Chapter 64: Med Surg Flashcards
osteomyelitis
severe infection of bone, usually through the metaphysis and once ischemia occurs, the bone dies
indirect entry
frequently affects boys younger than 12 years old and is associated with blunt trauma, if it affects adults most likely has diabetes, GI or respiratory infection
direct entry
occurs at any age through an open wound
sequestra
devitalized bone separates from living bone
involucrum
part of the periosteum that continues to have blood supply and forms a new bone
acute osteomyelitis
initial infection or an infection lasting less than 1 month, s/s fever, night sweats, restless, nausea, constant bone pain, swelling, tenderness, warmth at infection site
chronic osteomyelitis
bone infection that persists longer than 1 month or an infection that has not responded to therapy, systemic signs not as much, but local signs including constant bone pain, swelling, tenderness, and warmth at infection site more prominent
diagnostic studies for osteomyelitis
elevated WBC & ESR, bone or soft tissue biopsy needed to determine causative organism
tx osteomyelitis
IV therapy for acute osteomyelitis (Penicillin or Keflex), chronic osteomyelitis responds more to oral therapy with fluoroquinolone (Cipro), response to therapy is watched through bone scans & ESR test
what to avoid and watch for with tx osteomyelitis
avoid exercise and warmth because these can accelerate infection, report any signs of toxicity from antibiotic tx and report any whitsh, yellow, curdlike lesions, since the spread of candidiasis is increased with prolonged antibiotic use
osteochondroma
benign overgrowth of cartilage and bone near the end of the bone at growth plate, painless, hard, immobile mass, lower than normal height for age
diagnosis for osteochondroma
x ray, CT, MRI
osteoclastoma
benign, common at the ends of arm and leg bones, reappears frequently after surgery and chemotherapy, “giant cell tumor”
endochroma
benign, cartilage tumor found in single hand or foot, common in 10-20 year olds
osteosarcoma
primary bone tumor that is extremely aggressive and metastasizes, usually occurs in metaphysis region of long bones, most commonly associated with paget’s disease and prior radiation s/s gradual pain and swelling usually around knee
diagnosis for osteosarcoma
tissue biopsy, elevated serum alkaline phosphatase and calcium, x ray, CT, PET, MRI
chondrosarcoma
occurs in cartilage of bone in arm, leg, pelvis or older generation, surgery usually indicated because does not respond well to chemotherapy
ewing’s sarcoma
occurs in long bones, children & teens, white people
chordoma
tumor in base of skull in older people, tx difficult because involves the spinal cord and nerves
overall goals with bone cancers
satisfactory pain relief, maintain preferred activities, demonstrate acceptance of body image, be free of injury, verbalize understanding and realistic idea of disease progression and prognosis
acute low back pain
lasts 4 weeks or less, often symptoms do not appear at time of injury but later on because of increased pressure on nerve, straight leg test positive if radicular pain persists
planning for low back pain
avoid prolonged bed rest, satisfactory pain relief, avoid constipation, learn back sparing activities, return to previous level
things that make back problems worse
leaning forward without bending knees, lifting anything above the elbows, sleeping on abdomen or back or side with legs straight out, smoking (decreases circulation to vertebral disks)
chronic back pain
lasts more than 3 months or is a repeated episode, spinal stenosis (narrowing of vertebral canal r/t bone moving into that space), disk herniation
disk herniation
compression of nerve roots, associated with stenosis and pain begins in lower back and proceeds to butt and leg, worsens with walking and standing
degenerative disk disease (DDD)
degeneration of both the lumbar and cervical disk, normal process of aging, contributes to OA, low back pain
herniated intervertebral disk
“slipped disk”, natural degeneration or repeated stress/trauma, radicular pain that radiates down buttock and below knee
acute nursing management for spinal surgery
place pillows under thighs of each leg when supine and between legs in side lying position to ensure comfort and alignment, watch for CSF (clear or slightly yellow +glucose), movement of extremities should be unaffected postop
serious nursing management for spinal surgery
report any new muscle weakness or paresthesias to surgeon immediately, loss of sphincter or bladder tone may indicate nerve damage, donor site usually causes greater pain than fused area, don’t twist spine, weight should be on thighs and knees
conservative tx for neck pain
soft cervical collars, heat and ice, massage, rest, physical therapy, ultrasound, NSAIDs, acupuncture, most pain resolves without surgical intervention
hallux valgus
painful deformity of great toe leans toward second toe
tx hallux valgus
wear shoes with wide forefoot or bunion pocket, surgical removal of bursal sac
hammer toe
deformity of second through fifth toes, burning on bottom of foot, pain when wearing shoes
tx hammer toe
passive manual stretching of PIP joint and arch support, surgical repairmen involves bringing raw bones together, wire used to maintain straight position
plantar wart
painful growth caused by HPV, sole of foot, tend to cluster on pressure points
tx plantar wart
remedies containing salicyclic acid (compound W) and surgical removal
proper shoe
long enough and wide enough to prevent crowding and causing hallux valgus, permits bending of toes, rigid enough to provide support, optimally heel should not exceed higher than 1 in
Duchenne muscular dystrophy
X-linked, usually only seen in males, onset before age 5, progressive weakness of pelvic and shoulder muscles, unable to walk after 12, cardiac and respiratory failure in teens and twenties, mental impairment
duchenne muscular dystrophy diagnosis
muscle enzymes (creatine kinase), electromyogram testing, muscle biopsy, genetic pedigree
what does a muscle biopsy tend to show in muscular dystrophy?
