Bone and Joint

8/13/2019 Bone and Joint

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Bone-Related Disorders: Calcium Functions and Requirements

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To better understand metabolic bone disease and its pharmacotherapy, you need basic

knowledge of calciums role in normal body functions. Calcium is necessary for

maintaining the health of the:

Musculoskeletal systemmuscle contraction and health of bones and teeth Nervous systemconduction of nerve impulses Cardiovascular systemblood coagulation

More than 99% of the bodys total amount of calcium is found in the bones; most of the

remaining calcium is in the blood. About half of this serum calcium is in the active form

(ionized), which plays a vital role in intracellular functions.1

The normal range of serum calcium is 4.55.5 mEq/L. Levels outside this range cause:2

Hypercalcemia (more than 5.5 mEq/L)very high levels can lead to kidney stonesor kidney failure, dysrhythmias, dementia, and coma

Hypocalcemia (less than 4.5 mEq/L)very low levels can lead to dysrhythmias,severe seizures and muscle spasms, hypotension,tetany,and bone fractures (if

chronic)

To maintain homeostasis, the body must obtain an adequate amount of calcium from the

diet or supplements. Otherwise, calcium is taken from the bones. Over time, low calcium

intake causes bones to become weak, prone to fractures and breaks.

Adults need to take in between 800 and 1200 mg of calcium per day.3Women who are

pregnant, breastfeeding, or postmenopausal typically need higher amounts. The amount

of calcium absorbed is influenced by certain body conditions:

Absorption increases with:o Moderate fat intakeo High protein intakeo High gastric acidityo Hormonal conditions causing low serum calcium

Absorption decreases with:o Vitamin D deficiencyo High-fat dieto Decreased gastric acidity
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o Increased GI motilityo Hormonal conditions causing high serum calcium

Bone-Related Disorders: How Calcium Balance Is Maintained


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The balance of calcium in the body is maintained through the actions of three

substances:
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Parathyroid hormone (PTH)produced by the parathyroid glands when serumcalcium levels drop too low, resulting in:

o Increased bone resorption(demineralization), which is the process ofbreaking down bone into calcium and other minerals

o Increased calcium reabsorption in the kidneyso Increased formation of activated vitamin D

Calcitoninhormone produced by the thyroid gland when serum calcium levelsrise too high, resulting in:

o Increased bone deposition, which is the process of moving calcium fromblood into bone

o Increased excretion of calcium by the kidneys Vitamin D

oThe only vitamin the body can synthesize

o Increases absorption of calcium in the small intestineThe process by which vitamin D is made and activated is as follows:

1. The inactive form of vitamin D, cholecalciferol, is synthesized from cholesterol.Serum levels of cholecalciferol are increased:

o By skin exposure to sunlight or ultraviolet lighto From dietary sources, such as milk or other substances fortified with

vitamin D2. Cholecalciferol is then converted to calcifediol, the intermediate form of vitamin

D.

3. Calcifediol is metabolized in the kidneys and becomes the active form of vitaminD, called calcitriol.

The primary role of calcitriol is to aid the absorption of calcium in the GI tract. From

there, calcium is transported to bone, muscle, and other tissues. Because the kidneys

have an active role in the formation of calcitriol, clients with severe renal disease may

exhibit both calcium and vitamin D abnormalities.

Bone-Related Disorders: Hypocalcemia


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A client is considered hypocalcemic if his/her serum calcium level drops below 4.5 mEq/L.

