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

2. Osteoporosis Characteristics Decrease in bone mass Bone Fracture Women

3. 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

4. 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

5. 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

6. 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

7. 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

8. What nursing problems can you identify from this slide?

9. 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

11. 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)

12. 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)

13. 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