Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Osteoporosis
 Osteomalacia
 Paget’s disease (osteitis deformans)
 Osteomyelitis

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Risk factors
History
 Genetic
 Culture
 Diet


Physical signs/symptoms
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Laboratory tests
 Imaging
 DEXA

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Strength
 Risk for fracture
 Injury prevention
 Nutritional status

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Safety precautions
 Medications
 Surgical management
 Patient teaching
 Collaborative health care team roles
 Community resources

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Benign bone tumors



Often asymptomatic
May be discovered on routine x-ray or as a cause of
pathologic fracture
Bone cancer
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Benign bone tumors




Nondrug pain-relief measures
Drug therapy (analgesics, NSAIDs)
Surgical therapy (curettage, joint replacement,
arthrodesis)
Bone cancer
Surgical intervention
Radiation, chemotherapy
 Psychosocial resources


Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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Hand
Dupuytren’s contracture
 Ganglion


Foot
Deformities
 Morton’s neuroma
 Plantar fasciitis

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Back


Scoliosis
Progressive muscular dystrophies
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Contractures
 Pain
 Mobility impairment


What types of nursing care are common to any of
these disorders?
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
A 64-year-old woman is seen in the adult outpatient
clinic. She was measured as standing 65 inches tall
last year. You note that the patient now measures 64
inches. She has mild kyphosis.
What assessment questions would you be sure to ask
at this time?
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
(cont’d)
The patient is diagnosed with possible osteoporosis.
Which diagnostic tests do you anticipate will be ordered? (Select
all that apply.)
A. Sodium
B. Phosphorus
C. Serum calcium
D. Electrocardiogram
E. Thyroid function tests
F. 24-hour urine collection
G. Dual x-ray absorptiometry (DXA)
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
(cont’d)
The patient is diagnosed with osteoporosis. Which
intervention would be appropriate?
A. Suggest a diet that is high in protein and calcium
but low in vitamin D.
B. Recommend walking for 30 minutes 3 to 5 times a
week.
C. Teach her to cut down on her cigarette-smoking.
D. Tell her to include high-impact activities, such as
running, in her exercise regimen.
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
(cont’d)
Which patient statement about self-care indicates a
need for further teaching by the nurse?
A. “I am going to swim at the YWCA.”
B. “My husband is getting rid of our throw rugs.”
C. “Low-fat yogurt is on my grocery list.”
D. “Joining a bowling team will help me exercise.”
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
(cont’d)
1.
The provider orders calcium 1.5 g orally twice a
day (1 g in the morning and 500 mg at bedtime).
The patient asks why she must drink extra fluids
with this medication. What is your best response?
2.
The patient also asks why she can’t just take the
calcium once a day. What is your best response?
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
18
What are the odds of a woman over the age of 50
breaking a bone because of osteoporosis?
A.
B.
C.
D.
1 out of 10
1 out of 7
1 out of 5
1 out of 2
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
A patient with Paget’s disease is at greatest risk for
developing:
A.
B.
C.
D.
Chronic fatigue syndrome
Kidney stones
Cardiac failure
Pathologic bone fractures
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Which symptom is particular to older patients
presenting with acute osteomyelitis?
A.
B.
C.
D.
Pain
Fatigue
Low-grade fever
Elevated leukocyte count
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