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Chapter 64 musculoskeletal problems & chapter 65 arthritis and connective tissue diseases
Terms in this set (66)
Results from resent respiratory or urinary infection
Could result from skin infections, recent surgery, poor perfusion, diabetes, chemotherapy, burns, fractures, or open wounds
What is osteomyelitis?
Severe infection of the bone, bone marrow, and surrounding soft tissue, which eventually leads to bone ischemia
Systemic and local signs
Chills, fever, fatigue
Local signs more common (pain, swelling, and warmth)
Care for acute osteomyelitis
Immobilize the area during the acute phase to prevent fracture
Diagnosis of osteomyelitis
Bone scan, injection of radioisotope that is taken up by bone
Collaborative care for osteomyelitis
Wow lots of antibiotics
Look at the bone and the skin
Lengthy IV antibiotics for 4-6 weeks
Then switch to oral antibiotics which can last for months
Watch for side effects and IV catheter site to ensure compliance
May require debridement, a wound VAC, oxygen therapy
PAIN MANAGEMENT (persistent throbbing pain)
Prevention of contractures (foot drop and flexion)
Educate patient on neutral position
NO HEAT THERAPY
Exercise during acute stage
ROM (since they're on bed rest and aren't allowed weight bearing exercises)
Primary, BENIGN, overgrowth of bone and cartilage near end of bone at growth plate. It occurs most often between the ages of 10 and 25.
It puts them at risk for falls. Most commonly occurs in the pelvis and is found after the discovery that one leg is longer than the other. It can lead to formation of an osteosarcoma.
Primary, extremely aggressive and rapid metastasis. Swelling pain in the knees.
Metastatic bone cancer
Most common type of malignant bone tumor.
Most important to monitor patient for hypercalcemia, prevent fractures and falls, regular rest, and grieving.
Affects of long term antibiotic therapy
Immune system depression. C-diff. Smooth muscle spasms. Hearing problems, loss. Kidney function loss.
Acute Low back pain
Associated activities causing excessive stress (often hyper flexion) on the lower back. Strain of lower
Treatment of acute low back pain
Avoiding activities that aggravate pain, analgesics, muscle relaxants, massage and back manipulation, and alternate heat and cold compresses.
Periodic short bed rest, during flair ups. Not extended rest periods though. Exercise, strength, and NSAIDS.
Sleeping position for acute low back pain
Chronic low back pain
Diagnosis based on subjective complaints of pain.
Caused by degenerative disk disease, lack of exercise, prior injury, obesity, structural and postural abnormalities, lasting for more than 3 months.
Treatment for chronic back pain
Weight reduction, analgesics, rest periods, alternate heat/cold application, exercise to keep muscles and joints mobilized, or surgery.
Education for patients with low back pain DO
Avoid straining the lower back by placing a foot on a step or stool during prolonged standing.
Sleep on a side lying position with knees and hips bent.
Sleep on back with a lift under knees and legs or on back with 10 inch high pillow under knees to flex hips and knees.
Regularly exercise 15 minutes in the morning and evening. Begin with exercises with 2 or 3 minute warmup period by moving arms and legs, alternately relaxing and tightening muscles; exercise slow,h with smooth movements.
Carry light items close to body.
Maintain appropriate body weight.
Use local heat and cold application.
Use a lumbar roll or pillow for sitting.
Education for patients with low back pain DON'T
Lean forward without bending knees.
Lift anything above level or elbows.
Stand in one position for prolonged time.
Sleep on abdomen or on back or side with legs out straight.
Exercise without consulting health care provider if having severe pain.
Exceed prescribed amount and type of exercises without consulting health care provider.
Prevention of low back pain
Maintain healthy weight
DO NOT sleep in a prone position
Sleep on side with knees flexed and a pillow between the knees
Avoid cigarette smoking and tobacco products
Obtain regular physical activity, including strength and endurance training
Use proper body mechanics to avoid low back strain, especially when lifting heavy objects, bend at the knees, not at the waist, and stand up slowly while holding object close to your body.
Radiating pain from butt to knee.
Caused by spinal channel narrowing.
Diagnosed by straight leg raising test.
Herniated intervertebral disk
Nucleus purposes bulges then herniated placing pressure on nearby nerves.
Conservative treatment of intervertebral disk disease
Physical therapy, pain medication with muscle relaxants, and epidural corticosteroid injection.
Neck or lumbar, lumina protect the vertebra.
Wound would be on the back.
