build bone up

*not stimulated without mobility (immobile clients need ROM)

mental status

general inspection, ht, wt, skin, nutritional status

Head and Neck: TMJ and crepitus

Skeletal: posture, spine, joint function, upper/lower extremities, gait, ROM, deep tendon reflexes, muscle strength/ tone, neurovascular, symmetry

Pain/stiffness

Visible/nonvisible deformity

"sideways curve"

Abnormal spinal curvature (various degrees)

can involve shortening of muscles/ligaments characterized by one shoulder becoming higher than the other

TX: milwaukee brace, internal fixative devices

"humpback"

usually a result of osteoporisis

curvature of cervical/thoracic spine

"swayback" "pregnancy stance"

curvature of lumbar spine

BEST test for soft tissue info

-usually used to produce detailed pictures of soft tissue like tendons, ligaments, and muscles

fiberoptic arthroscope allows endoscopic visual examination of various joints

• Clients must be able to flex joint
• ROM exercises/analgesics are prescribed
• Monitor for complications
• Ice the Joint

needle into nerves + electircity= determination of exactly where nerve impulse problems are located.

Inspect neddle sites for s/s hematomas

Used to assess problems such as muscle weakness, altered gait

"gold standard" for diagnosing osteoporosis

T-Score 1.0-2.5 = osteopenia

T-Score >2.5 = osteoporisis

NEUROVASCULAR!!!!

always check distal to the injury/surgical site

ex: pedal pulses on a knee replacement

older women (post menopausal)

 caucasion

smokers 

steroid users

nulliparity (0 pregnancies)

slight build

by inhibiting parathyroid hormone

(PTH triggers release of Ca⁺ from bones)

• Ca⁺, vit D, estrogen replacement
• Parathyroid hormone replacement- Stops Ca loss
• Bisphophonates-inhibit osteoclasts:  (Fosamax, Boniva, Actonel)
• Calcitonin (IM, subcut, or nasal-redness & irritation)
• fluoride, estrogen with progestin
• SERM with antioxidents (Evista)
• Forteo: PTH **BUILDS BONE**watch s/s hypocalcemia
• Exercise
• Pathologic fracture safety

"no reason fracture"

a fracture without the use of the bone

True/False

Osteoporosis is a bilateral disease

False

patient can have osteoporosis in 1 limb if not being used for a long time

Young adults need ____ mg Ca⁺ with vit D/day

Post menopausal pts need ______ mg

Osteoporosis pts need ______ mg

1200

1500

3000

Secondary osteoporosis results from an associated medical condition such as:

_______1_______

_______2_______

_______3_______

1) hyperparathyroidism: pulls Ca⁺ out of bones

2) long-term immobility: osteoblasts need

stimulation to build bone

3) long-term med therapy: corticosteroids,

antiseizure, heparin, and thyroid hormones affect Ca+ absorption and metabolism

Corticosteroids

thyroid meds

anticonvulsants (Dilantin, Phenobarbitol)

Lasix (pee out Ca⁺)

Heparin

ETOH

Depo Provera (has lots of progesterone)

while affecting the spine the patient bends farther and farther over.

eventually the lower ribs may actually tough the iliac crests, leaving minimal room for lung expansion

Weight bearing:

Walking

Swimming

A metabolic disorder where increased reabsorption (osteoclasts) of bone make the osteoblast overwork.  They build disorganized, lousy bones

*possibly caused by a latent virus

(20-30 yrs prior)

spine

femur

skull

pelvis

*watch for pathological fractures of femur & tibia

>80 yrs old

Europeans

80% are asymptomatic

20% experience aching bone pain, esp. at rest,

Lethargy,

bony enlargement/deformitits (usually bilateral),

Kyphosis

1) Calcitonin, some bisphosphonates (Boniva), mithramycin, NSAIDS,

2) Assistance devices, hot/cold therapy

3) Surgery: tibial osteotomy, partial/total joint replacement. Removal of thickened bone

(Fosamax, Boniva, Actonel)

-inhibits osteoclasts from tearing down bone

• Contraindicated with GERD or renal pts
• can cause esophagitis
• take in morn with 8oz H2O, sit up for 30 min

Lack of Vitamin D

softening of the bone tissue characterized by inadequate mineralization of osteoid

Diagnostic findings: X-Ray shows perpendicular lines on bones: Loser's Lines

lack of sunlight

malabsorption of vit D in small intestine

Meds: anticonvulsants, barbiturates, fluoride

Any disease/surgery that affects absorption of GI tract

In US: elderly, poor nutrition, homeless

3rd world countries: children (Ricketts) big belly, bowed legs