Break in the continuity of a bone Can happen to any bone in the body

Mobility part 2 Flashcards by brooke posey

The most prevalent bone disease in the world?

osteoporosis

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means porous bone, is a disease in which the density and quality of bone are reduced.

osteoporosis

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a disease of the bones that happens when you lose too much bone, make too little bone or both.

osteoporosis

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low bone density, middle ground, not enough bone density lost to be diagnosed as osteoporosis

osteopenia

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break down bone

ostoeclasts

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rebuild bone

osteoblasts

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What medication risk factors are there for osteoporosis?

steroids
anti-seizure
antacids
chemotherapy drugs

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What disease risk factors are there for osteoporosis?

–Anorexia
–Malabsorption syndrome
–Chronic Kidney failure

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– Measures bone mineral density (BMD)
– Recommended for ALL women >65yrs
– Post-Menopausal women >50yrs w/risk factors

Dual-energy x-ray absorptiometry (DEXA)

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10 year probability of getting a fracture based on assessment

Fracture Risk Assessment Tool (FRAX)

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What are osteoporosis medication treatment?

Calcium and Vitamin D supplements
Raloxifene Hydrochloride (Evista)
Calcitonin
Bisphosphonates
Teriparatide (Forteo)
Denosumab (Prolia)

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– Inhibits bone breakdown (osteoclast activity)
– Available as a daily, weekly, monthly or yearly
dose
– Potential side effects: GI symptoms –dyspepsia,
nausea, flatulence, diarrhea and constipation
• Take on an empty stomach
• Take with a full glass of water
• Stay upright for 30-60 minutes after ingestion
– Do NOT take at the same time as Calcium

Bisphosphonates

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–Selective Estrogen Receptor Modulator
(SERM) – mimics natural estrogen without
increasing cancer effects from estrogen
–Inhibits bone breakdown (osteoclast
activity)
–Side Effects: Increase risk of blood clots, hot
flashes

• Raloxifene Hydrochloride (Evista)

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–Inhibits bone breakdown (osteoclast activity) and
stimulates bone formation (osteoblasts)
–Available as an injection or nasal spray
–No major side effects
*good option

Calcitonin

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– Synthetic Parathyroid Hormone – stimulates
formation of bone (osteoblast activity)
– For use with:
• Men and postmenopausal women with
osteoporosis at high risk for fractures
• Men and women with chronic steroid use
• Those unable to take other osteoporosis
medications
– Can’t take for more than 2 years in a lifetime
– Side effect: orthostatic hypotension, joint and
muscle pain and weakness, nausea
– Daily Subcutaneous Injection

Teriparatide (Forteo)

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– Inhibits bone breakdown (osteoclasts)
– For osteoporosis with a high risk of fractures
OR can’t use other osteoporosis medications
OR other medications were not effective
– Contraindicated with low blood calcium
levels
– Side effects: jaw bone necrosis, thigh
fractures, serious infections

Denosumab (Prolia)

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Which types of treatment medications are there available for osteoporosis?

Denosumab (Prolia)

* Teriparatide (Forteo)

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What are fractures?

Break in the continuity of a bone

* Can happen to any bone in the body

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– Break is across entire width of the bone

complete fracture

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– Break is through only part of the bone, and the other side is bent

incomplete fracture (greenstick)

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– Produces bone fragments

Comminuted Fracture

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– No break in the skin

Closed Fracture aka Simple Fracture

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– Bone breaks through the skin or mucus

membranes

Open Fracture aka Compound Fracture

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How are gustilo open (compound) fractures classified?

Grade I
Grade II
Grade III

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– Least severe – Wound < 1 cm – Wound is clean

Grade I

– Wound >1 cm and < 10 cm | – Without extensive soft tissue damage

Grade II

``` – Most severe injury and mostly > 10cm – Extensive soft tissue damage – Highly Contaminated Wound – May also have nerve or vascular damage or associated with a traumatic amputation ```

Grade III

a fracture that remains contained, with no disruption of the skin integrity

simple fracture

a fracture in which damage also involves the skin or mucous membranes, also called a compound fracture

open fracture

a fracture occurring at an angle across the bone (less stable than a transverse fracture)

oblique fracture

a fracture that is straight across the bone shaft

transverse fracture

a fracture that twists around the shaft of the bone

spiral fracture

a fracture in which a bone fragment is driven into another bone fragment

impacted fracture

a fracture in which bone has been compressed (seen in vertebral fractures ONLY)

compression fracture

a fracture in which fragments are driven inward (seen frequently in fractures of skull and facial bone)

depressed fracture

a fracture in which a fragment of bone has been pulled away by a tendon and its attachment

avulsion

What are risk factors for fractures?

* elderly * vitamin deficiency * sedentary lifestyle * sensory perception problems * cancer of the bone

What are some clinical manifestations?

* Deformity (Shortening) * Pain * Loss of function * Crepitus * Edema and Ecchymosis

What should be done for emergency management for a fracture?

``` • DON’T MOVE • Stop any bleeding • Immobilize (Splint) DO NOT realign the bones !!! • Apply ice • Cover for Open Wound ```

What should be done for medical management for a fracture?

