Osteomyelitis + Osteoporosis

Question 1

osteomyelitis

Answer 1

severe infection of the bone, bone marrow & surrounding soft tissue
-most commonly caused by staph aureus
very difficult to treat

Question 2

delayed identification of osteomyelitis can lead to

Answer 2

-chronic pain, infection & drainage
-loss of function
-amputation
-death

Question 3

osteomyelitis risk factors

Answer 3

-IV drug use
-diabetes
-immunosuppression
-hx of blood infections
-presence of pressure ulcers/chronic open wounds

Question 4

limiting spread of osteomyelitis is limited by

Answer 4

-malnutrition
-alcoholism
-liver failure

Question 5

how does the bacteria gain entry into the bone in osteomyelitis

Answer 5

indirect: blood stream
direct: open wound/direct entry

Question 6

osteomyelitis: acute characterists

Answer 6

-< 1mo in duration
-local manifestations: bone pain that worsens w/ activity/unrelieved by rest, swelling/tenderness/warmth at infection site and restricted movement of affected part
-systemic: fever & chills, night sweats, restlessness, nausea & malaise

Question 7

osteomyelitis: chronic characterists

Answer 7

->1mo in duration OR has failed to respond to initial abx
-can be continuous & persistent or a process of remission & exacerbations
-systemic manifestations are reduced
-local: constant bone pain, swelling & warmth at site

Question 8

osteomyelitis dx studies

Answer 8

-bone/tissue biopsy
-blood/wound culture +
-inc WBC & ESR
-x rays (but do not show changes until 10 days into infection)
-radionuclide bone scans preferred
-MRI

Question 9

osteomyelitis collaborative care

Answer 9

-vigorous/prolonged IV abx (through picc)
-surgical debridement
-some immobilization of affected limb, initially may be on bedrest
-pain control

Question 10

bone remodeling

Answer 10

requires a balance between bone formation by osteoblasts and bone resorption by osteoclasts

Question 11

osteoporosis

Answer 11

condition characterized by loss of bone density & subsequent fractures
“silent disease” & “low bone mineral density”

Question 12

what areas are most affected by osteoporosis

Answer 12

wrist
hip
vertebral column

Question 13

why are women more likely to get osteoporosis

Answer 13

-lower calcium intake
-have less bone mass/smaller frame
-bone resorption begins sooner & accelerates @ menopause
-have increased longevity

Question 14

who is at risk for osteoporosis

Answer 14

-women
-family hx
-low body wt (<128lbs)
-use of corticosteroids >3 mo
-advanced age
-diet low in calcium
-inadequate physical activity
-cigarettes/excessive alcohol

Question 15

osteoporosis CM

Answer 15

-compression fracture (break in vertebral body of bone due to loss of bone mass; consequently, back pain
-progressive vertebral deformities
-height shortens

Question 16

anatomy of the vertebrae

Answer 16

cervical: 7
thoracic: 12
lumbar: 5 most at risk for problems
sacral: 5 (fused)
coccyx: 4 (fused)

Question 17

osteoporosis collaborative mgt

Answer 17

prevent
-adequate Ca intake (1000mg per meno & post menu taking estrogen, 1500mg for post meno w/o taking estrogen)
-vit D (800-1000 UI daily; diet + sups)
-load bearing exercise for 30 min 3x/w
-avoid tobacco & excessive alcohol
-corset to prevent vertebral collapse

Question 18

calcium supplements

Answer 18

-take w/ food
-chewable preferred
-2 types: carbonate & citrate
-difficult to absorb in single dose

Question 19

osteoporosis drug therapy: biphosphonates

Answer 19

MOA: inhibit osteoclast resorption
drugs: alendronate & ibandronate
NC: take w/ full glass of water 30 min before food/other meds and then remain upright for 30 mins after

Question 20

osteoporosis drug therapy: selective estrogen receptor modulators (SERM)

Answer 20

-mimic estrogen effects on bone by reducing bone resorption w/o stimulation breast/uterus
drug: raloxifene