Even though hypocalcemia is not a bone disease process, it is a sign of an underlying


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problem that could greatly weaken the bones. Finding that underlying cause is essential

for proper therapy. Many factors may contribute to hypocalcemia:

Lack of dietary intake of calcium or vitamin D Excessive vomiting Malabsorption disorders Chronic renal disease Decreased secretion of PTH due to disease or surgical removal of the thyroid or

parathyroid

Drug therapy:o Phenytoin (Dilantin)o Furosemide (Lasix)o Phosphate therapyo Bisphosphonateso Long-term corticosteroid therapy

Blood transfusionsOften, hypocalcemia occurs without symptoms. However, a client with this condition may

exhibit:

Hyperactive reflexes Twitching muscles (for example, a positive Chvostek signcontraction of facial

muscles when the facial nerve is tapped)

Tremors Abdominal cramping Numbness and tingling of extremities Confusion

Bone-Related Disorders: Osteomalacia


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Metabolic bone disease (MBD)is a term used to describe disorders that cause defects

in the structure of bone. MBDs are caused by abnormal amounts of vitamins/minerals


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(such as calcium, phosphate, or vitamin D) or hormones (such as PTH or calcitonin) that

play a role in bone homeostasis.

Osteomalaciais an MBD that is also known as ricketswhen it occurs in children. In this

condition, the bones become softened without disturbing the basic bone structure. As aresult, skeletal deformities can occur from weight-bearing stress.

The main cause of osteomalacia is a deficiency of calcium and vitamin D. Although this

MBD is very rare in the United States, those most at risk are premature infants, vegans

(vegetarians who do not eat dairy products), and older adults. Other risk factors may

include:

Malabsorption disorders of the small intestine Damage to the kidneys tubules Adverse effects of antiseizure therapy Liver impairment Limited exposure to sunlight

Symptoms of osteomalacia include:

Hypocalcemia Muscle weakness and/or spasms Scattered bone painparticularly in the hip area but also in the spine, arms, or

legs

Bowed legs and pigeon breast (typical in children)Diagnostic testing includes:

X-rays and biopsy of bones CT scans of the spine Serum levels of vitamin D, calcium, and phosphate

Bone-Related Disorders: Osteoporosis


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Click on the image to view the video

Osteoporosis, the most common MBD in the United States, is distinguished by:

Bone demineralization Decreased bone density Bone fractures

The exact cause of osteoporosis is not known. However, two main theories of

pathogenesis are:
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Slow bone deposition caused by the presence of defective bone cells, which havea very short life span and are less efficient

Increased rate of bone resorption caused by bone cells that have an increasedlevel of activity

Risk factors for osteoporosis include:

Onset of menopause (most common association) Age over 60 History of osteoporosis in the family Asian or Caucasian racial heritage Anorexia nervosa Low level of dietary calcium Vitamin D deficiency Hormonal deficiencies (estrogen or androgen) Lack of exercise High consumption of alcohol History of smoking

Because osteoporosis is usually asymptomatic, diagnostic testing is important in

identifying this MBD:

Bone mineral density (BMD) testing Dual-energy x-ray absorbtiometry (DEXA) scan

Bone-Related Disorders: Paget Disease


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Paget disease is a chronic progressive disorder that causes enlarged and weakened

bones, especially in the:

Spinal column Skull Sternum


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Pelvis Femur and tibia

Other characteristics of Paget disease:

The cause is unknown, but genetic and viral factors may play a role. Bone loss and new bone formation occur concurrently at an abnormally fast rate. Bone changes lead to fractures and deformities. This MBD occurs in both genders aged over 40.

Most people with Paget disease have no symptoms. A few clients report:

Headaches

Joint inflammation Pain in the hips, femurs, face, and spine Hearing loss

Paget disease is diagnosed by:

X-ray Elevated serum level of the enzyme alkaline phosphatase (ALP) Elevated serum level of calcium

Successful treatment of Paget disease depends largely on an early diagnosis. Kidney

stones, arthritis, permanent bone abnormalities, and heart disease may result if a

diagnosis is not made until late in the disease process.