• Immobilization – A means of preventing movement to keep bone alignment – Internal Fixation vs. External Fixation • Fracture Reduction – Restoring the bones to their original positions – Closed Reduction vs. Open Reduction • Treatment of Symptoms

What should be done first in immobilization?

Reduction if needed

What are methods of reduction?

* internal fixation | * external fixation

includes pins, screws, wires, plates, nails, rods

internal fixation

includes bandages, splints, casts, traction, external fixators

external fixation

``` –Immobilizes the body part while allowing for movement of the rest of the body –Materials: • Plaster • Fiberglass ```

External Fixation: CAST

Used for temporary immobilization

External Fixation: SPLINTS and BRACES

Maintains alignment and can reduce muscle spasms | and pain

External Fixation: TRACTION | – 2 Types: Skin Traction vs. Skeletal Traction

What other concerns do you have with a patient in traction?

* pneumonia * incontinence * skin breakdown * blood clots

– Bones are realigned and then mobilized for | healing using an external fixation device

closed reduction

– Surgical Procedure – Bones are realigned and held in place using nails, screws, wires, plates and rods

open reduction

What are the 5 P's of the neurovascular assessment?

``` – Pain – Pulse – Pallor – Paresthesia – Paralysis ```

What factors affect the healing of fractures?

``` • Immobilization and reduction (realignment) of bone and bone fragments • Blood supply • Nutrition • Exercise • Hormones (Parathyroid, Growth Hormone, Thyroid, Calcitonin, Steroids) • Medications • Diseases ```

What are the EARLY complications of fractures?

``` Early • Compartment Syndrome • Hypovolemic Shock • Fat Embolism Syndrome* • Blood Clot (DVT or Emboli)* ```

occurs when excessive pressure builds up inside an enclosed space in the body. This syndrome usually results from bleeding or swelling after an injury. The dangerously high pressure in compartment syndrome impedes the flow of blood to and from the affected tissues. It can be an emergency, requiring surgery to prevent permanent injury

compartment syndrome

``` occurs during massive blood loss from hemorrhage Treatment • Stop the bleeding • Restore blood volume • Oxygen therapy ```

hypovolemic shock

DEFINITION: Fat emboli become lodged in the blood vessels causing clinical symptoms similar to a blood clot (embolus) • ONSET OF SYMPTOMS: 12 to 72 hours after injury – may occur up to a week after injury

fat embolism syndrome (FES)

• CLASSIC TRIAD of SYMPTOMS: – Hypoxemia (Respiratory Distress) – Neurological Compromise – Petechial Rash (later – 48-72 hours)

fat embolism syndrome (FES)

can become lodged in a | vessel obstructing blood flow

blood clot

blood clot develops in the lower extremities.

Distal Venous Thrombosis (DVT)

can become lodged in any part of the body – Heart Vessels – chest pain, heart attack – Brain – neurological symptoms, stroke – Lungs – hypoxia, dyspnea Coughing up blood

emboli

How to prevent blot clot (DVT or emboli)

Prevention – Blood Thinners – Movement

How to treat blood clots (DVT or emboli)?

Treatment – Respiratory Support – oxygen including mechanical ventilation if needed – Heparin therapy – blood thinners to prevent further blood clotting – Fluid Replacement – to prevent dehydration – Thrombolytic – in some cases to break up the clots – Surgical Interventions – insertion of a filter in the vena cava

What are the late complications for fractures?

Late • Delayed Union & Non-Union • AvascularNecrosis • Infection; Osteomyelitis

When bone does not heal at a normal rate Treatments • Eventually fracture heals

delayed union

``` Failure of the ends of the bone to unite or to heal in a misaligned position Treatments • Internal Fixation • Bone grafting • Electrical stimulation • Combination of therapies ```

non-union/malunion

``` Bone loses it blood supply and dies • Symptoms: pain and limited movement • Risk Factors: steroid use, excessive alcohol intake, trauma, medical conditions • Diagnosis: – X-Rays – MRI or CT Scan – Bone Scans ```

Avascular Necrosis

``` • DEFINITION: Infection in the Bone • SYMPTOMS: – Bone Pain – Fever – Edema, Erythema, Warmth and Tenderness at the site of infection – Chronic Osteomyelitis – non-healing ulcerated wound over the site of the infected bone – Purulent Drainage ```

Osteomyelitis

A chronic degeneration of the cartilage of the joints Also called: -wear and tear -degenerative

Osteoarthritis

What are risk factors for osteoarthritis?

* age * gender * genetic deformities * joint injury or overuse * obesity * diseases

What are some clinical manifestations you would find in your patient?

* pain * stiffness * functional impairment * crepitus(pieces of bone from joint possible fracture)/grating sensation

A chronic (long-term) disease. There is no cure, but treatments are available to manage symptoms.

Osteoarthritis

Long-term management of the disease will include several factors:

* managing symptoms pair, stiffness swelling * improving joint mobility and flexibility * lifestyle modifications

Surgical management for osteoarthritis includes

* osteotomy * arthroscopy * arthrodesis( joint fusion) * arthroplasty (joint replacement)

``` Begins with the decision to have surgery Includes where and how long? *informed decision making *written list of patients needs *written instructions *medication review *safety issues ```

Preoperative phase

What is the floor nurse requirements during the preparation phase?

* pre-op teaching * pre-op checklist * planning