In older adults high p bone tumor acromegaly healing

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osteoporosis, osteomalacia; dec. in older adults High P: bone tumor, acromegaly, healing bone fracture Low P: osteomalacia; dec. in older adults High ALP: metastatic bone cancer, Paget’s disease, osteomalacia; slight inc. in older adults High Ck: muscle trauma, musc. dystrophy, effect of electromyography High LDH: skeletal muscle necrosis, extensive cancer, musc. dystrophy High ALD: polymyositis, dermamyositis; musc. dystrophy High AST: skeletal muscle trauma, musc. dystrophy; inc. in older adults Discuss the correct use and functioning of therapeutic devices that support mobility. (Note: I’m including diagnostic tests here) > Assessment - Goniometer : used by rehabilitation therapists or RNs to provide an exact measurement of flexion/extension or joint ROM > Imaging - Standard x-ray : most common ; shows bone density, alignment, swelling, intactness; joint condition (size of space, smoothness of cartilage, swelling) may also be assessed - Tomography : Produces places/slices for focus and blurs images of other structures - Xeroradiography : highlights contrast between structures ; “edge enhancement” * Disadvantages: higher level of radiation, inability to determine tissue densities - Myelography : contrast medium is injected into subarachnoid space of spine; allows visualization of column, intervertebral disks, spinal nerve roots, blood vessels; uncommon, replaced by CT and MRI - Arthrogram : visualization of a joint after contrast medium (air or solution) is injected - MRI and CT : MRI is most appropriate for joints, soft tissue, bony tumors involving soft tissue; CT is the test of choice for injuries/pathology involving only bone - Ultrasonography : used to view soft-tissue disorders (masses, fluid accumulation), traumatic joint injuries, osteomyelitis, surgical hardware placement > Nuclear imaging scans - Bone scan : radionuclide test in which radioactive material is injected for viewing entire skeleton; primarily used to detect tumors, arthritis, osteomyelitis, osteoporosis, vertebral compression factors, unexplained bone pain (esp. r/t hairline fractures) - Gallium and thallium scans : similar to bone scan but more specific/sensitive in detecting bone problems; thallium preferred for osteosarcoma
> Other diagnostic tests - Biopsy (may be bone or muscle; needle or open) - Electromyography : evaluates diffuse or localized muscle weakness and aids diagnosis of neuromuscular and nerve disorders; multiple small needle electrodes are inserted and pt performs activities to measure muscle potential; nerve/muscle activity is recorded for later interpretation * Contraindicated w/ pts in anticoagulant therapy ; skeletal muscle relaxants discontinued several days prior - Arthroscopy : athroscope is inserted into a joint for direct visualization (common for knee, shoulder) > Devices to aid with ADLs - Shower chair or handheld shower; long-handled bathing sponge - Reacher, grabber, or dressing stick - Safety bars > Immobilization devices - Bandage, splint : used to keep bone in place during healing; removable - Cast : a rigid device that immobilizes the affected body part; used for more complex fractures * Arm cast : elevate arm above the heart to reduce swelling; ice may be prescribed for first 24-48 hours. Arm is supported with sling for first few days.

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