686 Pagets Disease by testing for decreased hearing and vision, difficulty swallowing, and problems with balance. Examine legs and arms for bowing and subsequent deformities. Ask the patient to walk across the room and back to observe a characteristic waddling gait.

Observe for signs of kyphosis. Note if the patient is bent forward with the chin resting on the chest or has a barrel chest. Kyphosis can compromise chest excursion and cause dyspnea. Palpate the affected areas for increased warmth. Paget's disease causes an increase in vascularity of the affected bones, thus causing the skin temperature to rise. Elderly patients or those with large, highly vascular lesions may develop congestive heart failure because of the heart's attempt to pump more blood through bones with increased vascularity. Assess the patient's apical pulse, respirations, and blood pressure. Note the presence of peripheral edema and neck vein distension from right-sided heart failure and pulmonary congestion.

PSYCHOSOCIAL. Because the diagnosis of Paget's disease is unexpected, the patient and family may experience increased anxiety levels. There may be fear related to possible falls with fractures and the possibility of self-care deficits. Social isolation may also occur as a result of increasing bone pain and deformities.

Diagnostic Highlights


Normal Result

Abnormality with Condition



Normal structure of

Disordered and architec

Disease causes increased osteo

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