Musculoskeletal management Flashcards
What is osteomyelitis?
Invasion of microorganism in bone tissue, bone marrow and surrounding soft tissue
Most common infecting agent is STAPH
What are the ways that you can get osteomyelitis?
Direct - infection enters from outside of body - Open wound
Indirect - infection carried by blood stream to THE BONE - most common males for example from external fixator from compound fracture
In osteomyelitis what is the possible problem caused by staphylococcus aureus?
Pressure ulcer, penetrating wound, open fracture, orthopedic surgery, vascular insufficiency disorder
In osteomyelitis what is the possible problem caused by staphylococcus epidermidis?
Indwelling prosthetic device
In osteomyelitis what is the possible problem caused by streptococcus viridans?
abscessed tooth, gingival disease
In osteomyelitis what is the possible problem caused by escherichia coli?
urinary tract infection
In osteomyelitis what is the possible problem caused by mycobacterium tuberculosis?
tuberculosis
In osteomyelitis what is the possible problem caused by neisseria gonorrhoeae?
gonorrhea
In osteomyelitis what is the possible problem caused by pseudomonas sp.?
puncture wounds, intravenous drugs
In osteomyelitis what is the possible problem caused by salmonella sp.?
sickle cell disease
In osteomyelitis what is the possible problem caused by fungi, mycobacteria?
immunocompromised host
What is acute osteomyelitis and what are the signs and symptoms?
Initial infection <1 month
Signs and Symptoms
Local and Systemic
Pain (unrelieved with rest, increases w/ activity)
Fever
Edema around area
Erythema and heat
Increased WBC countWhat is chronic osteomyelitis and what are the signs and symptoms?
Present longer than one month/fails to respond to initial course of antibiotics
Local signs of infection more common
Ulcerations
Constant pain
Drainage/warmth at site
What diagnostic studies are done to diagnose osteomyelitis?
bone biopsy blood cultures, wound cultures radionuclide bone scans MRI x-rays (may not reveal osteomyelitis 10days to weeks after clinical symptoms)
How do you non-surgically manage chronic osteomyelitis?
Vigorous/ prolonged
IV antibiotic 4-6 weeks
Followed by oral antibiotics 2-3 months
Penicillin, Nafcillin, Vancomycin, Gentamicin
Hyperbaric Oxygen Therapy
Wound VAC
Immobilization
Pain ManagementHow do you surgically manage osteomyelitis?
Debridement Bone grafts Muscle flaps Amputation Pain management
What nursing management is done for osteomyelitis?
Educate "at risk" populations Pain relief: splint, careful movement, meds Sterile dressing changes Bedrest/avoid contracture Affects of long term antibiotic therapy Physical and Psychological support
What health information so you need to collect regarding osteomyelitis?
Past health history bone trauma open fracture open or puncture wounds other infections medications surgery or other treatments
What subjective data must you collect when performing an assessment for osteomyelitis?
IV drug use, malaise, anorexia, weight loss, chills, weakness, paralysis, muscle spasms, local tenderness over affected area, increase in pain in affected area
What objective data must you collect when obtaining an assessment for osteomyelitis?
General: restlessness, high spiking temperature, night sweats
Integumentary: diaphoresis, erythema, warmth, edema at infected bone
Musculoskeletal: restricted movement, wound drainage, spontaneous fractures
What are some nursing diagnosis for osteomyelitis?
acute pain
ineffective self-health management
impaired physical mobility
What are the overall goals for someone with osteomyelitis?
have satisfactory pain and fever control
do not experience any complications associated with osteomyelitis
cooperate with treatment plan
maintain a positive outlook on outcome of disease
What health promotions would you want for someone with osteomyelitis?
control infections already in body susceptible adults immunocompromised wear orthopedic prosthetic devices have vascular insufficiencies instruct susceptible adults and their families on local and systemic manifestations
What are some acute interventions for osteomyelitis?
