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211 exam 1
Arthritis and osteoporosis as it effects the elderly
| Question | Answer |
|---|---|
| osteoblasts | remove Ca & phosphate from blood secrete collagen into bone, responds to stress and strain |
| osteoclasts | remove Ca & phosphate from bone responds to hormones |
| how is bone density measured? | grams of apatite per cm2 |
| fracture threshold | 1 gm apatite/cm2 - greater than this decreases fx risk - less than this increase fx risk |
| main factor that determines bone density | genetics determines 75% bone density |
| calcium regulating hormones | PTH (parathyroid), calcitonin, estrogen |
| parathyroid (PTH) function | tells osteoclasts that more Ca is needed in blood takes Ca from bone |
| calcitonin function | works opposite of PTH |
| estrogen function (in relation to bone) | suppresses osteoclasts |
| when is peak bone mass | 25 – 35 y/o try to maintain it. |
| demineralizing factors (9) | 1. Calcium availability 2. Cigarette smoking – premature osteoporosis counter acts estrogen 3. Genetics 4. Gender – men have 30% greater density 5. Corticosteroid use 6. Celiac Disease 7 physical activity 8. anthropometrics 9. advanced age |
| what increases the excretion of Ca | caffeine/alcohol |
| how does low physical activity affect bone demineralization | bedrest loss of 1%/week |
| how can high physical activity affect bone demineralization | amenorrhea/hormone changes (young gymnast with skeletal system of 70y/o woman) |
| how do anthropometrics affect bone demineralization | lighter weight people have demineralization |
| how does calcium absorption affect bone mineralization | increased Ca absorption = increased bone mineralization |
| how does vitamin D affect bone mineralization | increased vitamin D = increased bone mineralization |
| how does lactose affect bone mineralization | aids in absorption of Ca |
| how does magnesium affect Ca absorption? | increases Ca absorption |
| how does fluoride affect bone mineralization | increase bone mineralization |
| how do protein and caffeine affect Ca balance | increase Ca urinary output |
| how does alcohol affect Ca absorption? | Reduces Ca absorption and Vit. D conversion |
| how does phosphorus affect Ca absorption | reduces Ca absorption through competition |
| how does sodium affect Ca? | increases Ca urinary output |
| how does sugar affect Ca? | Extreme intakes reduce stomach acidity & Ca absorption |
| OA | Deterioration of articular cartilage New bone in sub chondral areas/joint margins |
| characteristics of OA | Minimal if any inflammation Found in weight bearing joints (hips, knees and distal interphalangeal joints.) bouchards and Heberden's nodes |
| problems from OA | Decrease ROM Muscle spasms secondarily to pain Osteophytes bony end feel Weakness secondarily to disuse |
| precautions/ contraindications for OA | No joint mob during acute inflammation no Max resistive exercise Avoid heavy stress to weight bearing joints (lifting, jumping, etc) Avoid deep flexion (sit to stand out of a low chair) Avoid poor alignment of a joint |
| treatment for OA | Foot Orthotics to help with alignment Taping for patellofemoral alignment Ultrasound and TENS |
| exercise for OA | Isometrics, Isotonic strengthening PRE’s for LE during non-inflamed periods Aerobic training with full or PWB – aquatics, bike, or walk |
| AD for OA | cane Force of the hip can be reduced by 60% with proper use of a cane |
| how can biomechanics be improved for people with OA? | Raising the level of a seat or toilet |
| RA characteristics | Remission and exacerbations Connective tissue disease -->Pannus forms and errodes cartilage Tenosynovitis may occur and may rupture tendon Rheumatoid nodules, atrophy and fibrosis of muscles --> weakness Ankylosing/sublux of joint Fatigue |
| RA symptoms are usually ____ | bilateral |
| RA exacerbation problems | Tenderness/warmth over joint with swelling Muscle guarding and pain with motion Joint stiffness Weakness Deformity |
| precautions/contraindications in RA exacerbation phase | Avoid fatigue Many meds for RA cause osteoporosis -->don’t stress bones No maximum resistive exercise No stretching exercises No joint mobilization EVER |
| why no stretching for RA exacerbation phase | (decrease ROM is due to swelling in joint space capsule will over stretch and hypermobility will result). |
| tx goals for exacerbation phase | Decrease pain and muscle guarding Minimize stiffness and maintain ROM Prevent muscle atrophy – gentle isometrics Prevent deformity and protect joint structures |
| decreasing pain and mm guarding for RA | Modalities Gentle massage Immobilization/splint |
| minimizing stiffness and maintaining ROM for RA | PROM or AAROM with in pain free range |
| preventing deformity and protecting joint structures | Supportive and assistive equipment Good bed positioning Avoid activities that stress joints Patient education |
| problems in the remission period of RA | Pain when stress is applied to mechanical restrictions Decrease ROM Muscle weakness Postural changes/joint deformities Decrease functional use of a joint(s) |
| what may be weakened by the rheumatic process? | Joint capsule, ligaments, and tendons - active stretching techniques must be done carefully/gently if at all. |
| what is contraindicated with RA | Vigorous stretching, traction, or mobilization techniques are all contraindicated. |
Created by:
bdavis53102
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