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Overview of Musculoskeletal System
- Allows us to be upright
- Necessary to allow us to comfortably carry out the most basic activities of daily living.
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The gerontological nurse in the musculoskeletal system: (2)
- Attends to the needs of older adults with musculoskeletal problems
- Works to promote healthy bone joints.
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Define Osteoporosis - Primary and Secondary
- from porous bones
- Primary: Process of lack of calcium, age, weight exercising, most common in women
- Secondary: Caused by another disease sate or by medications -- Paget's disease or long term steroid use
- Characterized by low bone mineral density (BMD) and subsequent deterioration of the bone structure
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Nonmodifiable risk factors for Osteoporosis
- Female gender
- caucasian race
- Northern European Ancestry
- Advanced age
- Family history of osteoporosis
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Modifiable risk factors for Osteoporosis
- Low body weight (underweight)
- Low calcium intake
- Estrogen deficiency
- Low testosterone
- Inadequate exercise or activity
- Use of steroids or anticonvulsants
- Excess coffee or alcohol intake
- Current cirgarette
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Implications for Gerontological Nursing and healthy aging in Osteoporosis
- Diagnosed through a DEXA scan
- Presumed in most older adults by
- 1. Nontraumatic fractures
- A loss of 3" or more in height
- Kyphosis - development of a C shape to the cervical vertebra
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Reducing Osteoporosis Related Risk and Injury
- Exercise: Weight-bearing physical activity helps maintain bone mass
- Nutrition
- Lifestyle changes that reduce risk factors
- Fall prevention
- Basic body mechanics
- Home safety
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Pharmacological Interventions of Osteoporosis
- Adequate intake of calcium and vitamin D
- Combination calcium-vitamin D: Calcitrate-D
- Bisphosphonates: Foxamax, Actonel, and Boniva
- Selective estrogen receptor modulators (SERMs)
- Parathyroids hormones: Teriparatide (Forteo)
- Calcitonin (Miacalcin)
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Definition of Arthritis
- The term used to refer to more than 100 diseases that affect 46.6 million individuals of all ages in the United States
- The number one reason for activity limitations from middle age on
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What is Osteoarthritis?
- Most common type of arthritis
- A degenerative joint disorder
- Risk factors: increased age, obesity, family history, (over use syndrome) repetitive use or trauma to the join
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What happens to your body in Osteoarthritis?
- The normal soft and resilient cartilaginous lining becomes thin and damaged
- The join space narrows, and the bones of the joint rub together causing destruction, pain, swelling, and loss of motion.
- Cannot be "cured" without a joint replacement
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Most common spots for arthritis are:
What is the alternative to prevent pain for arthritis?
- Neck
- hips
- knees
- lower back
- - Surgery: Joint replacement
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What is polymyalgia Rherumatica (PMR)
- Causes severe stiffness, especially in the morning, and lasts >1 hour
- Severe stiffness and pain in the muscles of the neck, shoulders, lower back, buttocks, and thighs rather than the joints
- Symptoms may be quickly relieved by small doses of corticosteroids
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What is Giant Cell Arteritis (GCA)
- AKA temporal arteritis
- An acute inflammation of the artieries of the scalp, especially in the temporal area
- Restricts blood flow
- If not treated early it can results in blindness
- Treatments in high doses steroids
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Rheumatoid Arthritis
- A chronic, systemic inflammatory joint disorder
- Considered an autoimmune disease
- Products from the inflamed lining of the joint invade and destroy the cartilage and bone within the joint
- characterized by pain and swelling in multiple joints in a symmetrical pattern
- Generalized fatigue and malaise, and occasional fevers
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What is the difference between Rheumatoid Arthritis and Osteoarthritis?
- Osteoarthritis: Wearing away of cartilage. Bone on bone causes pain
- Rheumatoid Arthritis: Chronic, systemic inflammatory joint disorder, an autoimmune disease
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Rheumatoid Arthritis:
- Disease-modifying antirheumatic drugs (DMARDs): enbrel, Remicade, Humira, interleukin
- Monitor the progression of the disease
- Provide comfort and support
- Monitor the effectiveness of treatment
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Gouty Arthritis (Gout)
- Results from the accumulation of uric acids crystals in a joint
- May be a one-time acute illness or it may become a chronic conditions with acute attacks
- The proximal joint of the great toe is the most typical site
- Also occurs in the ankle, knee, wrist, or elbow
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Gouty Arthritis - describe the pain
- Pain in the affected joint
- Joint is bright purple-red, hot, and too painful to touch
- Acute attack may become chronic with periods of exacerbations and remission
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Gourty Arthritis Risk Factors:
- High blood pressure
- Diet high in purines
- Medications: VVV
- Thiazide diuretics
- Salicylates (e.g., aspirin)
- Niacin
- Cyclosporines
- Levodopa (Synamet)
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Examples of Foods high in purines (aggravates gout)
- Asparagus
- beef kidneys
- brain
- sweetbread
- dried beans and peas
- Game meat
- gravy
- herring, mackerel, and sardines
- mushrooms
- scallops
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Treatments of gouty arthritis
- Avoidance of drugs or foods that are high in purines and alcohol
- Allopurinol or colchicine: Decrease uric acid production
- Probencid: Increase excretion of uric acid
- Increase fluids to help flush the uric acid through the kidneys (2 L/day if not contraindicated)
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Implications for Gerontological Nursing and Healthy aging in Gouty Arthritis
- Assessment
- Examine the joint and muscles for tenderness, swelling, warmth, and redness
- Hands are examined for the presence or absence of osteopytes
- heberden's nodes or bouchard's nodes
- Evaluate passive ROM and active ROM
- Test the flexibility of the hands
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Interventions for Arthritis
- Adequate and prompt treatment
- pain control
- medications administration
- evaluation
- patient teaching
- surgical replacement of the joint (arthroplasty)
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Complementary and Alternative interventions of OA
- Glucosamine
- Acupuncture
- Massage
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Functional Decline
- Every day spent in bed takes 3.8 days to return a baseline function aka DECONDITIONING
- 2 days = 7.6 days
- 3 days = 11.4 days
- 4 days = 15.2 days
- (It you lie in bed for 2 days, it'll take 7.6 days of walking around to recover, etc)
- Falls more likely to occur when baseline function is diminished
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