Metabolic Diseases of the Bone Osteoporosis Osteomalacia Paget’s Gout Bone Tumors

Osteoporosis Characteristics Decrease in bone mass Bone Fracture Women

Osteoporosis Predisposing Factors Assessment Family history Intake of caffeine, alcohol, sodium, protein, some medications Inactivity Diseases including hyperthyroidism, diabetes Assessment Back pain, loss of height, Dowagers hump Diagnosis: normal lab studies; decreased bone density Prevention: Calcium to 1000 mg/day; avoid alcohol; calcitonin, Fosamax, Actonel Osteoporosis treat, prevention

Osteomalacia Characteristics Predisposing Factors Assessment Vitamin D Deficiency, like rickets in children Predisposing Factors Lack of UV light GI malabsorption Kidney disease Assessment Skeletal pain Bowing of legs, kyphosis, Osteomalacia help

Osteomalacia Diagnosis WHY? Treatment Decreased serum calcium X-ray show bone demineralization Increased serum alkaline phosphatase Increased urinary hydroxyproline WHY? Treatment Increase Vit D , normal diet, UV , exercise

Paget’s Disease Characteristics Predisposing factors Assessment Bone deformities due to abnormal regeneration and reabsorption of bone Affects pelvis, lone bones, spine, cranium Predisposing factors White male over 50 Assessment Small hat syndrome, pathologic fractures, bone pain May lead to osteosarcoma, chondrosarcoma Paget’s disease help

Paget’s Disease Diagnosis Nursing diagnosis Treatment Increased serum alkaline phosphatase X-ray shows thickened bone, curved, abnormal structure Nursing diagnosis Treatment Supportive Calcitonin, EHDP, Mithramycin Exercises

What nursing problems can you identify from this slide?

Gout Caused by disturbed uric acid metabolism Urate salts deposited in articular, periarticular and subcutaneous tissue Primary result of genetic defect purine metabolism Secondary due to increased cell turnover ? Who gets secondary gout? Gout help

Assessment Gouty Arthritis Manifestations Swollen, tender red joints Diagnostic Tests Nursing Diagnosis Interventions Acute: alleviate pain, inflammation Bedrest Medications including ASA, NSAID, Colchicine IV or orally (GI symptoms)

Assessment Gouty Arthritis Manifestations Swollen, tender red joints Diagnostic Tests Nursing Disgnosis Interventions Acute: alleviate pain, inflammation Bedrest Medications including ASA, NSAID, Colchicine IV or orally (GI symptoms)

Management of Gout Uricosuric Agents Probenecid (ASA an antagonist); inhibits resportion of uric acid thus increases excretion of uric acid Sulfinprazone (anturan) to block resorption uric acid Need high fluid intake, alkaline urine Xanthine-oxidase inhibitors decrease uric acid production Allopurinal (zyloprim); may cause agranucytosis Need high fluid intake, and alkaline urine