Download Chapter 46 Nursing Care of Patients with Musculoskeletal and

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N124IN
Spring 2013
Pathophysiology/Etiology
• Bacteria invades bone and soft tissues
nearby
 Inflammation, ischemia occur
 Necrosis occurs in bone tissue
• Modes of entry by bacteria
 Direct inoculation
 Contiguous spread
 Hematogenous spread
Signs/symptoms
• Acute osteomyelitis
 Fever
 Local inflammation signs (tenderness,
redness, heat, pain, swelling)
• Chronic osteomyelitis
 Ulceration
 Drainage
 Localized pain
Diagnostic
Tests
• Increased WBC count
• Increased ESR
• Bone biopsy
• May have positive blood culture
• MRI, X-ray, CT scan
Therapeutic Measures
• Long-term antibiotic therapy
• Drainage
• Splinting
• Surgery to remove necrosis of
bone tissue/place healthy bone
tissue
• Amputations
Nursing
Care
• Educate patient on IV antibiotic therapy
 Side effects, toxicity, interactions,
precautions
 Home health care nurse may be necessary
• Use sterile technique when working
with wound, if present
 Educate patient on wound care/dressing
changes if applicable
Pathophysiology
• Imbalance in bone remodeling process
• 30-35 years old: bone density peaks
 After this age, bone breakdown rate is
greater than bone building rate
 Causes bones to be porous inside and
weaker
 Can result in fractures
 Types/Risk Factors
• Primary: not related to another disease or health
condition
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Aging
Female
Caucasian/Asian/Hispanic/Latino
Fracture history/family history
Small bones/petite
Postmenopausal
Decreased testosterone/estrogen in males
Decreased calcium/vitamin D intake
Increased caffeine/protein/sodium intake
Sedentary lifestyle
Excessive alcohol intake
Smoking
 Types/Risk
Factors, cont.
• Secondary: caused by medical
condition/procedure
 Hyperparathyroidism
 Renal dialysis
 Steroids
 Antiseizure meds
 Sleeping meds
 Antacids with aluminum
 Hormones for endometriosis
 Cancer meds
 Extended immobility
Prevention
• Positive health habits and nutritional
intake prior to age 30
 Proper calcium and vitamin D intake
 Weight-bearing/muscle-strengthening
exercises
 Decreased alcohol consumption
 Not smoking
Signs/symptoms
• Fracture
• Kyphosis
• Height decrease
• Back pain
Diagnostic Tests
• Computed Tomography
• Ultrasound
• Dual-energy x-ray absorptiometry
(DEXA)
• Decreased serum calcium/vitamin D
• Increased serum phosphorus
• Alkaline phosphatase levels may be
increased
Therapeutic
Measures
• No cure
• Reduce Risk Factors
• Medications
 Calcium supplements
 Vitamin D
 Therapeutic Measures, cont.
• Medications, cont.
 Antiresorptive drugs
 Bisphosphonates
 Prevent, slow osteoporosis progress
 Ex: alendronate (Fosamax), risedronate (Actonel),
 Synthetic thyroid hormone
 Decreases bone loss
 Ex: Calcitonin (Fortical, Miacalcin)
 Selective estrogen receptor modulator (SERM)
 Increases bone mass
 Ex: Raloxifene (Evista)
 Estrogen therapy
 Prevents bone loss related to menopause
 Bone-forming drugs
 Teriparatide (Forteo)
 Increases osteoblast action and number: increases bone mass
Therapeutic
Measures, cont.
• Diet
 Increase calcium/vitamin D intake
 Calcium:
 18-49 years: 1000 mg/day
 >50 years: 1200 mg/day
 Vitamin D:
 50-60 years: 400 IU
 >70 years or with low sunlight: 600 IU
Therapeutic
Measures, cont.
• Exercise
 Weight-bearing exercise
Stimulates building of bones
 Resistance exercise
Fall
prevention
• Assess home environment
• Educate patient family on creating
environment that will help prevent falls
 No rugs
 No slippery floors
 No uneven areas
 Clutter free
• Proper shoes
• Provide walker or cane
Nursing
Care
• Educate on prevention
• Pain relief
• Symptom care
• Education on medication
 Pathophysiology
• 3 phases
 Active
 Osteoclasts increase and cause bone deformity and
destruction
 Mixed
 Osteoblasts create new bone, but it is disorganized
 Inactive
 Occurs when osteoblast activity surpasses osteoclast
activity
 Bone is sclerotic with high vascularity
• Common bones: spine, femur, skull, pelvis
Etiology
• Unknown cause
• Usually runs in families
• Could be related to latent viral
infection from young adulthood
Signs/Symptoms
• Usually no symptoms, especially when
only one bone is affected
• Pain
• Dependent on bone(s)
• Other medical conditions can occur
 Ex: heart failure
Diagnostic
Tests
• X-rays
• Bone scans
• Increased serum alkaline phosphatase
(ALP)
• Bone biopsy
Therapeutic
Measures
• No cure
• Controlled by meds
 NSAIDs
 Bisphosphonates
 Synthetic thyroid hormone
• Exercise
• Surgery
Nursing
Care
• Pain relief
• Symptom care
• Educate
Malignant
tumors can be:
• Primary: originating in bone
• Metastatic: originating in other area of body
and moving to bone
Pathophysiology
cancer type
Unknown cause
unique to bone
 Primary
Malignant Tumors
• Osteosarcoma/osteogenic sarcoma
 Most fatal tumor of bones
 Usually metastasizes to lungs in 2 years of
diagnosis/treatment
 Typically involves people 10-25 years old and boys more
than girls
 Site of origin: typically long bones of arms, legs
 Signs: pain/swelling, lump, limp
 Diagnostic tests: X-ray, bone biopsy, CT scan, bone scan,
MRI
 Treatments: chemotherapy, surgical removal with bone
grafting or amputation
Primary
cont.
Malignant Tumors,
• Ewing’s sarcoma
 Bone tumor that is most malignant
 Signs/symptoms: local pain/swelling,
low-grade fever, leukocytosis, anemia
 Often affects pelvis and legs in
children and younger men
Primary
Malignant Tumors,
cont.
• Chondrosarcoma
 Cartilaginous cell cancer
 Better prognosis
 Typically occurs in middle-aged and
elderly
Metastatic
Bone Disease
• Bone-seeking cancers: primary
malignant tumors in prostate, breast,
lung, thyroid gland
• Once metastasized, numerous bone
sites are usually found
• Important concerns: pathological
fractures, severe pain
Signs/symptoms
• Primary tumors:
 Local swelling
 Pain
 Tender mass
• Metastatic disease
 Diffuse severe pain
Can cause disability
Diagnostic Tests
• X-ray
• CT scan
• Bone scan
• Bone biopsy
• MRI
• Increased ALP
• Increased ESR
Therapeutic
Measures
• Dependent on tumor type and extent
• Primary bone tumors
 Surgery
 Chemotherapy/radiation
• Metastatic bone disease
 No surgery
 External radiation
 Palliation
Nursing
Care
• Assist patient with diagnosis
• Refer patient to appropriate
resources
• Appropriate care with
chemotherapy/radiation
• Postoperative care
 https://www.youtube.com/watch?v=vpLZ
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 https://www.youtube.com/watch?v=q7b5
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