Pharmacotherapy of Bone-Related Disorders: Calcium


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In mild cases of hypocalcemia, foods rich in calcium should first be added to or increased

in the clients diet. Good sources include:

Dairy products Orange juice fortified with calcium


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Cereals Dark green leafy vegetables such as spinach, broccoli, and kale Seafood such as salmon, clams, and oysters

If dietary changes fail to correct the hypocalcemia, over-the-counter calciumsupplements, many of which also contain vitamin D, will likely be recommended by the

health care provider. Severe hypocalcemia may require an emergency IV infusion of

calcium salts, such as calcium chloride or calcium gluconate.

Calcium supplements/salts may also be prescribed for clients who are diagnosed with

MBDs.

Pharmacotherapy of Bone-Related Disorders: Vitamin D


Vitamin D is required for intestinal absorption of calcium. When providing vitamin D

therapy, keep the following in mind:

Client needs will vary based on sunlight exposure. Daily requirement increases from 400 to 600 units after age 70.4
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Between 50,000 and 100,000 units per day may be administered in cases ofsevere malabsorption.5

Vitamin D is available as a medication in three forms: active, intermediate, andinactive.

Many calcium supplements contain vitamin D. Overdoses can occur, because vitamin D is fat-soluble. Watch for signs of

hypercalcemia such as vomiting, fatigue, loss of appetite, and excessive thirst.

Examples of vitamin D analogs are:

GenericNames Trade Names Nursing Considerations

calcitriol Calcijex,Rocaltrol Used to manage hypocalcemia andparathyroid dysfunctionElevates serum calcium levels by

promoting absorption of calcium in the

intestines and renal retention of

calcium

Pregnancy category C

Routes of administration are PO and IVergocalciferol Activated

Ergosterol,

Drisdol, D-

ViSol

Treatment for osteomalacia,

osteoporosis, familial

hypophosphatemia (vitamin D-

resistant rickets), hypocalcemia

associated with hypoparathyroidism

Prophylaxis for nutritional rickets

Regulates levels of serum calcium and

phosphate ions by enhancing

absorption in the intestines

Pregnancy category C

Route of administration is POClick to review more details on the prototype drugcalcitriol.

Pharmacotherapy of Bone-Related Disorders: Bisphosphonates
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Bisphosphonatesare bone metabolism regulators. In general, they slow the rate of bone

resorption, which results in increased bone mass and decreased incidences of fractures.

Medications in this classification include:

Generic Names Trade Names Routes of Administrationalendronate sodium Fosamax POetidronate disodium Didronel, EHDP POibandronate sodium Boniva POpamidronate disodium Aredia IVrisedronate sodium Actonel POtiludronate disodium Skelid POzoledronic acid Reclast, Zometa IV

Click to review more information onalendronate sodium.

Bisphosphonates are frequently the drugs of choice for treating Paget disease and

osteoporosis. Indications for these medications include:

Osteoporosis in postmenopausal womenalendronate, ibandronate, risedronate,zoledronic acid (Reclast)

Osteoporosis in menalendronate, risedronate Corticosteroid-induced osteoporosisalendronate, risedronate, zoledronic acid

(Reclast) Paget diseasealendronate, etidronate, pamidronate, risedronate, tiludronate,

zoledronic acid (Reclast)

Bone metastasespamidronate, zoledronic acid (Zometa) Malignant hypercalcemiapamidronate, zoledronic acid (Zometa)

Nursing considerations include:
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Depending on the specific bisphosphonate, contraindications and reasons forcautious use may include: hypocalcemia, fever or infection, active upper GI

problems, difficulty swallowing or narrowed esophagus, liver disease, renal

impairment, hyperphosphatemia, congestive heart failure, osteomalacia,

pregnancy, or lactation.

Some of the adverse effects frequently associated with bisphosphonates arenausea, vomiting,dyspepsia,and esophageal irritation. These medications should

be taken on an empty stomach, 3060 minutes before eating. After

administration, clients should remain upright for 3060 minutes. In the case of

etidronate, clients should avoid eating for 2 hours after taking it.6

Antacids and other drugs containing calcium, as well as foods and beverages highin calcium, should be avoided for at least 2 hours before and after taking

bisphosphonates.

