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51 Cards in this Set

  • Front
  • Back
Osteomyelitis

Definition
Infection of the bones
Osteomyelitis

Etiology
70-80% from Staph Aureus
Rest from blood-bourne(other infection like strep
)direct bone contamination (from surg)and indirect extension (pressure ulcer)
Osteomyelitis
Who is at risk?
malnourished pts
elderly
long term steroid use
immunosuppressed
Osteomyelitis

Types
Acute <1mo
Chronic > 1mo
Osteomyelitis

Signs and symptoms
inflammation
redness
edema
fever
pain
open draining wound
Osteomyelitis
Why is it so hard to treat?
Bone infections are more difficult to eradicate than soft tissue infections b/c the infected bone becomes walled off and the antibiotics can't penetrate as well.
PREVENTION is key, delay elective surg if hx of infection
Osteomyelitis
Labs/Diagnositcs
x-rays- takes a couple of weeks to see in bone, early x-ray may show soft tissue swelling
Bone scan /MRI
Labs- increased leukocytes, increased sed rate
blood/wound cultures
Osteomyelitis
Treatment
Control infection before area is wall off from perfusion
Drug therapy iv antibiotics based on c&s then PO once under control up to 3mo if there is no response rq SURGERY to remove necrotic tissue
BACK PAIN
What is it most likely caused by
2nd most common reason to see DR (resp 1st)
Most caused by lumbar/sacral strain
OA, Stenosis, Disk problems, bony metastisis, kidney problems, abd. anyuerism, pelive pain
BACK PAIN
Etiology
increasing age-disks change become dense, irregular and degenerate
Smk, prolonged driving, obesity, psychological stress, poor posture, poor muscle tone, unequal leg length, occupation
BACK PAIN
What causes the pain
As the disk change it puts pressure on nerves
BACK PAIN
What are the most common locations for pain
L 4&5
L5-S1
BACK PAIN
Pt history
Family hx
hx of pain
pain on movement
examine pt lying
Straight leg raise-cause sharp sudden pain+nerve root pain.
standing, gait, csm
BACK PAIN
Diagnosis
constant pain for 4wks and not relieved with conservitive tx then do
x-ray and MRI
CT, myelofram, discography
BACK PAIN
Treatment
Weight reduction
cold/heat therapy
exercises-teach good body mechanic
low back support
Meds- NSAIDS, muscle relaxants, opiods, steroids
Manipulation
HERNIATED LUMBAR DISK
What is it
Low back pain w/varying degrees of sensory and motor impairment
HERNIATED LUMBAR DISK
Signs and symptoms
>pain with bending, lifting, straining
<pain with bedrest
Positive straight leg raise
Alt in DTR's
Sensory Loss
SURGICAL MGMT
may occur in any area of spine
depends on location, rate of development and effect o nsurrounding tissues
Surgical MGMT/Types
Discectomy
Removal of herniated or extrunded fragments of intervertebral disk
Surgical MGMT/Types
Laminectomy
laminotomy
Removal of the bone between the spinal process and facet pedicle junction to expose the neural elements in the spinal cord. allows surgeon to inspect the spinal canal, identify and remove pathology, and relieve compression of the cord and roots/
incision of one of the vertebral laminae
Surgical MGMT/Types

