osteomyelitis, low back pain, osteoporosis, and osteoarthritis

Question 1

What is osteomyelitis?

Answer 1

Severe infection of the bone, bone marrow, and surrounding soft tissue

Most common infecting organism: staphylococcus aureus

Risk factors:

• Mostly affects: growing bone in boys less than 12 yo
• Adults with vascular insufficiency disorders, GU, and respiratory infections are at higher risk for a primary infection to spread via the blood to the bone
• Pelvis, tibia, and vertebrae (vascular-rich bone) are the most common sites of infection

Question 2

S/S of osteomyelitis:

Answer 2

Acute osteomyelitis

1. initial infection or less than 1 month
2. Systemic: fever, night sweats, chills, restlessness, nausea, malaise
3. Local: constant bone pain worsens with activity and unrelieved by rest, swelling, tenderness, warmth at infection site, restricted movement of the affected part

Chronic osteomyelitis

1. infection that persists longer than 1 month
2. Systemic: symptoms diminished
3. Local: constant bone pain, swelling and warmth at infection site

Question 3

what is the treatment of choice for osteomyelitis:

Answer 3

IV antibiotic therapy is treatment of choice

• prolonged - from 4-6 weeks to 3-6 months
• long because it’s difficult to heal -> bone is less vascular
• Cultures or biopsy should be done before drug therapy to give correct antibiotic
• Typically a central line is needed or a PICC or port

Surgical debridement and decompression often needed if antibiotic therapy delayed

Chronic osteomyelitis: long-term oral antibiotics may be used, 6-8 weeks

Question 4

What is the collaborative care for osteomyelitis?

Answer 4

Response to drug therapy is monitored by bone scans and ESR rates

Treatment includes:
antibiotics, and surgical removal of poorly perfused tissue and dead bone
- Antibiotic beads can be implanted in the bone

Suction irrigation system can be inserted

Protect the limb with casts or braces

HBO treatment (Hyperbaric Oxygen Treatment = 100% O2)

Remove prosthetic devices if they are source of infection

Muscle flaps, skin grafts, bone grafts - may be needed

Complications: septicemia, septic arthritis, pathologic fractures
- amputation may be necessary

Question 5

What is nursing care for osteomyelitis?

Answer 5

Control other current infections

Education on S&S if pt is susceptible (immunocompromised, diabetes, use of orthopedic prosthetic devices, vascular insufficiency)

Pain management:

1. limb immobilization
2. limit handling of limb
3. NSAIDs
4. opioid analgesics
5. muscle relaxants
6. also guided imagery, music to distract

Dressings if needed (sterile) – open or surgical pt only

Bed rest

1. avoid contractures and foot drop
2. splint to keep limb in neutral position

Educate on S&S of antibiotic toxicity

1. hearing changes
2. impaired renal function
3. neurotoxicity

Will need peak/trough levels of antibiotic

Question 6

What is treatment for low back pain?

Answer 6

1. Pain management: NSAIDs
2. Weight management
3. Sufficient rest periods
4. Local heat or cold
5. Exercise and activity throughout day
6. Antidepressants
7. Antiseizure medications
8. Physical therapy
9. CAT (Complementary and alternative therapies)
   - acupuncture, yoga
10. Epidural steroid injection
11. surgical intervention if severe or have neurological deficits

Question 7

What is osteoporosis?

Answer 7

Chronic, progressive metabolic bone disease

Bone demineralization, causes porous bone, low bone mass, structural deterioration of bone tissue

Leads to increased bone fragility

Question 8

What are risk factors for osteoporosis?

Answer 8

1. female, increasing age (>65 yr)
2. family history
3. White or Asian
4. low body weight
5. estrogen deficiency in women
6. sedentary lifestyle
7. insufficient dietary calcium
8. vit D deficiency
9. current cigarette smoking, excessive use of alcohol
10. testosterone deficiency in men
11. long-term use of steroids

Question 9

What can decrease the risk of osteoporosis?

Answer 9

1. regular weight-bearing exercise

2. fluoride, calcium, and vitamin D ingestion

Question 10

What is the gold standard for diagnosing osteoporosis?

Answer 10

DXA: dual-energy x-ray absorptiometry

1. Measures bone density in the spine, hips, and forearm
2. Useful to evaluate bone density over time and to assess the effectiveness of treatment

Question 11

What is osteoarthritis?

Answer 11

Slowly progressive non-inflammatory disorder of the synovial joint

i. Results from cartilage damage that triggers a metabolic response
ii. Affected cartilage becomes softer, less elastic, less able to resist wear
iii. Osteophytes (bony growths) increase at the joint margins

Most common form of joint disease in US

Advancing age is risk factor
Other risk factors include:
1. Estrogen reduction at menopause
2. Genetic factors
3. Obesity
4. Lack of exercise
5. Overuse of knees
6. Frequent kneeling and stooping

Question 12

what are the clinical manifestations of osteoarthritis?

Answer 12

Joint pain!!!!
Not systemic, but is specific to joint (sometimes symmetric joints)
- pain at rest (sometimes)
- joint stiffness after rest
- crepitation
-Heverden's and Bouchard's nodes

Question 13

What are treatments for osteoarthritis?

Answer 13

1. Managing pain and inflammation
2. preventing disability
3. maintaining and improving joint function
4. Rest and joint protection
5. heat (mostly) and cold (for inflammation) applications
6. nutritional therapy and exercise (weight reduction)
7. complementary and alternative therapies (acupuncture, yoga, massage)
8. drug therapy (NSAIDs, topical analgesics, steroids, more)
9. sometimes surgery

Question 14

nursing interventions for osteoarthritis?

Answer 14

1. pain medication
2. medication related to inflammation
3. massage
4. heat or cold
5. meditation, yoga
6. rest
7. stabilization of inflamed joints (splint)
8. teach on modifiable risk factors (weight, occupational and recreational hazards)