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Pharmacotherapy of Bone-Related Disorders: Bisphosphonates
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Bisphosphonatesare bone metabolism regulators. In general, they slow the rate of bone

resorption, which results in increased bone mass and decreased incidences of fractures.

Medications in this classification include:

Generic Names Trade Names Routes of Administrationalendronate sodium Fosamax POetidronate disodium Didronel, EHDP POibandronate sodium Boniva POpamidronate disodium Aredia IVrisedronate sodium Actonel POtiludronate disodium Skelid POzoledronic acid Reclast, Zometa IV

Click to review more information onalendronate sodium.

Bisphosphonates are frequently the drugs of choice for treating Paget disease and

osteoporosis. Indications for these medications include:

Osteoporosis in postmenopausal womenalendronate, ibandronate, risedronate,zoledronic acid (Reclast)

Osteoporosis in menalendronate, risedronate Corticosteroid-induced osteoporosisalendronate, risedronate, zoledronic acid

(Reclast) Paget diseasealendronate, etidronate, pamidronate, risedronate, tiludronate,

zoledronic acid (Reclast)

Bone metastasespamidronate, zoledronic acid (Zometa) Malignant hypercalcemiapamidronate, zoledronic acid (Zometa)

Nursing considerations include:
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Depending on the specific bisphosphonate, contraindications and reasons forcautious use may include: hypocalcemia, fever or infection, active upper GI

problems, difficulty swallowing or narrowed esophagus, liver disease, renal

impairment, hyperphosphatemia, congestive heart failure, osteomalacia,

pregnancy, or lactation.

Some of the adverse effects frequently associated with bisphosphonates arenausea, vomiting,dyspepsia,and esophageal irritation. These medications should

be taken on an empty stomach, 3060 minutes before eating. After

administration, clients should remain upright for 3060 minutes. In the case of

etidronate, clients should avoid eating for 2 hours after taking it.6

Antacids and other drugs containing calcium, as well as foods and beverages highin calcium, should be avoided for at least 2 hours before and after taking

bisphosphonates.

7

Pharmacotherapy of Bone-Related Disorders: Raloxifene
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Raloxifene hydrochloride (Evista) belongs to the class of drugs called selective estrogen

receptor modulators (SERMs). It is used to prevent and treat osteoporosis in

postmenopausal women.


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Raloxifene works by reducing bone loss, thereby increasing bone density. As a result, the

probability of fractures is decreased.

Nursing considerations for raloxifene include:

Contraindications Other Considerations

Pregnancy and lactation

(pregnancy category X)

History of deep vein

thrombosis (active or

past)

Immobilized clients (due

to risk for thrombosis)

Severe liver impairment

Children

Hypersensitivity to

raloxifene

Hot flashes are a common adverse effect. Others

may include leg cramps and weight gain.

This drug should not be given at the same time as

cholestyramine (Questran, Prevalite), or any drugs

that contain estrogen.

Calcium and vitamin D supplements are

recommended with raloxifene.

Click to review more details onraloxifene hydrochloride.

Pharmacotherapy of Bone-Related Disorders: Miscellaneous Drugs


Two miscellaneous drugs used to treat MBDs are:
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Drug Names Descriptions

calcitoninsalmon

(Fortical, Miacalcin)

Salmon form of the hormone calcitonin

Classified as a bone metabolism regulator

Inhibits bone resorption and promotes excretion of

calcium by the kidneys

Treatment for Paget disease and postmenopausal

osteoporosis

Calcitonin salmon is administered SC, IM, or

intranasal spray (calcitonin human is administered SC

only)

teriparatide (Forteo) Human form of PTH produced by genetic

engineering technology

Classified as a parathyroid hormone agonist

Increases new bone formation

Treatment of osteoporosis in men and

postmenopausal women

Usually given to clients at high risk for fractures

Administered SC daily

Joint Disorders: Osteoarthritis


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Click on the image to view the video

Arthritis can be categorized as inflammatory or noninflammatory. The video on this

screen provides an overview and examples of both types.

