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Metabolic Diseases of the Bone
•Osteoporosis
•Osteomalacia
•Paget’s
•Gout
•Bone Tumors
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Osteoporosis
•Characteristics•Decrease in bone mass
•Bone Fracture
•Women
Osteoporosis
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Osteoporosis
Predisposing Factors• 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
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Osteomalacia
Characteristics• 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
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Osteomalacia
Diagnosis• Decreased serum calcium
• X-ray show bone demineralization
• Increased serum alkaline phosphatase
• Increased urinary hydroxyproline
• WHY? Treatment
• Increase Vit D , normal diet, UV , exercise
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Paget’s Disease
Characteristics• 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
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Paget’s Disease
Diagnosis• Increased serum alkaline phosphatase
• X-ray shows thickened bone, curved, abnormal structure
Nursing diagnosis Treatment
• Supportive
• Calcitonin, EHDP, Mithramycin
• Exercises
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What nursing problems can you identify from this slide?
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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
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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)
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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)
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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