Care of Patients with Musculoskeletal Problems II Flashcards
Loss of bone related to a vitamin D deficiency
Interventions:
Child form: rickets
Osteomalacia
Bones soften secondary to inadequate amounts of calcium and phosphorus in the bone matrix - not calcify properly without D
Loss of bone related to a vitamin D deficiency - Osteomalacia
Increase vitamin D intake through diet
Daily sun exposure
Vitamin D supplements
Interventions: - Osteomalacia
Milk, eggs, swordfish, chicken, liver, enriched cereals and bread products
Read labels that things high in D
Increase vitamin D intake through diet
5 minutes each day
UV radiation to activate D
Daily sun exposure
Ergocalciferol
Vitamin D supplements
Also called osteitis deformans
Second most common bone disease after osteoporosis
Pathophysiology
May occur in one bone or multiple sites - bone and joint pain; reforming not in proper way
Two types
Clinical manifestations
Increased risk for bone cancer
Diagnostic assessment
Interventions
Aspirin or NSAIDS for mild to moderate pain
Heat and gentle massage - help with pain
Exercise - good idea; weight bearing helps rebuild bone
Diet rich in calcium and Vitamin D - risk for hypocalcemia with bisphosphonates
Paget’s disease
Chronic metabolic disorder
Bone is excessively broken down and then reformed - increased osteoblasts and clasts
Bone is structurally disorganized
Bones are weak and at increased risk for fractures - not as strong
Risk for bowing
Pathophysiology - Paget’s disease
Familial and sporadic
Two types - Paget’s disease
Asymptomatic OR
Bone and joint pain
Pathological fractures
Bowing of long bones
Enlarged, thick skull
Clinical manifestations - Paget’s disease
Increase in serum alkaline phosphatase (ALP)
Increase in urinary hydroxyproline levels
Elevated uric acid
X-rays - enlarged bones; indicate make have paget’s
Bone scan - definitive; inject radioactive dye
Diagnostic assessment - Paget’s disease
Caused by overactive osteoblasts
Increase in serum alkaline phosphatase (ALP)
Indicates the degree of disease severity
Reflects bone collagen turnover/breaking down
Increase in urinary hydroxyproline levels
Oral bisphosphonates when ALP levels are at least twice the normal level - prevent breakdown bones
Monoclonal antibody
Calcitonin
Interventions - Paget’s disease
Ex. aldreonate (Fosamax); risedronate (Actonel)
Oral bisphosphonates when ALP levels are at least twice the normal level - prevent breakdown bones
Ex. denosumab (Prolia)
Binds to a protein that is essential for the formation, function, and survival of osteoclasts
Inhibits osteoclasts life
Monoclonal antibody
Hormone that reduces bone resorption and relieves pain
Given SQ
Used in patients that do not tolerate bisphosphonates
Prevent breaking down bone and resorption
Calcitonin
Infection in a/of bone
Etiology
May be acute or chronic
Can be severe and difficult to treat
Clinical manifestations of acute infection
Osteomyelitis
Bacteria, virus or fungi
Diff treat
Infection in a/of bone - Osteomyelitis
Infectious organisms enter from outside of the body to bone
Organisms are carried by the bloodstream from other areas of infection in the body
Once enters bone tissue inflamed, vessels leak causing edema compromising blood flow to bone causing necrosis, tissues around bone inflamed
Etiology - Osteomyelitis
Fever - VERY HIGH
Swelling - infected around
Erythema - infected around
Tenderness
Bone pain that is constant, localized, and pulsating and intensifies with movement - adequately address
Clinical manifestations of acute infection - Osteomyelitis
Physical assessment
Lab
Diagnostic
Osteomyelitis: assessment
Assess for clinical manifestations
Physical assessment
Elevated WBC - infection
Elevated erythrocyte sedimentation rate (ESR)
Positive blood cultures
Lab
Radionuclide scanning
MRI
*While bone changes can not be detected early with x-ray, changes in blood flow to the bone can be seen by radionuclide scan and MRI
Diagnostic
normal early in the course of the disease - inflammation; stay elevated for long-period time
Elevated erythrocyte sedimentation rate (ESR)
Occurs when bacteremia is present - infection in bloodstream can get into bone
Positive blood cultures
IV antibiotic therapy long-term
Contact precautions
Wound care - take care external wounds
Drug therapy for pain control
Osteomyelitis: interventions: Acute
May possibly need multiple antibiotics
IV antibiotic therapy long-term
If the presence of copious wound drainage
MRSA/S aureus
Antibiotic resistant organisms sometimes
Contact precautions
IV antibiotic therapy
Hyperbaric oxygen chamber (HBO) therapy
Surgery
Osteomyelitis: interventions: Chronic
Optimal time not well established
IV antibiotic therapy
Used to increase tissue perfusion by exposure to high levels of oxygen
High doses O2; increase O2 treatment
Hyperbaric oxygen chamber (HBO) therapy
Debride or get rid necrotic so treatments can be effective
Check for neurovascular compromises
Surgery
Most often occurs in people between 10 and 30 - peds most often
Small percentage of cancers
Osteosarcoma most common type
Ewing’s sarcoma
Chondrosarcoma - cartilage tissue
Fibrosarcomas - fibrous tissue
Metastasis to lungs often
Bone cancer: Primary
More than 50% occur in the distal femur - LE long-bones
Seen in Paget’s disease pats
Osteosarcoma most common type
Most malignant but not as often
Ewing’s sarcoma
Originate in other tissues and metastasize to the bone
Pathological fractures often
Secondary: Bone cancer
Unknown
exposed to prior radiation, Paget’s disease
Genetic and environmental factors are likely causes
Etiology: Bone cancer
Determine the patient’s general health
Ask the patient if they have had previous radiation therapy
Clinical manifestations depend on the type of lesion
Diagnostic
Bone cancer: assessment
Pain
Local swelling
Tender, palpable mass is possible
Clinical manifestations depend on the type of lesion - Bone cancer: assessment
X-rays - pathological fractures, tumor, mass
CT - pathological fractures, tumor, mass
MRI - pathological fractures, tumor, mass
Needle bone biopsy - definitive
Diagnostic - Bone cancer: assessment
For primary tumors, treatment is aimed at reducing the size of or removing the tumor
Palliative therapies are to treat metastatic bone tumors
Nonsurgical
Surgical - depends on location tumor, type it is, what caused it
Bone cancer: interventions
Drug therapy (includes chemotherapy)
Radiation therapy - good for bone therapy for palliative to reduce tumor and help with pain
Interventional Radiology
Nonsurgical - Bone cancer: interventions
