Chapter 64: Med Surg

Question 1

osteomyelitis

Answer 1

severe infection of bone, usually through the metaphysis and once ischemia occurs, the bone dies

Question 2

indirect entry

Answer 2

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

Question 3

direct entry

Answer 3

occurs at any age through an open wound

Question 4

sequestra

Answer 4

devitalized bone separates from living bone

Question 5

involucrum

Answer 5

part of the periosteum that continues to have blood supply and forms a new bone

Question 6

acute osteomyelitis

Answer 6

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

Question 7

chronic osteomyelitis

Answer 7

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

Question 8

diagnostic studies for osteomyelitis

Answer 8

elevated WBC & ESR, bone or soft tissue biopsy needed to determine causative organism

Question 9

tx osteomyelitis

Answer 9

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

Question 10

what to avoid and watch for with tx osteomyelitis

Answer 10

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

Question 11

osteochondroma

Answer 11

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

Question 12

diagnosis for osteochondroma

Answer 12

x ray, CT, MRI

Question 13

osteoclastoma

Answer 13

benign, common at the ends of arm and leg bones, reappears frequently after surgery and chemotherapy, “giant cell tumor”

Question 14

endochroma

Answer 14

benign, cartilage tumor found in single hand or foot, common in 10-20 year olds

Question 15

osteosarcoma

Answer 15

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

Question 16

diagnosis for osteosarcoma

Answer 16

tissue biopsy, elevated serum alkaline phosphatase and calcium, x ray, CT, PET, MRI

Question 17

chondrosarcoma

Answer 17

occurs in cartilage of bone in arm, leg, pelvis or older generation, surgery usually indicated because does not respond well to chemotherapy

Question 18

ewing’s sarcoma

Answer 18

occurs in long bones, children & teens, white people

Question 19

chordoma

Answer 19

tumor in base of skull in older people, tx difficult because involves the spinal cord and nerves

Question 20

overall goals with bone cancers

Answer 20

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

Question 21

acute low back pain

Answer 21

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

Question 22

planning for low back pain

Answer 22

avoid prolonged bed rest, satisfactory pain relief, avoid constipation, learn back sparing activities, return to previous level

Question 23

things that make back problems worse

Answer 23

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)

Question 24

chronic back pain

Answer 24

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

Question 25

disk herniation

Answer 25

compression of nerve roots, associated with stenosis and pain begins in lower back and proceeds to butt and leg, worsens with walking and standing

Question 26

degenerative disk disease (DDD)

Answer 26

degeneration of both the lumbar and cervical disk, normal process of aging, contributes to OA, low back pain

Question 27

herniated intervertebral disk

Answer 27

“slipped disk”, natural degeneration or repeated stress/trauma, radicular pain that radiates down buttock and below knee

Question 28

acute nursing management for spinal surgery

Answer 28

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

Question 29

serious nursing management for spinal surgery

Answer 29

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

Question 30

conservative tx for neck pain

Answer 30

soft cervical collars, heat and ice, massage, rest, physical therapy, ultrasound, NSAIDs, acupuncture, most pain resolves without surgical intervention

Question 31

hallux valgus

Answer 31

painful deformity of great toe leans toward second toe

Question 32

tx hallux valgus

Answer 32

wear shoes with wide forefoot or bunion pocket, surgical removal of bursal sac

Question 33

hammer toe

Answer 33

deformity of second through fifth toes, burning on bottom of foot, pain when wearing shoes

Question 34

tx hammer toe

Answer 34

passive manual stretching of PIP joint and arch support, surgical repairmen involves bringing raw bones together, wire used to maintain straight position

Question 35

plantar wart

Answer 35

painful growth caused by HPV, sole of foot, tend to cluster on pressure points

Question 36

tx plantar wart

Answer 36

remedies containing salicyclic acid (compound W) and surgical removal

Question 37

proper shoe

Answer 37

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

Question 38

Duchenne muscular dystrophy

Answer 38

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

Question 39

duchenne muscular dystrophy diagnosis

Answer 39

muscle enzymes (creatine kinase), electromyogram testing, muscle biopsy, genetic pedigree

Question 40

what does a muscle biopsy tend to show in muscular dystrophy?

Answer 40

fat and connective tissue deposits, degeneration and necrosis of muscle fibers, deficiency of muscle protein dystrophin

Question 41

goal of tx for muscular dystrophy

Answer 41

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

Question 42

osteomalacia

Answer 42

uncommon disease of adult bone associated with vitamin D deficiency, resulting in decalcification and softening of bone

Question 43

causes of osteomalacia

Answer 43

lack of exposure to UV rays, GI malabsorption, extensive burns, chronic diarrhea, pregnancy, kidney disease, and Dilantin

Question 44

s/s of osteomalacia

Answer 44

localized bone pain, difficulty rising from a chair, difficulty walking, low back pain, progressive muscular weakness in pelvic girdle, weight loss, kyphosis

Question 45

common diagnostics of osteomalacia

Answer 45

decreased calcium and phosphorous levels, decreased vitamin D, elevated serum alkaline phosphatase

Question 46

looser’s transformation zones

Answer 46

ribbons of decalcification in bone found on x ray indicative of osteomalacia

Question 47

tx of osteomalacia

Answer 47

Vit D supplement, eggs, meat, oily fish, milk, breakfast cereals, UV exposure, weight bearing exercises

Question 48

osteoporosis

Answer 48

porous bone (fragile bones), chronic, low bone mass and deterioration of bone tissue, often called the “silent thief”

Question 49

why is osteoporosis more common in women?

Answer 49

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

Question 50

drugs that interfere with bone metabolism

Answer 50

long term corticosteroids (loss of bone and inhibition of new bone formation), antiseizure drugs, Dilantin, aluminum containing antacids, heparin, cancer tx, excessive thyroid hormones

Question 51

s/s of osteoporosis

Answer 51

silent disease, back pain, loss of height, spinal deformities such as kyphosis

Question 52

diagnostics of osteoporosis

Answer 52

cannot be detected by x ray until 25%-40% bone has been lost, BMD such as QUS & DEXA

Question 53

DEXA scores

Answer 53

<-2.5 indicates osteoporosis and -1 to -2.5 indicates osteopenia

Question 54

when is tx for osteoporosis indicated?

Answer 54

a score <-2.5, a score -1 to -2.5 with additional risk factors, or prior history of hip or vertebral fracture

Question 55

tx of osteoporosis

Answer 55

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

Question 56

vertebroplasty

Answer 56

bone cement is injected into the collapsed vertebra to stabilize it and does not correct the deformity

Question 57

kyphoplasty

Answer 57

an air bladder is inserted into the collapsed vertebra and inlafted to regain vertebral body height and then bone cement is injected

Question 58

estrogen therapy

Answer 58

inhibits osteoclast activity

Question 59

bisphosphates

Answer 59

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

Question 60

Alendronate

Answer 60

if osteopenia is evident on bone densitometry, consider this bisphosphonate

Question 61

paget’s disease

Answer 61

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

Question 62

s/s of paget’s disease

Answer 62

bone pain, complaints of fatigue, progressive development of waddling gait, complaints of pt becoming shorter or head getting larger, headaches, dementia, visual defects

Question 63

diagnostics of paget’s disease

Answer 63

x ray, elevated alkaline phosphatase

Question 64

Calcitonin

Answer 64

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