Some immobilization of affected limb will ↓ pain, Limb should be handled carefully to avoid excessive manipulation and ↑ pain, Assess and manage patient’s pain level, Apply dressings to absorb exudate from draining wounds, Patient is frequently on bed rest in early stages of acute infection, Good body alignment and frequent position changes prevent complications associated with immobility and promote comfort, Flexion contracture is a common sequela of osteomyelitis, Patient frequently positions affected extremity in a flexed position to promote comfort, Contracture may then progress to deformity.
Footdrop can develop quickly in lower extremity if foot is not supported in a neutral position by a splint, or if there is excessive pressure from a splint, Instruct patient to avoid activities that ↑ circulation and swelling and serve as stimuli to spread infection, Exercise, heat application, Teach patient potential adverse and toxic reactions with prolonged and high-dose antibiotic therapy, Lengthy antibiotic therapy can result in overgrowth of Candida albicans, Patient and family are often frightened and discouraged, Continued psychologic and emotional support is an integral part of nursing management.
IV antibiotics can be administered to patient in a skilled nursing facility or home setting. If at home, Patient and family must be instructed on proper care and management of venous access device. Must also be taught how to administer antibiotics. Importance of continuing antibiotics after symptoms have subsided should be stressed. Periodic nursing visits provide support and decrease anxiety. Frequent dressing changes for open wounds. May require supplies and instruction in technique.
What is muscular dystrophy?
genetically transmitted diseases progressive wasting of skeletal muscles no neurological involvements loss of strength increase in disability types of dystrophies differ in groups of muscles affected age of onset, rate of progression and mode of genetic inheritance
What forms of muscular dystrophy are only seen in males?
Duchenne
Becker
What diagnostic studies are performed to diagnose muscular dystrophy?
muscle serum enzymes (CK)
EMG
muscle fiber biopsy
What are the goals of treatment for those with muscular dystrophy?
muscle biopsy confirms diagnosis no definitive therapy available to stop progressive wasting preserve mobility PT, orthopedic appliances ROM exercises emotional care for patient and family assist them to be independent
How do you help with management of muscular dystrophy?
Corticosteroid therapy Preserve mobility and independence through exercise physical mobility physical therapy orthopedic appliances Teach family communication ROM nutrition signs and symptoms of disease progression When an acute infection occurs, you may need to help with ADLS need more protein in diet
What are bone tumors?
cancerous cells travel from primary tumor site: breast, prostate, lungs, kidneys, thyroid
lesions typically found: vertebrae, pelvis, femur, humerus, ribs
can occur at any time
any bone pain and history of cancer should be evaluated for bone mets
primary tumors are rare in adults
usually metastatic from another area
the name of the cancer is based on the area of the bone and surrounding area
primary bone cancer is called sarcoma
What are the types of bone cancer?
osteosarcoma, chrondrosarcoma, ewings, sarcoma and chordma
What is osteochondroma?
primary benign tumor. grows near cartilage and bone near the end of the bone or growth plate
clinical manifestation: painless, hard, immobile mass, lower than normal height for age, soreness of muscles near the mass
diagnostic: x-ray, CT, MRI, biopsy
What is osteosarcoma?
aggressive and rapidly metastasizes
usually long bones
affects children and young adults
clinical manifestations: gradual onset of pain and swelling
diagnostic: tissue biopsy, elevation of serum alkaline phosphatase and calcium levels
treatment: chemo, radiation and surgery
What is the nursing management for bone cancer?
nursing assessment nursing diagnosis planning nursing implementation health promotion acute intervention evaluation
Why is is back pain common in the lumbar region?
bears most of body weight
is most flexible region of the spinal column
contains nerve roots that are susceptible to injury
poor biomedical structure
What are risk factors for back pain?
lack of muscle tone excess body weight poor posture stress repetitive lifting degenerative disc disease
What causes lower back pain?
acute lumbosacral strain instability of lumbosacral bony mechanism osteoarthritis of lumbosacral vertebrae degenerative disk disease herniation of intervertebral disease
how long does acute low back pain last and how do you treat it?
