NURS 676 MDC Bone Mineralization Discussion Replies

Write Two Replies:

Julie Jacobs

Prompt:

Bone mineralization is a complex process involving multiple factors, such as hormones, vitamins, minerals, and cellular interactions. Discuss your understanding of the key factors and mechanisms that contribute to bone mineralization, including the roles of calcium, phosphate, vitamin D, and the hormones parathyroid hormone (PTH) and calcitonin. How does this knowledge inform your approach to assessing and managing patients with bone health concerns or disorders?

Response:

           Bone mineralization is a tightly regulated process involving an interplay between hormones, vitamins, and minerals. Calcium and phosphate are the primary minerals that make up hydroxyapatite crystals, giving bones their rigidity. Vitamin D plays an essential role in facilitating the absorption of calcium and phosphate from the intestines. Parathyroid hormone (PTH) is released in response to low calcium levels in the blood and acts to increase calcium and phosphate resorption from bones, enhance calcium reabsorption in the kidneys, and stimulate the conversion of vitamin D to its active form, which subsequently increases calcium and phosphate absorption from the gut. On the other hand, calcitonin is released in response to high levels of calcium in the blood and inhibits osteoclast activity, thereby reducing bone resorption and subsequently lowering calcium levels (Karsenty & Wagner, 2002).

Understanding these complex interactions informs my approach as a healthcare provider in assessing and managing patients with bone health concerns. For example, in a patient presenting with osteoporosis, a thorough assessment would include evaluation of vitamin D levels, serum calcium, and phosphate levels along with other relevant factors such as dietary intake and exposure to sunlight. Additionally, a patient’s hormonal status would need to be assessed as conditions like hyperparathyroidism or thyroid disorders can significantly impact bone health. Hormone replacement therapy or antiresorptive agents like bisphosphonates may be considered alongside vitamin D and calcium supplements based on the individual’s clinical profile. Continuous monitoring and reassessment are essential to evaluate treatment efficacy and to make necessary adjustments over time. The goal is to create a comprehensive, personalized treatment plan that addresses the root causes and contributing factors to bone demineralization or other bone health issues (Karsenty & Wagner, 2002).

Roxanne Noriega

Scenario #3 Managing patients with rheumatoid arthritis (RA) requires a comprehensive understanding of the available drug therapies, including nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and disease-modifying antirheumatic drugs (DMARDs). Discuss the key principles of managing these patients, including appropriate assessment, patient selection, and factors to consider when choosing between the available drug classes.

Rheumatoid arthritis is an autoimmune disease characterized as painful swelling of the joints, causing stiffness, decreased range of motion and systemic involvement to include fever, fatigue, thinning of the skin and scleritis to name a few (Radu & Bungau, 2021). Several methods of pain relief to include non-drug and drug methods should be considered with the goal of treatment to be to relieve overall symptoms and pain control, abate systemic involvement, maintain range of motion and delay disease progression.

Nondrug options can include physical therapy, exercise, massage, heat applications and warm baths. On the other hand, there are many drug therapy options available including nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and disease-modifying antirheumatic drugs (DMARDs) (Rosenthal & Burchum, 2021).

Nonsteroidal anti-inflammatory drugs provide quick and effect pain relieve but are not effective in slowing disease progression or reducing joint destruction.

Glucocorticoids provide quick relief, but unlike NSAIDs they can slow down the disease progression. However, patients taking corticosteroids should be monitored closely for risk of toxicity when taking long term.

Disease-modifying antirheumatic drugs (DMARDs) unlike the two previously mentioned drugs work well to both reduce joint destruction and slow disease progression. This is due to their effect on the patient’s immune system. DMARDs are broken down into subcategories of conventional, biological, and targeted. DMARDs should be avoided in breastfeeding mothers and the elderly due to the immunosuppressive effects. With that being said age and certain conditions must be carefully considered. DMARDs have a high probability of toxicity and must be dispensed carefully (Rosenthal & Burchum, 2021).