Nurb Test 2: Bone and joint disease Flashcards
- can be asymptomatic= hard mass,
- can affect your height bc on growth plate, could experience muscle soreness with exercise
- shortened extremity on affected side
Osteochondroma
Clinical Manifestations
Benign and malignant
Rare in adults
Named according to are of the bone and tissues affected and type of cells that form the tumor
bone tumors
- asymptomatic don’t do anything
Can have surgically receipted, if all the cartilage cap is removed it will not come back
Monitor so it does not become malignant
tx osteochondroma
- cancerous, extremely aggressive, metasis 10-20% to other sites most common are the lung
- happens in children or young adults
if happens over 60 it is secondary bc pagets disease
Osteogenic Sarcoma
Malignant Bone Tumor
- large bones with fastest growth rate, proximal tibia: below the knee, distal femur=above the knee, proximal humorous, pelvis
locations osteogenic sarcoma
pain and swelling gradually, notice a lot around the knees, restricted range of motion if around a joint,
Minor injury could not cause this but can help it to be found
Manifestations:
osteogenic sarcoma
- xray, ct, mri,
- biopsy of tissue, increase serum alkaline phosphate= bc produced in bone cell, calcium level increased, pet scan- radioactive material will show higher areas of acitivity
dx osteogenic sarcoma
- aimed at quality of life
- amputation: follow up with chemo to give better survival rate
- limb spearing surgery: start chemo before to shrink the tumor
tx osteogenic sarcoma
Spread From Primary tumor-comes from another tumor
Metastatic Bone Cancer
breast, prostate, lungs, kidneys, ovaries, thyroid, GI
sites metastatic bone cancer
Travel through lymph and blood supply moves to other sites: pelvis, vertebral, humorous, femur, ribs
metastatic bone cancer
____fx bc weakening of bone
Increased serum calcium= bc ca released from bones that is damaged
pathological
manifestations of metastatic bone cancer
- bone scan= after find primary lesion
dx metastatic bone cancer
- palliative= comfort, radiation, pain management , fx can have surgery
tx metastatic bone cancer
:Open wound
Foreign body: implant, plates, prosthetic device
Direct entry
osteomyelitis
- infection somewhere else then migrates to the bone
Indirect entry
osteomyelitis
Abscess, sickle cell anemia, diabetes mellitus, tb
Vascular insufficiency- pelvis, tibai, vertbrea
Urinary
Respiratory
causes
osteomyelitis
Invasion of pathogen Inflammatory process Edema- increase pressure Ischemic necrosis- bone dies Sequestrum
PATHOPHYSIOLOGY
osteomyelitis
becomes an island of dead bone, seperated by puss, white blood cell can’t reach, hard to treat, Site for microorganisms to spread to lung and brain , can move out of the bone to soft tissue
Sequestrum-
- Removed by normal immune process if acute
- Removed by surgical debridement
- New bone grow around it =involucrum
- If not heal trap cab form abd puss can escape
- Typically you have exacerbations, May develop into chronic site- scar tissue can dev and it is harder to get rid of
tx sequestrum
– Infection of <1 month in duration
Acute Osteomyelitis
: fever, night sweats, chills, restlessness, nausea
Systemic Sx
acute osteomyelitis
: constant pain worse with activity not better with rest, swelling, tenderness, warmth at site, could have restricted mov
Local sx
acute osteomyelitis
Later sign: drainage
acute osteomyelitis
- Infection of >1 month in duration or infection that didn’t respond to the first around of antibiotics
Chronic Osteomyelitis
: diminishing signs are not there any more
Systemic sx chronic osteomyelitis
same, constant bone pain, tenderness, swelling, warmth at site
Local sx:
chronic osteomyelitis
*Definitive way to find the causative organism: Bone or soft tissue biopsy
Blood/wound culture- present with microorganism
WBC/ESR- elevated
Bone scan- help find area of infection
MRI,CT- helps to see extent of the infection
- don’t appears till ten days to weeks= disease has progressed
dx chronic osteomyelitis
Vigorous and prolonged intravenous IV/Oral antibiotic therapy, *Iv tx of choice if acute as long as bone ischemia has not occurred
- do cultures and biopsy before starting
- important to finish all the way weather sx are there
COLLABORATIVE CARE: Drug Therapy:
osteomyelitis
= red man syndrome: flushing, sudden severe hypotension, rash on chest, neck or upper extremities: slow the infusion down
vancomycin
Toxicity: look at visual, hearing, renal issues
gentamyocin
Removal necrotic tissue and bone
Antibiotic-impregnated bead chains may also be implanted in site after bone is removed
- close up, use wound vac to help speed up healing process
Bone and skin grafting
Amputation- bone is gone, too extensive to save
COLLABORATIVE CARE :Surgical Treatment For chronic Osteomyelitis
