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51 Cards in this Set
- Front
- Back
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Osteomyelitis
Definition |
Infection of the bones
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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) |
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Osteomyelitis
Who is at risk? |
malnourished pts
elderly long term steroid use immunosuppressed |
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Osteomyelitis
Types |
Acute <1mo
Chronic > 1mo |
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Osteomyelitis
Signs and symptoms |
inflammation
redness edema fever pain open draining wound |
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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 |
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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 |
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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 |
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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 |
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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 |
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BACK PAIN
What causes the pain |
As the disk change it puts pressure on nerves
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BACK PAIN
What are the most common locations for pain |
L 4&5
L5-S1 |
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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 |
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BACK PAIN
Diagnosis |
constant pain for 4wks and not relieved with conservitive tx then do
x-ray and MRI CT, myelofram, discography |
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BACK PAIN
Treatment |
Weight reduction
cold/heat therapy exercises-teach good body mechanic low back support Meds- NSAIDS, muscle relaxants, opiods, steroids Manipulation |
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HERNIATED LUMBAR DISK
What is it |
Low back pain w/varying degrees of sensory and motor impairment
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HERNIATED LUMBAR DISK
Signs and symptoms |
>pain with bending, lifting, straining
<pain with bedrest Positive straight leg raise Alt in DTR's Sensory Loss |
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SURGICAL MGMT
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may occur in any area of spine
depends on location, rate of development and effect o nsurrounding tissues |
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Surgical MGMT/Types
Discectomy |
Removal of herniated or extrunded fragments of intervertebral disk
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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 |
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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
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POST OP CARE of pt with back surgery
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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 |
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Lupus
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Chronic, inflammatory, auto immune, collagen,, vascular disease. Involves multiple body system. Etiology;UNKNOWN
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Clinical manifestations of Lupus
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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 |
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Treatment for LUpus
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Corticosteroids BEST TX
NSAIDS use with steroids to reduce amt of use anti malarials immunosuppressive agents (more advanced lupus) |
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Nursing Measures for Lupus
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teach;medications
stress mgmt, lifestyle changes avoid infections skin integrity;protect from sunlight/UV rays Exercise;RX arthritis symptoms provide references;arthritis |
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Rheumatoid Arthritis
Define |
Chronic, systemic, inflammatory disease with destructive synovitis in multiple diarthrodial joints
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What does it affect first
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Small bones of feet and hands
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Cause of RA
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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 |
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RA-epidemiology
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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) |
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ASSESSMENT
RA |
history; past, family, social
anatomic location of symptoms ABILITY TO PERFORM ADL's arthritis impact measurement scales |
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ASSESSMENT
PAIN |
Location, type and severity
duration, circumstance swelling, limitation of movement weakness/fatigue stiffness |
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PHYSCIAL EXAM
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funciton/structure
inspection/palpation ROM Strength |
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CLINICAL MANIFESTATIONS
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Systemic:FATIGUE
AM stiffness >30min anorexia wt, loss joint swelling fixed deformities;ulnar drift, swan neck, boutonniere deformity |
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Difference between RA and OA
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RA- affects the proximal joints
OA-affects the distal joints |
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Diagnosis:
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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 |
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ARA CLASSIFICATION OF RA
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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 |
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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 |
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JOINT PROTECTION
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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 |
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PHARMACOLOGY RA
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Start aggressive!!!
salicylates; 6gm/day NSAIDS/cox-2 inhibitors corticosteroids |
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PHARMACOLOGY RA CONT....
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DMARDS
anti-malarial agents gold salts methtrexate, Immuran penicillamine arava BRM remicade enbrel |
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What is the ultimate goal of treatment?
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to prevent destruction of joint
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RN care RA
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COmfort; pain, siffness and sleep
SELF CARE; mobility, nutrition, house work CONTROL; partnership, education, hope COPING; body image, self-esteem, sexuality |
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BONE TUMORS
3 TYPES BENIGN |
slow growing, well circumscribed
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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 |
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Most common sites for malignant bone tumor?
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distal femur, proximal tibia, humerus
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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 |
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Assessment and diagnostics
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H&P-may lead to more testing
CT, Bone scan, MRI, biopsy LABS- increased serum alkaline phosphatase, calcium CXR-mets Surg stageing-determines tx |
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S/S Hypercalcemia
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poly uria, muscle weakness and fatigue, N/V, dysrhythmias
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RN interventions
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teaching
pain relief preventing path. fx promote coping and self-esteem watch for complications |
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Potential complications
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delayed wound healing; radiation, poor nutrition, infection
Inadequate nutrition; may need TPN, supplements OM, wound infections Hypercalcemia- tx hydration, diuresis, calcitonin |
