Osteomyelitis
Infection of bone
-indirect entry (start somewhere else in body)
-direct entry (open fracture)
Acute vs. chronic
-chronic when longer than 4 weeks
Clinical manifestations:
-severe bone pain
-swelling, tenderness, warmth at site
-systemic symptoms (fever,
Osteomyelitis
Management
Vigorous antibiotic therapy (usually IV with PICC)
-assess for adverse effects of antibiotics
-wound may receive antibiotic irrigation
Strict sterile technique with dressing changes
Handle extremity carefully
-risk of fracture
-pain
Prevent contractures
Osteomyelitis
Collaborative Care
Debridement (removal of dead bone or tissue)
May need negative pressure (wound vac)
Hyperbaric oxygen therapy
Low Back Pain
-Second only to the "headache" as the most common complaint
-Results from muscle strain, arthritis, intraventrebral disk degeneration and hernia toon of intervertebral disk
Clinical manifestation: reports of pain and stiffness, posture and gait may be sti
Low Back Pain
Risk Factors
-lack of muscle tone
-excess weight
-poor posture
-jobs that require repetitive heavy lifting or vibration
Low Back Pain
Management
Mild-Moderate
-analgesics
-NSAIDs
-muscle relaxants
-bracing or corset
-bed rest (not ideal)
-hot and cold therapy
Severe
-corticosteroids and anesthetic injections
-surgery (diskectomy, laminectomy, spinal fusion)
Low Back Pain
Patient Teaching
Best position while in bed is knees bent, use a pillow under knees when lying on back
Low Back Pain
Surgical Therapy
Diskectomy allows for decompression of the nerve root
Laminectomy involves the surgical removal of part of the vertebral arch
Spinal fusion is performed when unstable bony mechanism is present. Fused with fixation rods, plates & screws and this gives more
Low Back Pain
Post Surgery
-flat bed rest with logrolling may be ordered for 1-2 days (need to verify with physician orders) do not elevate their head
-report severe headache or leakage of CSF on dressing immediately
-frequent neuro vascular checks
-assess bowel and bladder functio
Low Back Pain
Nursing Diagnoses
-pain r/t muscle spasms, muscle strain & herniated disk
-impaired physical mobility r/t limited ROM movement restrictions & muscle spasms
-ineffective individual coping r/t effects of chronic pain
-body image disturbance r/t chronic pain
Metabolic Bone Diseases
-Osteomalacia
-Osteoporosis
-Paget's Disease
Osteoporosis
Porous bone, low bone mass, structural deterioration of bone tissue leading to increased bone fragility
Women are 8 times more likely to develop than men because of lower calcium intake, pregnancy, longer life, and lower initial bone mass
Leading cause of
Osteoporosis
Clinical Manifestations
-Often called the "silent disease" because bone loss occurs without symptoms. May go undetected until a fracture occurs
-May cause collapse of vertebrae, leading to loss of height or kyphosis
Osteoporosis
Diagnostic Studies
-Will not be detected in standard x-ray until 25-45% of calcium in bone is lost
-Bone density scans will measure bone density of hips, spine and forearm
Osteoporosis
Prevention
-Calcium intake (1000mg per day, either by diet or supplements, postmenopausal need 1200-1500mg)
-Vitamin D (assist with calcium absorption)
-Weight bearing exercises (walking, hiking, stair climbing, tennis, dancing)
-Stop smoking
-Decrease alcohol consu
Osteoporosis
Drug Therapy
Inhibit bone resorption by osteoclasts (slow rate of bone breakdown)
-Estrogen (not primary treatment due to potential risks)
-Estrogen receptor modulators (Raloxifene (Evista) synthetic estrogen mimics effects of estrogen with fewer side effects, normall
Osteoarthritis (Degenerative Joint Disease)
Slow profession disorder of articulating joints (degeneration of articulate joint cartilage/cushion) that is not systemic
Degenerative changes over time cause normally smooth white, translucent cartilage to become yellow, opaque with rough edges & areas o
Osteoarthritis
Clinical Manifestations
-pain with activity
-stiffness after periods of inactivity
-progressive loss of function
-crepitation
-gross deformity & subluxation in advanced stages
-Heberden's and Bouchard's nodes (more common in women and genetic)
Osteoarthritis
Diagnostic Studies
-X-rays will show joint space narrowing, spur formation and subluxation
-Bone scan, CT, or MRI may be used
-Synovial fluid analysis (no inflammation: this helps differentiate between osteo- and rheumatoid arthritis)
-No specific serological studies are us
Osteoarthritis
Interventions
-Goal of therapy is pain control, prevention of progression & disability, restoration of function
-Rest & joint protection
-Heat, cold, and exercise
-Weight loss if obese
-Complementary and Alternative therapies
Continue activity without overuse, may use
Osteoarthritis
Collaborative Care
Drug Therapy
-acetaminophen (4g daily max or liver issue)
-NSAIDs (GI and renal issues may occur)
-Intraarticular corticosteroid
-IA hyaluronic acid (synovial fluid viscosity)
Surgery
-debridement
-arthroplasty
-osteotomy
-total joint replacement
Rheumatoid Arthritis
Chronic, systemic disease characterized by recurrent inflammation of the joints & related to structures
It is an inflammatory process which differentiates it from OA which is a degenerative no inflammatory process
Peak incidence is 30-50 years of age
Wome
Rheumatoid Arthritis
Etiology
Autoimmunity:
-autoantibodies against IgG
-this is currently the most widely accepted theory
Genetic factors:
-RA tents to occur in families
Rheumatoid Arthritis
Four Stages of Progression
1 - joint inflammation, synovial membrane swelling & increased synovial fluid
2 - granulation tissue invades joint capsule
3 - granulation tissue coverts to fibrous tissue
4 - fibrous tissue calcified resulting in joint immobilization
Increases stiffness
Rheumatoid Arthritis
Clinical Manifestation
Early:
-fatigue, anorexia, weight loss, generalized stiffness
-usually effects joints bilaterally, especially hands
-joint stiffness upon rising in morning or after inactivity
Moderate:
-joints become tender, painful, red, swollen, and warm (CV effect fro
Rheumatoid Arthritis
Diagnostic Studies
-Anemia is common
-Sed Rate elevated (in 85% of cases)
-Serum rheumatoid factor positive in 80% of pts with RA
-Synovial fluid analysis (shows inflammatory changes)
-X-rays (may only show bone demineralization in early stages and later show joint narrowin
Rheumatoid Arthritis
Management
Similar to OA except drug therapy
-rest & energy conservation
-heat & cold therapy
-joint protection (splint)
-balanced nutrition
-total joint replacement
Rheumatoid Arthritis
Drug Therapy
DMARDs (disease modifying antirheumatic drugs): take time to work and have risk for infection because they suppress immune system. Potential to lessen permanent effects
-Methotrexate (Rheumatrex): usually first choice
-Hydroxychloroquine (Plaquenil): may
Nursing Diagnosis for Arthritis
-ineffective role performance
-pain
-self care deficit
-risk for infection
Gout
-Recurrent attacks of acute arthritis associated with increased levels of serum uric acid
-Uric acid is end product of purine (found in organ meats and beer) catabolism and is excreted by kidneys
-Occurs predominantly in middle aged men
Form of arthritis
Gout Management
Prevention of future attacks
-allopurinol (reduces uric acid levels)
-weight reduction, as needed
-avoid alcohol and foods high in purines (red and organ meats)
Prevent kidney stones
-adequate urine output
Acute attacks
-Colchicine (antiinflammatory and n