last 4 weeks or less-caused by undue stress to back Treatment rest analgesics-NSAIDS, narcotics muscle relaxants: flexaril massage heat/cold
What is chronic low back pain and what causes it?
lasts more than 3 months repeated incapacitating episode causes degenerative disc disease lack of exercise obesity previous injury structural/postural abnormalities
Whar are goals for patient with lower back pain
pain relief
avoid constipation
learn back sparing practices
return to prior level of function
What is spinal stenosis?
narrowing of vertebra canal/nerve root canals
congenital
traumatic
degenerative
pain in back radiates to buttock and leg, increases with walking/standing A condition that primarily afflicts elderly patients,spinal stenosisis caused by degenerative changes that result in enlargement of the facet joints. The enlarged joints then place pressure on the nerves, and this pressure may be effectively relieved with the laminectomy.
What is degenerative disc disease?
intervertebral disc lose: elasticity, flexibility, and shock absorbing capabilities
compression of nerve root and cord may occur
normal part of aging process
thinning of disc
most people have some thinning by age 60
DDD contributes to osteoarthritis and formation of bone spurs
What is a herniated intervertebral disc?
slipped disc
result of natural degeneration with age or repeated stress or trauma to spine
the nucleus pulpous can bulge and the herniate, putting pressure on nearby nerves
What are the clinical manifestation of lumbar disc damage?
low back pain radicular pain positive straight leg test diagnostic testing x-rays myelogram CT or MRI
What is a myelogram?
specialized x-ray lumbar puncture below L3 and injection of contrast agent into subarachnoid space can show bony overgrowth spinal cord tumors spinal abscesses HNP or pinched nerve
How do you manage disc damage?
Conservative treatment first limitation of mobility heat or ice rest ultrasound or massage traction TENS NSAIDS/muscle relaxants/narcotics
When do you surgically manage disc disease?
when patients do not respond to conservative treatment
persistant pain
neurologic deficits
laminectomy is most common procedure
diskectomy or spinal fusion may also be performed
get them walking as soon as you can
make sure they are being turned in bed to keep them comfortable
How do manage care for someone after spinal surgery?
maintain alignment pain control hydration assess peripheral nerve function assess bowel and bladder function assess donor site if patient had spinal fusion
In the nursing care for a patient with spinal surgery whow do you manage their activity and pain
respiratory status proper alignment of back at all times know specific activity orders logroll activity is usually less TED's/ sequential stockings narcotics-assess respiratory status muscle relaxants constipation
What nursing care do you provide for a patient who had spinal surgery?
Assess area for redness/drainage infection
did patient have a bone graft - know where donor site is
watch the spinal canal entrance which could lead to spinal fluid leak
neurological signs such as weakness, paresthesias
bladder or bowel issues
What is osteoporosis?
metabolic disease low bone mass deterioration of bone tissue leads to bones being much more fragile referred to as the "silent thief"
What are risk factors for osteoporosis?
alcohol use corticosteroid use calcium low estrogen low smoking sedentary lifestyle
What is the etiology/genetic risk for osteoporosis?
age >65 post menopausal female body build-thin, lean, white, asian exercise-too much, not enough diet low in calcium/vitamin D deficiency ETOH/smoking
What does the assessment entail for osteoporosis?
inspect vertebral column dowager's hump-kyphosis back pain compression fractures normal x-rays: osteoporosis is no noted until more than 25-40% of calcium in bone is lost Bone mineral density (DEXA)
What nursing interventions do you apply to osteoporosis?
nutrition - calcium and vitamin D supplements
exercise - moderation
safety - prevention of falls
patient and family education
drug treatment
assess for DME needs
Medication
Hormone replacement-estrogen prevention strategy
parathyroid hormone-calcitonin in synthetic forms
bisphosphonates-inhibit bone resorption-increase total bone mass - Fosamax, Boniva