Discectomy with fusion
a bone graft is used to fuse the vertebral spinous process. The object is to bridge over the defective disk to stabilize the spine and reduce rate of recurrence
POST OP CARE of pt with back surgery
sensitive to alignment
LOGROLL
Know pre-op CSM
check CSM freq
takes 6wks for ligaments to heal-avoid activities that cause excess flexation for ex. driving
avoid heavy work for 2-3 monther
Lupus
Chronic, inflammatory, auto immune, collagen,, vascular disease. Involves multiple body system. Etiology;UNKNOWN
Clinical manifestations of Lupus
NO SINGLE LAB TO CONFIRM
Joint involvement
Skin manifestations:butterfly mask(rash on bridge of nose/cheek
Oral ulcers
Raynauds' Phenomenon lymph enlargement
Pericarditis, pleural effusions
Lymph and vascular effects
Kidney diseas
Neuropsych disorders
95% positive for ANA (anti nuclear antibody),anemia, leukopenia,thrombocytopenia and Proteinuria
Treatment for LUpus
Corticosteroids BEST TX
NSAIDS use with steroids to reduce amt of use
anti malarials
immunosuppressive agents (more advanced lupus)
Nursing Measures for Lupus
teach;medications
stress mgmt, lifestyle changes
avoid infections
skin integrity;protect from sunlight/UV rays
Exercise;RX arthritis symptoms
provide references;arthritis
Rheumatoid Arthritis
Define
Chronic, systemic, inflammatory disease with destructive synovitis in multiple diarthrodial joints
What does it affect first
Small bones of feet and hands
Cause of RA
autoimmune, Pannus is formed(newly formed synovial tissue that is infiltrated with immflammatory cells-destroys cartilidge and bone loss of articular surfaces, loss of motion and muscle changes
80% of patients have RF (rheumatoid factor
RA-epidemiology
occurs worldwide, all races and ethnic groups
incidence peaks in 4th-6th decade
woman affected 2-3x more than men
Increased prevelence of RA with genetic marker(HLA-DR4)
ASSESSMENT
RA
history; past, family, social
anatomic location of symptoms
ABILITY TO PERFORM ADL's
arthritis impact measurement scales
ASSESSMENT
PAIN
Location, type and severity
duration, circumstance
swelling, limitation of movement
weakness/fatigue
stiffness
PHYSCIAL EXAM
funciton/structure
inspection/palpation
ROM
Strength
CLINICAL MANIFESTATIONS
Systemic:FATIGUE
AM stiffness >30min
anorexia wt, loss
joint swelling
fixed deformities;ulnar drift, swan neck, boutonniere deformity
Difference between RA and OA
RA- affects the proximal joints
OA-affects the distal joints
Diagnosis:
Labs: RF, ANA, EST, C-reactive protein
X-RAY- see erosions, narrow jnt spaces. Used to monitor and guide treatment
SYNOVIAL FLUID ANALYSIS- aspirate synovial fluid if CLODUY OR MILKY -would have leukocytes
ARA CLASSIFICATION OF RA
morning stiffness >30min
soft tissue swelling 3-4 jnts
swelling of at least one wrist
symmetrical swelling of jnts
SC reheumatoid nodules
presence of RF
radiographic ersions; hand and/or wrist
Nursing interventions
TEACHING
education is huge- fatigue, energy conservation, exercise (if exasb. passive ROM )remission active ROM
moderate pain-active with pain tolerence
stress mgnt
jnt protection and work simplicficaiton
JOINT PROTECTION
reduce efforts to joints;slide vs. lift
avoid positions of stress on jnts;tight grip flextion/rotation
use larger joints
use joints in most stable position;rise from chair symetrically, no leaning
avoid remainin in one postion;change Q 20min
Avoid activities that can't be stopped;break into defined parts
PHARMACOLOGY RA
Start aggressive!!!
salicylates; 6gm/day
NSAIDS/cox-2 inhibitors
corticosteroids
PHARMACOLOGY RA CONT....
DMARDS
anti-malarial agents
gold salts
methtrexate, Immuran
penicillamine
arava
BRM
remicade
enbrel
What is the ultimate goal of treatment?
to prevent destruction of joint
RN care RA
COmfort; pain, siffness and sleep
SELF CARE; mobility, nutrition, house work
CONTROL; partnership, education, hope
COPING; body image, self-esteem, sexuality
BONE TUMORS
3 TYPES
BENIGN
slow growing, well circumscribed
BONE TUMORS
3 TYPES
MALIGNANT
most common osteosarcoma, YET RARE males 10-25 yrs, S/S pain, swelling, wt. loss
may have palpable mass, increased skin temp
Most common sites for malignant bone tumor?
distal femur, proximal tibia, humerus
BONE TUMORS
3 TYPES
METASTATIC
CA from kidney, prostate, lung, breat, ovary, thyroid.
Most freq attacks skull, spine, pelvis, femr, humerus
TYPICALLY INVOLVES MORE THAN ONE BONE
Assessment and diagnostics
H&P-may lead to more testing
CT, Bone scan, MRI, biopsy
LABS- increased serum alkaline phosphatase, calcium
CXR-mets
Surg stageing-determines tx
S/S Hypercalcemia
poly uria, muscle weakness and fatigue, N/V, dysrhythmias
RN interventions
teaching
pain relief
preventing path. fx
promote coping and self-esteem
watch for complications
Potential complications
delayed wound healing; radiation, poor nutrition, infection
Inadequate nutrition; may need TPN, supplements
OM, wound infections
Hypercalcemia- tx hydration, diuresis, calcitonin