Nurb Test 2: Bone and joint disease Flashcards
0
Q
- can be asymptomatic= hard mass,
- can affect your height bc on growth plate, could experience muscle soreness with exercise
- shortened extremity on affected side
A
Osteochondroma
Clinical Manifestations
1
Q
Benign and malignant
Rare in adults
Named according to are of the bone and tissues affected and type of cells that form the tumor
A
bone tumors
2
Q
- 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
A
tx osteochondroma
3
Q
- 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
A
Osteogenic Sarcoma
Malignant Bone Tumor
4
Q
- large bones with fastest growth rate, proximal tibia: below the knee, distal femur=above the knee, proximal humorous, pelvis
A
locations osteogenic sarcoma
5
Q
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
A
Manifestations:
osteogenic sarcoma
6
Q
- 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
A
dx osteogenic sarcoma
7
Q
- 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
A
tx osteogenic sarcoma
8
Q
Spread From Primary tumor-comes from another tumor
A
Metastatic Bone Cancer
9
Q
breast, prostate, lungs, kidneys, ovaries, thyroid, GI
A
sites metastatic bone cancer
10
Q
Travel through lymph and blood supply moves to other sites: pelvis, vertebral, humorous, femur, ribs
A
metastatic bone cancer
11
Q
____fx bc weakening of bone
Increased serum calcium= bc ca released from bones that is damaged
A
pathological
manifestations of metastatic bone cancer
12
Q
- bone scan= after find primary lesion
A
dx metastatic bone cancer
13
Q
- palliative= comfort, radiation, pain management , fx can have surgery
A
tx metastatic bone cancer
14
Q
:Open wound
Foreign body: implant, plates, prosthetic device
A
Direct entry
osteomyelitis
15
Q
- infection somewhere else then migrates to the bone
A
Indirect entry
osteomyelitis
16
Q
Abscess, sickle cell anemia, diabetes mellitus, tb
Vascular insufficiency- pelvis, tibai, vertbrea
Urinary
Respiratory
A
causes
osteomyelitis
17
Q
Invasion of pathogen Inflammatory process Edema- increase pressure Ischemic necrosis- bone dies Sequestrum
A
PATHOPHYSIOLOGY
osteomyelitis
18
Q
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
A
Sequestrum-
19
Q
- 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
A
tx sequestrum
20
Q
– Infection of <1 month in duration
A
Acute Osteomyelitis
21
Q
: fever, night sweats, chills, restlessness, nausea
A
Systemic Sx
acute osteomyelitis
22
Q
: constant pain worse with activity not better with rest, swelling, tenderness, warmth at site, could have restricted mov
A
Local sx
acute osteomyelitis
23
Q
Later sign: drainage
A
acute osteomyelitis
24
- Infection of >1 month in duration or infection that didn’t respond to the first around of antibiotics
Chronic Osteomyelitis
25
: diminishing signs are not there any more
Systemic sx chronic osteomyelitis
26
same, constant bone pain, tenderness, swelling, warmth at site
Local sx:
| chronic osteomyelitis
27
*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
28
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
29
= red man syndrome: flushing, sudden severe hypotension, rash on chest, neck or upper extremities: slow the infusion down
vancomycin
30
Toxicity: look at visual, hearing, renal issues
gentamyocin
31
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
32
- 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
33
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
34
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
35
```
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
36
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
37
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
38
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
39
Supplements with vit d 3 and 2
Add foods: cheese, butter, fortified milk, fish
Encourage sun light
Give ca supp
tx osteomalacia
40
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
41
- 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
42
: Fractures, Back pain, Loss of height, Spinal deformities-kyphosis
Clinical Manifestations
| osteoporosis
43
- nutrition, ca supp=enough vit d , exercise= weight bearing Ex: walking hiking, increase calcium in the diet, preventing fractures, and medication
Care
| osteoporosis
44
```
estrogen replacement
calcitonin
bisphosphonates
selective estrogen receptor modulators
parathyroid hormone
```
drug therapy osteoporosis
45
- after menopause, no longer primary tx bc uterine and breast cancer/ most effective when taken with calcium
Estrogen replacement
| osteoporosis
46
- secreted by thyroid, decrease by , give vit c supp can cause hypoparthyroidism
Calcitonin
| osteoporosis
47
- inhibits bone reabsorptions, sit upright, full glass of water, monitor ca and phosphours levels, remain upright 30 min after give, photosensitivity
Bisphosphonates
| osteoporosis
48
bisphosphonates
etidronate (Didronel)
alendronate (Fosamax)
Ibantaronate (Boniva)
49
- act like estrogen by decreasing bone reabsorption, don’t stimulate breast and uterine tissue, take any time of day
Selective estrogen receptor modulators
50
Selective estrogen receptor modulators
Raloxifene (Evista)
51
- 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
```
52
Parathyroid hormone (PTH)
Teriparatide (Forteo)
53
- 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
54
- 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
55
calcitonin
bispsphonate
ca and vit d supp
drug therapy pagets disease
56
- would be given to relieve sx=bone pain assess pain level/ if stopped then will go right back to the beginning
Calcitonin
| pagets disease
57
Calcitonin
Ex: (Cibacalcin) (Calcimar)
58
Bisphosphonate
| pagets disease
risedronate (Actonel), alendronate (Fosamax), ibandronate (Boniva)
59
- to decrease hypocalcemia cause by drugs
Ca and Vit D supplements
| pagets disease
60
= brace, firm mattress for back support
Nonpharmacological
| pagets disease
