Chapter 64
Osteomyelitis
 What is it?
o Severe infection of the
 Bone
 Bone marrow
 Surrounding soft tissue
o Most com...
o Microorganisms grow causing increased pressure within the
bone
o Increased pressure leads to ischemia and vascular
compr...
 Signs and Symptoms
o Systemic
 Fever, night sweats, chills, restlessness, nausea
o Local
 Constant bone pain that wors...
o Computed tomography (CT)
 Help identify extent of infection, including soft tissue
involvement
 Treatment
o Vigorous a...
 Extended use of antibiotics
 Antibiotic-impregnated bead chains can be
implanted
o Hyperbaric oxygen therapy with 100% ...
 Nursing Implementation
o Health Promotion
 Control infections already in body
 Susceptible adults
o Acute Intervention...
o Emotional support
 Patient and family often frightened and discouraged
Osteoporosis
 What is it?
o Chronic, progressiv...
 Bone resorption begins earlier and accelerates
after menopause
 Pregnancy and breastfeeding
o Deplete woman’s skeletal ...
 Patho: Normal vs. Osteoporotic Bone
o Osteoporosis: bone resorption exceeds bone deposition
 Occurs most commonly in sp...
 Diagnostic Studies
o Dual-energy x-ray absorptiometry (DEXA)
 Measures bone mass of spine, femur, forearm and
total bod...
 Poultry
 Pork
 Apples and bananas
 Potatoes and carrots
o Supplemental vitamin D
 May be recommended
o Exercise
 Sh...
 Bisphosphonates
 Examples: etidronate (Didronel), alendronate
(Fosamax)
 Inhibit bone resorption
 Proven to increase ...
 Signs and Symptoms
o Pain
 Severe, persistent
 Worsened by weight-bearing activities
o Cranial enlargement
o Barrel-sh...
 Treatment
o Calcitonin
 Slows rate of bone breakdown
o Pain reduction
 Examples: ASA, Tylenol, NSAIDs
o Orthotics
 Ex...
Intervertebral Lumbar Disk Damage
Degenerative disk disease
 Degenerative Disk Disease
o What is it?
 Progressive degene...
 Repeated stress and trauma to spine
 Most common sites of rupture: L4-5 and L5-S1
 Can occur in cervical disks
 Signs...
 Treatment
o Conservative
 Restricted activity
 Medication
 NSAIDs, short-term opioids, muscle relaxants
 Epidural st...
 Postoperative Care
o Bedrest
o Log rolling
 Pillow can be placed in between legs for comfort
o Proper body alignment
o ...
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Chapter 64.docx - Amazon Simple Storage Service (Amazon S3)

  1. 1. Chapter 64 Osteomyelitis  What is it? o Severe infection of the  Bone  Bone marrow  Surrounding soft tissue o Most common infecting microorganism  Staphylococcus aureus  Common causes o Trauma o Acute infection originating elsewhere o Puncture injury to soft tissue o Infection in adjacent bone o Orthopedic prosthetic device  Patho: o After entry, microorganisms lodge in an area of bone where circulation slows  Usually the metaphysis
  2. 2. o Microorganisms grow causing increased pressure within the bone o Increased pressure leads to ischemia and vascular compromise of periosteum o Eventually, infection passes through bone cortex and marrow cavity o Once ischemia occurs, bone dies o Sequestrum forms  Devitalized bone separates from living bone o Part of periosteum that continues to have a blood supply forms new bone  Involucrum
  3. 3.  Signs and Symptoms o Systemic  Fever, night sweats, chills, restlessness, nausea o Local  Constant bone pain that worsens with activity  Swelling, tenderness, warmth at infection site  Restricted movement of affected part  Lab Studies o Bone or soft tissue biopsy  Definitive way to determine causative microorganism  Patient’s blood and/or wound culture o Elevated WBC count o Erythrocyte sedimentation rate (ESR)  Radiologic signs o Usually do not appear until 10 days to weeks after start of clinical symptoms o Radionuclide bone scans  Helpful in diagnosis and usually positive in areas of infection o Magnetic resonance imaging (MRI)
  4. 4. o Computed tomography (CT)  Help identify extent of infection, including soft tissue involvement  Treatment o Vigorous and prolonged intravenous (IV) antibiotic therapy  Treatment of choice for acute osteomyelitis  Patients are often discharged to home care or skilled nursing facility with IV antibiotics  Antibiotic therapy may be continued at home for 4 to 6 weeks or as long as 3 to 6 months  Variety of antibiotics may be prescribed  Penicillin, Nafcillin  Neomycin, Vancomycin o Monitor for visual or hearing changes o BUN and creatinine should be monitored  Cephalexin (Keflex)  Cefazolin (Ancef) o Surgical treatment  Removal of poorly vascularized tissue and dead bone
  5. 5.  Extended use of antibiotics  Antibiotic-impregnated bead chains can be implanted o Hyperbaric oxygen therapy with 100% oxygen  Stimulate circulation and healing o Bone grafts  Help restore blood flow o Amputation  Extensive bone destruction  Nursing Diagnoses o Acute pain  Inflammatory process secondary to infection o Impaired physical mobility  Pain, immobilization devices, weight-bearing limitations  Inability or unwillingness to change positions o Ineffective therapeutic regimen management  Lack of knowledge regarding long-term management of osteomyelitis
  6. 6.  Nursing Implementation o Health Promotion  Control infections already in body  Susceptible adults o Acute Intervention  Assessment and management of patient’s pain level  Dressings to absorb exudate from draining wounds  Immobilization of affected area  Maintain proper body alignment  Bed rest  Promotes healing  Reposition frequently o Prevent complications related to immobility o Teaching  Activities to avoid  Examples: exercise, heat application o ↑ circulation and swelling  Adverse reactions with prolonged antibiotic therapy  Secondary infections o Example: Candida albicans