- wound vac= negative pressure vacum, pulls edges together to speed up healting process
- hyperbaric oxygen chamber- stimulates circulation, increases oxygenation, and healing of tissues
- d VAC
COLLABORATIVE CARE : Osteomyelitis Nonsurgical Treatment
Maintain antibiotic therapy- keep on schedule, wake up to give
Pain management: Immobilization limb will ↓ pain= Splint limb
Dressing changes and wound care
* avoid exercise and heat bc it increases circulation and swelling- causes to spread faster
Watch for foot drop if on bed rest
Emotional support- pt and family
Will go home with picc
Observe for overgrowth of Candida albicans
NURSING IMPLEMENTATION: Acute Intervention Osteomyelitis
Instruct patient/family- how important it is to complete antibiotics, care of iv site, sx of infection in iv, importance to get testing done on time for the antibiotics
Ambulatory and Home Care Osteomyelitis
Softening of the bones Similar to Rickets in children Defective bone mineralization Rare associated with vit d deficiency: causes decalcification= soften bone – need vit d to absorb ca and phosphorus
Osteomalacia
Lack of UV rays
GI malabsorption- gastric surgery, siliac disease
Kidney disease- parathyroid hormone stimulation is necessary to convert vit d to active form so body can use it
Chronic diarrhea
Drugs: phenytoin, (Dilantin)
Etiology
osteomalacia
Achy localized Bone pain
Muscle Weakness progressive
Progressive deformity- more likely to bow= specially spine and extremities
Fractures- bc weakening of the bone
Weight loss
Difficulty arrising from chair and walking
Clinical Manifestations
osteomalacia
Low serum Ca & P
Low serum 25-hydroxyvitamin D, active form of vit d
High alkaline phosphate= increase in bone demineralization
X-rays= show demineralization
METABOLIC BONE DISEASES: Osteomalacia
Diagnostics
Supplements with vit d 3 and 2
Add foods: cheese, butter, fortified milk, fish
Encourage sun light
Give ca supp
tx osteomalacia
Chronic, progressive metabolic bone disease characterized by
Low bone mass
Structural deterioration of bone tissue
Increased bone fragility leads to bone fractures – 1 in 2 women over 50 will have a fx related to osteoporosis
Effects women 8 times more than men
osteoporosis
- bone is constantly going through bone breakdown and reabsorption, bone reabsorption is a lot faster than deposits and has porous bone
effects spine, wrist - silent disease bone loss occurs without symptoms
Osteoporosis
: Fractures, Back pain, Loss of height, Spinal deformities-kyphosis
Clinical Manifestations
osteoporosis
- nutrition, ca supp=enough vit d , exercise= weight bearing Ex: walking hiking, increase calcium in the diet, preventing fractures, and medication
Care
osteoporosis
estrogen replacement calcitonin bisphosphonates selective estrogen receptor modulators parathyroid hormone
drug therapy osteoporosis
- after menopause, no longer primary tx bc uterine and breast cancer/ most effective when taken with calcium
Estrogen replacement
osteoporosis
- secreted by thyroid, decrease by , give vit c supp can cause hypoparthyroidism
Calcitonin
osteoporosis
- inhibits bone reabsorptions, sit upright, full glass of water, monitor ca and phosphours levels, remain upright 30 min after give, photosensitivity
Bisphosphonates
osteoporosis
bisphosphonates
etidronate (Didronel)
alendronate (Fosamax)
Ibantaronate (Boniva)
- act like estrogen by decreasing bone reabsorption, don’t stimulate breast and uterine tissue, take any time of day
Selective estrogen receptor modulators
Selective estrogen receptor modulators
Raloxifene (Evista)
- first drug that stimulates new bone formation, used a lot in men, expensive, long term use can increase risk for osteosarcoma
Parathyroid hormone (PTH) osteoporosis
Parathyroid hormone (PTH)
Teriparatide (Forteo)
- Abnormal bone destruction and regrowth
- Results in deformity.
- Excessive bone absorption then replaced with fibrous connective tissue
- Softer weaker bones
- Bones commonly affected- pelvis, long bones, spine, ribs, sternum, and cranium
- Rare in individual less than 40
- Men two times more likely to get
- Excessive bone resorption
- Followed by replacement of normal marrow with fibrous connective tissue
Paget’s Disease
- bone pain, fatigue, waddling gate, changes in the skull that can lead to headaches, dementia, bone deformities, mild form no sx
Clinical Manifestation
pagets disease
calcitonin
bispsphonate
ca and vit d supp
drug therapy pagets disease
- would be given to relieve sx=bone pain assess pain level/ if stopped then will go right back to the beginning
Calcitonin
pagets disease
Calcitonin
Ex: (Cibacalcin) (Calcimar)
Bisphosphonate
pagets disease
risedronate (Actonel), alendronate (Fosamax), ibandronate (Boniva)
- to decrease hypocalcemia cause by drugs
Ca and Vit D supplements
pagets disease
= brace, firm mattress for back support
Nonpharmacological
pagets disease