fat and connective tissue deposits, degeneration and necrosis of muscle fibers, deficiency of muscle protein dystrophin
goal of tx for muscular dystrophy
corticosteroid therapy can halt progression for up to 2 years, preserve mobility and independence, keep pt as active as possible, prolonged bed rest should be avoided
osteomalacia
uncommon disease of adult bone associated with vitamin D deficiency, resulting in decalcification and softening of bone
causes of osteomalacia
lack of exposure to UV rays, GI malabsorption, extensive burns, chronic diarrhea, pregnancy, kidney disease, and Dilantin
s/s of osteomalacia
localized bone pain, difficulty rising from a chair, difficulty walking, low back pain, progressive muscular weakness in pelvic girdle, weight loss, kyphosis
common diagnostics of osteomalacia
decreased calcium and phosphorous levels, decreased vitamin D, elevated serum alkaline phosphatase
looser’s transformation zones
ribbons of decalcification in bone found on x ray indicative of osteomalacia
tx of osteomalacia
Vit D supplement, eggs, meat, oily fish, milk, breakfast cereals, UV exposure, weight bearing exercises
osteoporosis
porous bone (fragile bones), chronic, low bone mass and deterioration of bone tissue, often called the “silent thief”
why is osteoporosis more common in women?
lower calcium intake than men, less bone mass because smaller frame, bone resorption begins at an earlier age and accelerates in menopause, pregnancy and breastfeeding deplete skeletal reserve, women live longer
drugs that interfere with bone metabolism
long term corticosteroids (loss of bone and inhibition of new bone formation), antiseizure drugs, Dilantin, aluminum containing antacids, heparin, cancer tx, excessive thyroid hormones
s/s of osteoporosis
silent disease, back pain, loss of height, spinal deformities such as kyphosis
diagnostics of osteoporosis
cannot be detected by x ray until 25%-40% bone has been lost, BMD such as QUS & DEXA
DEXA scores
<-2.5 indicates osteoporosis and -1 to -2.5 indicates osteopenia
when is tx for osteoporosis indicated?
a score <-2.5, a score -1 to -2.5 with additional risk factors, or prior history of hip or vertebral fracture
tx of osteoporosis
calcium intake of 1000 mg/day in premenopause and postmenopause women taking estrogen, 1500 mg/day in postmenopausal women not taking estrogen, turnip greens, cottage cheese, sardines, spinach, sun exposure for 20 min daily, walking
vertebroplasty
bone cement is injected into the collapsed vertebra to stabilize it and does not correct the deformity
kyphoplasty
an air bladder is inserted into the collapsed vertebra and inlafted to regain vertebral body height and then bone cement is injected
estrogen therapy
inhibits osteoclast activity
bisphosphates
Fosamax, Actonel, Boniva increase bone mass and inhibit osteoclast bone resorption- take with full class of water, take 30 minutes before food and other medications, remain upright for at least 30 minutes after taking
Alendronate
if osteopenia is evident on bone densitometry, consider this bisphosphonate
paget’s disease
chronic skeletal bone disorder with excessive bone resorption followed by the replacement of normal marrow with fibrous connective tissue, new bone is larger, disorganized, and weaker
s/s of paget’s disease
bone pain, complaints of fatigue, progressive development of waddling gait, complaints of pt becoming shorter or head getting larger, headaches, dementia, visual defects
diagnostics of paget’s disease
x ray, elevated alkaline phosphatase
Calcitonin
helps with bone resorption, relief of acute symptoms, lowers alkaline phosphtase levels, indicated in pt who cannot take bisphosphonate - be sure to take with calcium b/c it lowers the serum calcium