Osteoarthritis (OA), a noninflammatory joint disorder, is the most common form of

arthritis and a major cause of disability in the United States. OA is a progressive

degenerative condition in which articular cartilage is broken down. The disease process

typically involves these changes:

Joint use and the bearing of weight may cause joint cartilage to thin.
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Bone is eventually exposed, causing bone spurs and bone cysts to form, and thejoint space becomes narrowed. Lubricating (synovial) fluid is also lost.

All of these factors combine to cause inflammation, pain, destruction of the jointlining, and instability of the joint.

The hips, knees, and spine are affected most often because they are the primaryweight-bearing joints. The hands are also affected because of repetitive use.

The two typesof OA are:

Idiopathicmost common type; no known cause but associated with the agingprocess

Secondarymay be caused by joint inflammation and instability resulting from:o Trauma or mechanical stresso Neurologic disorders

People at risk for OA include:

Overweight individuals Postmenopausal women, due to a lower production of estrogen Those who have an overproduction of either growth hormone or PTH

X-rays, physical exams, and clients medical histories are used to diagnose OA. Symptoms

include:

Initial joint pain (mild to severe) and stiffness Deep, aching joint pain that feels worse when moving, but is alleviated by rest Numbness or tingling with pain at night Reduced range of motion (ROM) and increased pain, as the condition progresses Increased size of joints, which usually feel hard and cool to the touch

Joint Disorders: Pharmacotherapy of OA


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Both pharmacotherapy and nonpharmacologic therapy are used to manage OA.

Nonpharmacologic therapy includes exercise that minimizes joint stress, such as walking,

swimming, bicycling, yoga, or passive ROM exercise.

The goals of pharmacotherapy are reduced pain and swelling of the joints, and

minimized disability. Medications used to achieve these goals include:

Generic Names TradeNames

Descriptionsacetaminophen Tylenol Nonnarcotic analgesic

Drug of choice for initial treatment of OA

For severe OA pain, products that

combine acetaminophen and codeine

may be prescribed


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capsaicin Capsin,Zostrix Topical analgesic

celecoxib Celebrex Nonsteroidal anti-inflammatory drugs(NSAIDs)

Treatment for OA pain unrelieved by

acetaminophenibuprofen Advil,

Motrinnaproxen sodium Aleve,

Anaproxtramadol

hydrochloride Rybix,Ultram Narcotic analgesicFor moderate to moderately severe painOther examples of OTC topical preparations for pain relief include salicylates such as

Aspercreme, and counterirritants such as Ben-Gay and Icy Hot.

Some drugs, such as corticosteroids, are injected directly into a joint for acute pain. This

pharmacotherapy often provides several months of pain relief.

Joint Disorders: Rheumatoid Arthritis


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Rheumatoid arthritis (RA)is an inflammatory joint disorder. This chronic, progressive

autoimmune disease is less common than OA. RA causes joint inflammation and

disfigurement of the affected joints. The disease process includes:

Autoantibodies, known as rheumatoid factors, combine with immunoglobulin G inresponse to the inflammatory process of RA.

Over time, chronic inflammation in the joints results in damage of the articularcartilage and nearby bone structures.

