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life span > Nurb Test 2: Bone and joint disease > Flashcards

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

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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

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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

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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

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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

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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

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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

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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

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8
Q

Spread From Primary tumor-comes from another tumor

A

Metastatic Bone Cancer

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9
Q

breast, prostate, lungs, kidneys, ovaries, thyroid, GI

A

sites metastatic bone cancer

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10
Q

Travel through lymph and blood supply moves to other sites: pelvis, vertebral, humorous, femur, ribs

A

metastatic bone cancer

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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

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12
Q
  • bone scan= after find primary lesion
A

dx metastatic bone cancer

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13
Q
  • palliative= comfort, radiation, pain management , fx can have surgery
A

tx metastatic bone cancer

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14
Q

:Open wound

Foreign body: implant, plates, prosthetic device

A

Direct entry

osteomyelitis

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15
Q
  • infection somewhere else then migrates to the bone
A

Indirect entry

osteomyelitis

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16
Q

Abscess, sickle cell anemia, diabetes mellitus, tb
Vascular insufficiency- pelvis, tibai, vertbrea
Urinary
Respiratory

A

causes

osteomyelitis

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17
Q 
Invasion of pathogen
Inflammatory process             
Edema- increase pressure
Ischemic necrosis- bone dies 
Sequestrum
A

PATHOPHYSIOLOGY

osteomyelitis

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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-

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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

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20
Q

– Infection of <1 month in duration

A

Acute Osteomyelitis

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21
Q

: fever, night sweats, chills, restlessness, nausea

A

Systemic Sx

acute osteomyelitis

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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

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23
Q

Later sign: drainage

A

acute osteomyelitis

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24
Q
  • Infection of >1 month in duration or infection that didn’t respond to the first around of antibiotics
A

Chronic Osteomyelitis

25
Q

: diminishing signs are not there any more

A

Systemic sx chronic osteomyelitis

26
Q

same, constant bone pain, tenderness, swelling, warmth at site

A

Local sx:

chronic osteomyelitis

27
Q

*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

A

dx chronic osteomyelitis

28
Q

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
A

COLLABORATIVE CARE: Drug Therapy:

osteomyelitis

29
Q

= red man syndrome: flushing, sudden severe hypotension, rash on chest, neck or upper extremities: slow the infusion down

A

vancomycin

30
Q

Toxicity: look at visual, hearing, renal issues

A

gentamyocin

31
Q

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

A

COLLABORATIVE CARE :Surgical Treatment For chronic Osteomyelitis

32
Q
  • 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
A

COLLABORATIVE CARE : Osteomyelitis Nonsurgical Treatment

33
Q

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

A

NURSING IMPLEMENTATION: Acute Intervention Osteomyelitis

34
Q

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

A

Ambulatory and Home Care Osteomyelitis

35
Q 
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
A

Osteomalacia

36
Q

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)

A

Etiology

osteomalacia

37
Q

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

A

Clinical Manifestations

osteomalacia

38
Q

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

A

METABOLIC BONE DISEASES: Osteomalacia

Diagnostics

39
Q

Supplements with vit d 3 and 2
Add foods: cheese, butter, fortified milk, fish
Encourage sun light
Give ca supp

A

tx osteomalacia

40
Q

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

A

osteoporosis

41
Q
  • 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
A

Osteoporosis

42
Q

: Fractures, Back pain, Loss of height, Spinal deformities-kyphosis

A

Clinical Manifestations

osteoporosis

43
Q
  • nutrition, ca supp=enough vit d , exercise= weight bearing Ex: walking hiking, increase calcium in the diet, preventing fractures, and medication
A

Care

osteoporosis

44
Q 
estrogen replacement
calcitonin
bisphosphonates
selective estrogen receptor modulators
parathyroid hormone
A

drug therapy osteoporosis

45
Q
  • after menopause, no longer primary tx bc uterine and breast cancer/ most effective when taken with calcium
A

Estrogen replacement

osteoporosis

46
Q
  • secreted by thyroid, decrease by , give vit c supp can cause hypoparthyroidism
A

Calcitonin

osteoporosis

47
Q
  • inhibits bone reabsorptions, sit upright, full glass of water, monitor ca and phosphours levels, remain upright 30 min after give, photosensitivity
A

Bisphosphonates

osteoporosis

48
Q

bisphosphonates

A

etidronate (Didronel)
alendronate (Fosamax)
Ibantaronate (Boniva)

49
Q
  • act like estrogen by decreasing bone reabsorption, don’t stimulate breast and uterine tissue, take any time of day
A

Selective estrogen receptor modulators

50
Q

Selective estrogen receptor modulators

A

Raloxifene (Evista)

51
Q
  • first drug that stimulates new bone formation, used a lot in men, expensive, long term use can increase risk for osteosarcoma
A 
Parathyroid hormone (PTH)
osteoporosis
52
Q

Parathyroid hormone (PTH)

A

Teriparatide (Forteo)

53
Q
  • 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
A

Paget’s Disease

54
Q
  • bone pain, fatigue, waddling gate, changes in the skull that can lead to headaches, dementia, bone deformities, mild form no sx
A

Clinical Manifestation

pagets disease

55
Q

calcitonin
bispsphonate
ca and vit d supp

A

drug therapy pagets disease

56
Q
  • would be given to relieve sx=bone pain assess pain level/ if stopped then will go right back to the beginning
A

Calcitonin

pagets disease

57
Q

Calcitonin

A

Ex: (Cibacalcin) (Calcimar)

58
Q

Bisphosphonate

pagets disease

A

risedronate (Actonel), alendronate (Fosamax), ibandronate (Boniva)

59
Q
  • to decrease hypocalcemia cause by drugs
A

Ca and Vit D supplements

pagets disease

60
Q

= brace, firm mattress for back support

A

Nonpharmacological

pagets disease

life span (23 decks)

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