  7. 7. o Emotional support  Patient and family often frightened and discouraged Osteoporosis  What is it? o Chronic, progressive metabolic bone disease  Characterized by porous bone and low bone mass  Structural deterioration of bone tissue o Increased bone fragility  Risk factors o Female gender  Eight times more common in women than men  Lower calcium intake than men
  8. 8.  Bone resorption begins earlier and accelerates after menopause  Pregnancy and breastfeeding o Deplete woman’s skeletal reserve of calcium  Longevity increases likelihood of osteoporosis o Women live longer than men o Increasing age  Decrease in hormones and weight-bearing activity o Early menopause o Excess alcohol intake o Cigarette smoking o Anorexia o Oophorectomy o Sedentary lifestyle  Obesity: more stress on bones o Insufficient calcium intake o Low testosterone levels in men
  9. 9.  Patho: Normal vs. Osteoporotic Bone o Osteoporosis: bone resorption exceeds bone deposition  Occurs most commonly in spine, hips, and wrist  Many drugs can interfere with bone metabolism  Diseases associated with osteoporosis  Intestinal malabsorption  Kidney disease  Rheumatoid arthritis  Hyperthyroidism  Chronic alcoholism  Cirrhosis of the liver  Hypergonadism  Diabetes mellitus  Signs and Symptoms o “Silent disease”  Usual first signs  Back pain  Spontaneous fractures o Examples: back, hip, wrist o Loss of height o Spinal deformities  Kyphosis
  10. 10.  Diagnostic Studies o Dual-energy x-ray absorptiometry (DEXA)  Measures bone mass of spine, femur, forearm and total body  Uses minimal radiation, painless procedure o Quantitative ultrasound  Evaluates density, elasticity, and strength of patella and calcaneus using ultrasound  Treatment o Proper nutrition  Prevention and treatment depend on adequate calcium intake  Increased calcium prevents future loss but will not form new bone  Good sources of calcium  Milk , yogurt  Turnip greens  Spinach  Cottage cheese  Ice cream  Sardines  Poor sources of calcium  Eggs  Beef
  11. 11.  Poultry  Pork  Apples and bananas  Potatoes and carrots o Supplemental vitamin D  May be recommended o Exercise  Should be encouraged to build up and maintain bone mass o Smoking cessation o Decrease alcohol intake  ↓ losing bone mass o Drug therapy  Estrogen replacement after menopause  Helps decrease bone resorption  Works best when combined with calcium supplementation  Calcitonin  Secreted by thyroid gland  Inhibits bone resorption
  12. 12.  Bisphosphonates  Examples: etidronate (Didronel), alendronate (Fosamax)  Inhibit bone resorption  Proven to increase bone mass by 5%  Medication teaching o Take med with full glass of water o Take 30 min before food or any other meds o Remain upright for at least 30 min after taking Paget’s Disease  What is it? o Bone disorder in which there is excessive bone resorption followed by replacement of the normal marrow with fibrous connective tissue o Causes bones to become larger but weaker o Structure of bone becomes unorganized o Usually affects pelvis, long bones, spine, ribs, sternum, and skull
  13. 13.  Signs and Symptoms o Pain  Severe, persistent  Worsened by weight-bearing activities o Cranial enlargement o Barrel-shaped chest o Asymmetric bowing of tibia and femur o Pathologic fractures o Loss of height o Headaches o Visual changes  Diagnostic Studies o Serum alkaline phosphatase ↑  Enzyme involved with bone cell formation o X-rays  Shows bone deformity and increased bone density
  14. 14.  Treatment o Calcitonin  Slows rate of bone breakdown o Pain reduction  Examples: ASA, Tylenol, NSAIDs o Orthotics  Example: Heel lifts o Physical therapy o Bed rest should be avoided  Helps prevent hypercalcemia o Nutritional support  Calcium and vitamin D
  15. 15. Intervertebral Lumbar Disk Damage Degenerative disk disease  Degenerative Disk Disease o What is it?  Progressive degeneration of intervertebral disks  Disk becomes thin and drys out  Compression of nerve roots and spinal cord can occur  Herniated intervertebral disk o What is it?  Can occur from natural degeneration with age
  16. 16.  Repeated stress and trauma to spine  Most common sites of rupture: L4-5 and L5-S1  Can occur in cervical disks  Signs and Symptoms o Low back pain  Can radiate down to the buttock to below the knee  Can be reproduced  Raising leg and flexing the foot at 90 degrees  Diagnostic Studies o X-rays o Myelogram  Injects dye into sac around the nerve roots  Patient may experience a spinal headache  Should resolve in 1-2 days with rest and fluids
  17. 17.  Treatment o Conservative  Restricted activity  Medication  NSAIDs, short-term opioids, muscle relaxants  Epidural steroid injections  Ice or heat  Physical therapy  Surgical therapy o Laminectomy  Removal of protruding disk o Diskectomy  Decompress nerve root o Spinal fusion  Performed if unstable bone pieces are present o Charite disk  Artificial disk used with patients with degenerative disk disease
  18. 18.  Postoperative Care o Bedrest o Log rolling  Pillow can be placed in between legs for comfort o Proper body alignment o Monitor for spinal headache o Frequent monitoring of peripheral neurologic status  Every 2-4 hrs after for the first 48 hours  Compare to baseline assessment o Monitor bowel and bladder function  Nerve damage possible

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