Diskectomy or spinal fusion
Anterior neck, wound on front
Post operative care for intervertebral disk disease
Logrolling, headache (possible CSF leakage), neuromuscular assessment, pain management, bowel/bladder in continence
A chronic, progressive metabolic bone disease characterized by low levels of calcium, low bone mass, and structural deterioration of bone tissue. Abnormal bone metabolism. Measurable loss of height (6 inches in a year).
Risk factors for osteoporosis
Family history of osteoporosis
White or Asian race
Long term use of corticosteroids
Insufficient dietary calcium
Insufficient vitamin D
Patients with Osteoporosis are at risk for falls
Which can lead to development of fractures
Silent disease. People may not know until a sudden fall causes a hip or vertebral fracture. Collapsed vertebrae: back pain (JFK episode of BONES) loss of height, or spinal deformities.
Diagnosis of osteoporosis
Dual energy x-Ray absorptiometry (DEXA), t-score
Collaborative care of osteoporosis
Calcium and vitamin D supplements, weightbearing exercise, estrogen is NO LONGER in use, bisphosphonates (fosamax), calcitonin, evista
Calcium for osteoporosis
1000 mg per day
2 doses 500 mg (body can only absorb this much at a time)
Vitamin D for osteoporosis
Increased calcium level
Slows down bone loss
Increases bone mass
Can cause reflux
Sit up right for 30 minutes
**watch for GI side effects
Swimming and bicycling
Not weightbearing exercise
Slows the rate of bone thinning
Regulates calcium levels
Calcitonin decreases calcium levels
Opposite effect of parathyroid hormone (which causes increased bone breakdown to increase calcium levels)
Slows bone loss.
Slowly progressive noninflammatory disorder of synovial joints, caused by damage and eventual loss of the cartilage of one or more joints. Bowed legs and swelled joints.
Causes of osteoarthritis
Aging, estrogen reduction, genetics, obesity, sports, occupations with frequent kneeling, and lack of exercise.
Manifestations of osteoarthritis
NOT PRESENT (fatigue, fever, and organ involvement)
Affects joints ASYMMETRICALLY
Pain provoked by activity, relieved by rest
Stiffness with rest/early morning, resolves within 30 minutes
Deformity of fingers (heberden's and bouchard's nodes)
Deformity of knees (bowlers)
Medication, joint rest, heat/cold, weight control, exercise, joint replacement.
Alternate exercise movement with rest.
Tylenol low dose.
Resting increases stiffness, resting decreases pain
If osteoathritis pain is chronic
Heat can be applied
If osteoarthritis pain is acute
Cold should be applied
Bring down inflammation
Chronic, systematic autoimmune disease, characterized by inflammation of connective tissue in synovial joints.
Often remission and exacerbation periods.
Etiology, genetic and autoimmune factors.
Manifestations of rheumatoid arthritis
Onset is insidious, beginning with nonspecific symptoms (fatigue, weight loss, generalized stiffness.)
Joint pain, stiffness after inactivity (lasts one hour or more), limitation of motion, and inflammation (heat, swelling, and tenderness).
Joint symptoms occur SYMETRICALLY
Deformity, disability, and subluxation (partial dislocation) may occur.
Can affect nearly every body system (rheumatoid nodules, Sjögren's syndrome, and felty syndrome.)
Diagnosis of rheumatoid arthritis
2 or more joints involved
Rheumatoid factor positive
Elevated erythrocyte sedimentation rate (ESR)
C reactive protein (CRP)
Indicative of active inflammation
Duration of longer than 6 weeks
Rheumatoid arthritis involves all joints
Osteoarthritis involves the weight bearing joints
Nursing care and management for osteoarthritis and rheumatoid arthritis
Nodules come and go between osteoarthritis and rheumatoid arthritis
They can be surgically removed, they just come back
Patient education joint protection and energy conservation
Maintain appropriate weight
Use assistive devices, if indicated
Avoid forceful repetitive movements
Avoid positions of joint deviation and stress
Use good posture and proper body mechanics
Seek assistance with necessary tasks that may cause pain
Develop organizing and pacing techniques for routine tasks
Modify home and work environment to create less stressful ways to perform
Prevention of osteoarthritis
Avoid trauma to joints
Avoid cigarette smoking
Maintain healthy weight
Use safety measures to protect and decrease risk of injury to joints.
Exercise regularly, including strength and endurance training.
Protection of small joints
1. Maintain joint in neutral position to minimize deformity. Press water from a sponge instead of wringing.
2. Use strongest joint available for any task. When rising from chair, push with palms rather than fingers. Carry laundry basket in both arms rather than with fingers.
