lewis ch 63 - musculoskeletal problems Flashcards
severe infection of bone, bone marrow, and surrounding soft tissue
osteomyelitis
most common organism causing osteomyelitis
s aureus
risk factors osteomyelitis (5)
- old age
- debilitation
- hemodialysis
- sickle cell disease
- IV drug use
most common infection site of osteomyelitis in adults
vertebrae
name for dead bone
sequestrum
S+S osteomyelitis (5)
- constant pain
- swelling
- tenderness
- warmth
- restricted movement
systemic manifestations acute osteomyelitis (7)
- fever
- night sweats
- chills
- restlessness
- nausea
- malaise
- drainage (late)
chronic osteomyelitis S+S (4)
- infection lasting longer than 1 month or not responding to antibiotics
- continuous exacerbations and remission
- pain and swelling
- more scar tissue
complications osteomyelitis (4)
- septicemia
- septic arthritis
- pathologic fractures
- amyloidosis
important nursing considerations when giving gentamicin antibiotic to osteomyelitis pt (4)
- assess for dehydration before
- ensure renal function testing has been done
- monitor peak and trough levels
- teach pt to report vision, hearing, or urinary problems
treatment options besides antibiotics for osteomyelitis (4)
- hyperbaric O2
- negative pressure wound therapy
- prosthetic device removed
- possible amputation
what kind of benign bone tumor is most common
osteochrondroma
malignant tumor in bone, muscle, fat, nerve,
or cartilage
sarcoma
- Aggressive primary bone cancer
- Rapidly spreads
- Mostly in kids and young adults
- Gradual onset of pain and swelling in affected bone
- Chemo is done to decrease size, followed by surgery and more chemo
osteosarcoma
most common type of muscular dystrophy
duchenne muscular dystrophy
most definitive diagnosis for osteomyelitis
bone/soft tissue biopsy
complications muscular dystrophy (2)
- cardiomyopathy
- decreased respiratory function
risk factors low back pain (5)
- excess body weight
- stress
- smoking
- pregnancy
- trauma
how long does acute low back pain last
4 weeks or less
how long does chronic low back pain last
3 months or more
metabolic bone disease:
-bone loses calcium and becomes soft
osteomalacia
treatment osteomyelitis
long term IV antibiotics
risk factors osteomalacia (6)
- limited sun exposure
- GI malabsorption
- diarrhea
- pregnancy
- chronic liver, kidney, small intestine disease
- long term antiseizure drugs and phosphate-binding antacids
when do you take a blood culture when giving antibiotics
before
S+S osteomalacia (4)
- bone pain: worse at night
- muscle weakness
- waddling gait
- fractures
metabolic bone disease:
-chronic, marked by low bone mass and deterioration of bone tissue that leads to fragility
osteoporosis
who is more common to develop osteoporosis
-women (white and asian)
risk factors osteoporosis in women (3)
- lower calcium intake
- bone reabsorption begins earlier and becomes rapid in menopause
- pregnancy and breastfeeding
high risk factors osteoporosis (4)
- low body weight
- smoker
- prior fractures
- long term use corticosteroids
what meds should osteoporosis pts take (3)
fluoride
calcium
vit d
what age is peak bone mass achieved
20 yo
S+S osteoporosis (4)
- pain common in spine, hips, wrists
- spontaneous fractures
- gradual loss of height
- kyphosis
what t score in bone mineral density test indicates normal bone density
between +1 and -1
what t score in bone mineral density test indicates osteopenia
between -1 and -2.5
what t score in bone mineral density test indicates osteoporosis
-2.5 and lower
drug therapy for osteoporosis
- bisphosphonates
- SERMs (selective estrogen receptive modifiers)
- calcitonin
- teriparatide
4 examples bisphosphonates
- alendronate
- ibandronate
- risedronate
- zoledronic acid
adverse effects bisphosphonates (4)
- headache
- GI upset
- joint pain
- esophageal burns
what should you teach the pt taking bisphosphonates (3)
- take with full glass water
- take 30 mins before food
- remain upright for 30 mins after taking
contraindications for bisphosphonates (3)
- hypocalcemia
- esophageal dysfunction
- inability to sit/stand upright for 30 mins
2 examples SERMs
raloxifene
tamoxifen
adverse effects SERMs (3)
- hot flashes
- leg cramps
- increased risk VTE
contraindications SERMs (3)
- pregnancy
- venous thromboembolic disorder
- retinal vein thromboiss
effect of calcitonin
inhibits osteoclastic bone resorption
only drug that stimulates bone formation
teriparatide
(3) nursing recommendations for osteoporosis
- weight bearing exercises
- quit smoking
- reduce alcohol intake
what meds increase risk of osteoporosis
corticosteroids