Eventually, scar tissue formed from the damage prevents joints from moving.The exact cause of RA is unknown, but genetic, environmental, and viral factors may play

a role. Symptoms of RA may include:

Initial stagejoint stiffness in the morning, joint swelling and pain, generalfatigue; joints may feel warm to the touch and appear reddened

As the disease progressesdegree of joint stiffness increases, deformities of thejoints and supporting tissues appear, muscle weakness occurs, ROM decreases

Advanced stagelow fever, anemia, weight loss, extreme fatigueDiagnosis is determined by:

Medical history and physical exam Elevated rheumatoid factor Elevated erythrocyte sedimentation rate (ESR) Elevated antinuclear antibody titers Elevated serum immunoglobulin levels

Joint Disorders: Pharmacotherapy of RA


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The main goals of pharmacotherapy for RA are:

Controlled inflammation Reduced pain Maximized tolerance of physical activity

Although the pharmacotherapy goals for RA and OA have things in common, the

treatment approach and many of the drugs used are different:

Therapy for RA is begun with NSAIDs because they reduce both pain andinflammation. These NSAIDs are given in higher doses than those for OA

treatment.


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Corticosteroids are prescribed for moderate to severe pain because of their anti-inflammatory properties. However, they are not used for long-term therapy, due

to adverse effects.

Tissue damage that results from RA can be treated with a group of medicationscalled disease-modifying antirheumatic drugs (DMARDs):

o Types of DMARDs include gold salts, antimalarial drugs, D-penicillamine,and drugs that alter immune and anti-inflammatory responses.

o The choice of DMARD depends on the health care provider and theparticular client.

o More than one DMARD may be prescribed concurrently, or withanalgesics.

Examples of DMARDs include:

Generic Names Trade Namesadalimumab Humiraanakinra Kineretetanercept Enbrelhydroxychloroquine Plaquenil Sulfateinfliximab Remicadeleflunomide Aravamethotrexate sodium MTXsulfasalazine Azulfidine

Click to review more information onhydroxychloroquine.
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Joint Disorders: Gout

Goutis a type of inflammatory arthritis caused by uric acid crystals gathering in joint

spaces and other tissues. There are two types of gout:

Primaryresults from the bodys inability to handle uric acid; caused by geneticproblems affecting purine metabolism

Secondarycaused by diseases or drugs that increase the metabolism of nucleicacids, or affect the excretion of uric acid:

o Examples of drugsthiazide diuretics, aspirin (Bayer, Ecotrin, Empirin),cyclosporine (Gengraf, Neoral, Sandimmune), chronic alcohol use


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o Examples of disordersdiabetic ketoacidosis, kidney impairment, multiplemyeloma, hypothyroidism, leukemia, hemolytic anemia

Symptoms of acute gouty arthritis may include:

Swollen, painful joints, especially in toes, heels, ankles, wrists, fingers, knees,elbows

Red inflamed tissue Elevated body temperature Hyperuricemia (increased level of uric acid in the blood)

Risk factors or triggers of acute gouty arthritis may include:

Alcohol intake

Dehydration Stress Joint injury Fever

Factors in the diagnosis of gout:

When completing a medical history and physical exam, be aware that initial signsmay be vague.

Many clients have normal uric acid levels even during an acute attack of goutyarthritis.

A definitive diagnosis can be made by analyzing the synovial fluid.

Joint Disorders: Pharmacotherapy of Gout


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The goals of pharmacotherapy for gout are:

Stop acute attacks


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Prevent future incidences from occurring Avoid complications such as kidney stones and formations of tophi

Preventative measures should include:

Changes in dietavoiding alcohol and foods such as mushrooms, oatmeal,legumes

Avoiding thiazide diuretics, aspirin (Bayer, Ecotrin), cyclosporine (Gengraf, Neoral)Although NSAIDs or corticosteroids may be used to treat the pain and inflammation

caused by gout, the drugs of choice are uric acid inhibitors and antigout medications.