3. Distribute weight over many joints instead of stressing a few. Slide objects instead of lifting them. Hold packages c,one to body for support.
4. Change positions frequently. Do not hold book or grip steering wheel for long periods without resting. Avoid grasping pencil or cutting vegetables with knife for extended periods.
5. Avoid repetitious movements. Do not knit for long periods. Rest between rooms when vacuuming. Modify home environment to include faucets and doorknobs that are pushed rather than turned.
6. Modify chores to avoid stress on joints. Avoid heavy lifting. Sit on stool instead of standing during meal preparation.
Onset: young to middle age
Gender: female/male ratio is 2:1 or 3:1. Less marked sex difference after age 60
Weight: lost or maintained weight
Disease: systematic disease with exacerbations and remissions
Affected joints: small joints typically first, wrists, elbows, shoulders, knees. Usually bilateral with symmetric joint involvement.
Pain characteristics: stiffness lasts 1 hour to all day and may decrease with use. Pain is variable and may disrupt sleep.
Nodules: present, especially on extensor surfaces
Synovial fluid: WBC count >20,000 wig mostly neutrophils
X-rays: joint space narrowing and erosion with bony over growths, subluxation with advanced disease. Osteoporosis related to corticosteroid use.
Laboratory findings: RF positive in 80% of patients. Elevated ESR, CRP indicative of active inflammation.
Onset: usually greater than 40 years of age.
Gender: Before age 50, more men and than women. After age 50, more women than men.
Disease: Localized disease with variable, progressive course.
Affected joints: Weight-bearing joints of knees and hips, small joints, cervical and lumbar spine. Often asymmetrical.
Pain characteristics: Stiffness occurs on arising but usually subsides after 30 minutes. Pain gradually worsens with joint use and disease progression, relieved with rest.
Nodules: heberden's and bouchard's nodes
Synovial fluid: WBC count <2000 mild leukocytosis
X-rays: joint space narrowing, osteopaths, subcontractors cysts, sclerosis
Laboratory findings: RF negative, transient legation in ESR related to synovitis.
Medications for arthritis
Disease modifying anti rheumatic drugs
Inhibits metabolism of folic acid
Treats cancers and autoimmune diseases
Causes of Gout
Elevated uric acid level
Risk factors for Gout
Obesity, hypertension, diuretic use, and excessive alcohol consumption
Manifestations of Gout
Typically at night, sudden swelling and pain (initially it's a problem of the big toes)
Possible kidney stones
Subside in 2-10 days with/without treatment
Chronic: joint involvement
Treatment for Gout
Acute gout use NSAIDS and colchicines
Systemic lupus Erythematosus
Chronic multi system inflammatory disease with immune system abnormalities. Extremely variable in its severity, ranging from a relatively mild disorder to rapidly progressive and affecting many organ systems: skin (butterfly rash over nose and cheeks), musculoskeletal (arthritis), lungs (pleurisy), heart (dysrhythmias), nervous tissue (seizures), kidneys (nephritis), and hematologic (bleeding) problems.
Infection (pneumonia) is a major cause of death.
Wide range of symptoms!
Vampires (have to be careful of the sun)
Raynaud's phenomenon, when the fingers change colors in different temperatures.
Treatment for systemic lupus erythematosus
Treatment challenge is to manage active disease while preventing treatment complications.
Drugs (NSAIDS, corticosteroids, antiseizure, and immunosuppressive drugs.)
Education: progress of the disease, stressors, pregnancy, rest/activities, pain management, skin protection, and self esteem.
Systemic sclerosis (Scleroderma)
Caused by overproduction of collagen.
C = Calcinosis, calcium deposits in the skin
R = raynaud, phenomenon, spasm of blood vessels in response to cold or stress
E = esophageal dysfunction, acid reflux and decrease in motility of esophagus
S = sclerodactyly, thickening and tightening of the skin on the fingers and hands
T = telangiectasias, dilation of capillaries causing red marks on surface of skin
Their mouth gets really small, the skin gets really tight.
While no specific drugs have been proven effective for treating SS, many drugs can be used in treating the various manifestations of SS.
Vasoactive agents (Serpasil) (Tracleer) (Flolan)
Calcium channel blockers (Cardizem) (Adalat and Procardia)
Angiotensin converting enzyme inhibitors (lisinopril)
Immunosuppressive drugs (cytoxan) (CellCept)
Systemic sclerosis (intervention)
Physical therapy (isometric exercise) maintains joint mobility, preserves muscle strength, Dysphagia and heartburn reduction, and protect from extreme temperature, infection, and smoking may help.
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