb is located moves toward forearm.
What is the purpose of a passive therapeutic exercise?
To reatin as much joint ROM as possible, to maintain circulation.
Page. 178 Med Surg
What is the purpose of Active Therapeutic Exercises
To increase muscle strength
What is the purpose of isometric or muscle setting?
To maintain strength when a joint is immobilized.
Med Surg. 178
In order to help prevent the development of an external rotation deformity of the hip in a pt who must remain in bed for any period of time, the most appropriate nursing action would be to use.
A. A trochanter roll extending from the crest of the ilium to the midthigh.
B. Pillows under the lower legs
C. A hip abductor pillow
D. A Foot board
A trochanter roll, properly placed, provides resistance to the external roatation of the hip. Pillows under the legs will not prevent the hips from rotating externally. A hip abductor pillow is used for the pt. after total hip replacement surgery. A footboard will not prevent the hips from rotating externally.
During which stage of pressure ulcer development does the ulcer extend into the sub q tissue?
A. Stage IV
B. Stage II
C. Stage III
D. Stage I
A stage IV ulcer extends into the underlying structure. A stage II ulcer exhibits a break in the skin through the epidermis or dermis. A stage one pressure ulcer is exhibited by an area of nonblanchable erythema, tissue swelling, and congestion, and pt. complains of discomfort.
Answer.: Stage III
The nurse monitors a client receiving enoxaparin (Lovenox) 30 mg S.C. b.i.d .after hip replacement surgery. Which adverse reaction is the client most likely to experience?
Bleeding is the most common adverse reaction associated with enoxaparin. The drug isn't known to induce anaphylactic shock or bronchospasm, and hypersensitivity reactions are rare.
NCLEX RN 3500
The nurse is caring for a client who underwent a total hip replacement. What should the nurse and other caregivers do to prevent dislocation of the new prosthesis?
1. Keep the affected leg in a postion of adduction.
2. Use measure other than turning to prevent pressure ulcers.
3. Prevent internal rotation of the affected leg.
4. Keep the hip flexed by placing pillows under the client's knee.
3. Prevent internal rotation of the affected leg. External rotation and abduction of the hip will help prevent dislocation of a new hip joint. Internal rotation and adduction should be avoided. Post op total hip replacement clients may be turned onto the unaffected side.
When advancing with cruches, when the pt lifts both feet, swings forward and leand feet next to cruches which type of gait is this?
1. 3 Point Gait
2. Swing To
3. Swing-Through Gait
4. 4 Point Gait
Swing To
Page 181 Chart 11-9
You have a patient who has poor balance, poor cardiovascular reserve, and can't lift very well. What is the best assistive device for this patient?
1.Rolling Walker
2. Cane.
3. Crutches
1. Rolling Walker b/c of the factors listed above, especially considering the pt. can't lift.