Uric acid inhibitors block the accumulation of uric acid in the blood and uric acid crystals

in the joints. Examples of drugs used to treat gout are:

Generic Names Trade Names Descriptionsallopurinol Alloprin,

Lopurin,

ZyloprimLowers both urinary and serum uric acid

levels

For managing primary hyperuricemia

and prevention of acute gouty attacks

Routes of administration are IV and POcolchicine Colcyrus Inhibits inflammation and decreases pain

and swelling in acute attacks of gouty

arthritis (given every hour untilsymptoms subside)

Prophylactic for recurring gouty arthritis

Has common adverse effects on GI

system, such as nausea, vomiting, and

diarrhea

Route of administration is POprobenecid Benemid,

Probalan Prevents formation of new tophi andbuildup of uric acid in the blood andtissues

Treats tophaceous gout and chronicgouty arthritis

Route of administration is POsulfinpyrazone Anturane Promotes excretion of uric acid in the

urine and inhibits reabsorption of uric

acid in the kidneys

Maintenance therapy for tophaceous gout


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and chronic gouty arthritis

Route of administration is PO

Nursing Role: Assessment and Planning

During the assessmentstage of the nursing process, you, as the nurse, are responsible

for obtaining a baseline assessment that may include:

Vital signs, height, and weight


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Pain assessment (onset, location, intensity, duration, character, precipitation, oralleviating factors)

Health and medication history, including drug allergies and history of fractures Physical examination, which may include:

o Assessment for signs of hypercalcemia and hypocalcemiao Assessment of tissue surrounding joints (presence or level of swelling,

tenderness, warmth, redness; ROM)

Checking for any contraindications to prescribed medication(s) Laboratory data, as ordered by health care provider

o X-rays of bones or jointso For bone-related disorders, may include complete blood count (CBC),

electrolyte (calcium, phosphate, magnesium) and vitamin D serum levels,

renal function studies, bone mineral densityo For RA, may include rheumatoid factor, erythrocyte sedimentation rate,

antinuclear antibody titers, serum immunoglobulin levels

o For gout, may include CBC, urinalysis, renal and liver function studies, uricacid level

In the planningstage, your role as a nurse includes doing what is necessary to ensure

that the client can:

Experience the desired therapeutic effects of the medication(s) with minimal to noadverse effects

Verbalize an understanding of new medication(s), including use, adverse effects,and precautions

Demonstrate accurate self-administration of medication(s) Verbalize when to notify the health care provider

One of the ways to help achieve these goals is to make sure you understand the reasons

why particular medications have been prescribed, before they are administered.

Nursing Role: Implementation


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Your role, as the nurse, in the implementationphase of administering medications for

bone and joint disorders may include:

Ensuring therapeutic effects by frequent client assessment and monitoring Minimizing adverse effects by:

o Frequent vital sign assessmento Verification of medications taken at home (medication reconciliation)

Client education regarding:o Medication use, adverse effects, and precautionso Self-administration of medications and importance of complianceo When to contact the health care providero Importance of periodic testing and follow-up appointments with the

health care provider


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o How to recognize symptoms of hypercalcemia, including nausea andvomiting, increased thirst and fatigue, loss of appetite

o How to recognize symptoms of hypocalcemia, including twitching muscles,abdominal cramping, numbness and tingling of extremities, confusion

o Safety precautions for avoiding injuries and preventing fractureso Lifestyle modifications

Dietary changes in cases of hypocalcemia (increasing intake ofcalcium-rich foods)

Dietary changes in cases of gout (avoiding alcohol and high-purinefoods)

Exercise that minimizes joint stress, for clients with OA

Nursing Role: Evaluation


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Your role in the evaluation phase of administering medications for bone and joint

disorders may include:


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Evaluating the effectiveness of the medication(s) for:o Relief of paino Ability to perform activities of daily livingo Improved or maintained ROMo Improved activity tolerance due to less paino Decreased progression of diseaseo In the case of gout, fewer or no incidences of recurring attackso In the case of osteoporosis, improved bone density and absence of bone

fractures

Evaluating the effectiveness of client education:o Client is able to verbalize an understanding of the education provided,

including self-administration of medications, adverse drug effects, and

when to contact the health care provider.

o Client demonstrates compliance with the drug regimen and recommendedlifestyle changes.

o Client has kept follow-up appointments for lab work and appointmentswith the health care provider.

Documents

Bone and Joint