Rans

• Osteomyelitis


  Severe infection of the bone, bone marrow, and surrounding soft tissue

  
• Osteomyelitis


  • Staphylococcus aureus is a common cause
  • Pelvis, tibia, and vertebrae are the most common sites of infection

  
• Osteomyelitis progression


  1. Microorganism gain entry into blood

  2. Microorganism grow resulting in increased pressure

  3. Increased pressure leads to ischemia and vascular compromise of periosteum

  4. Part of periosteum with blood supply forms new bone (involucrum)

  5. Sequestrum may become reservoir for microorganisms

  
• Acute osteomyelitis


  Infection of less than 1 month in duration

  
• Local clinical manifestations of acute osteomyelitis

  • Constant bone pain
  • Swelling
  • Tenderness
  • Warmth at infection site
  • Restricted movement of affected part

  
• Systemic manifestations of acute osteomyelitis

  • Fever
  • Night sweats
  • Chills
  • Restlessness
  • Nausea
  • Malaise

  
• Chronic osteomyelitis


  Bone infection more than 1 month or an infection that has failed to respond to initial antibiotic therapy

  
• Manifestations of chronic osteomyelitis

  • Constant bone pain
  • Swelling
  • Warmth at infection site

  
• Collaborative care for osteomyelitis


  • Culture and bone biopsy
  • Antibiotic therapy
  • Surgical debridement
  • Hyperbaric oxygen
  • Removal of orthopedic prosthetic devices
  • Muscle flaps or skin grafting
  • Amputation

  
• Nursing implementation for osteomyelitis


  • Instruct patient to report symptoms
  • Immobilize affected limb
  • Assess patient's pain
  • Provide comfort measures
  • Encourage non-drug pain management
  • Handle soiled dressings carefully
  • Advise bedrest and good body alignment
  • Teach patient about antibiotic therapy
• Ambulatory and homecare for osteomyelitis

  • Instruct patient and caregiver on venous access device care
  • Teach administration of antibiotics and follow-up lab tests
  • Continue physical and psychological support
• Benign bone tumors


  More common than primary malignant tumors

  
• Osteochondroma


  Overgrowth of cartilage and bone near the end of the bone at the growth plate

  
• Clinical manifestations of osteochondroma

  • Painless, immobile mass
  • Lower-than-normal height for age
  • Soreness of nearby muscles
  • One leg or arm longer than the other
  • Pressure or irritation with exercise
  • Asymptomatic

  
• Treatment of asymptomatic osteochondroma


  No treatment necessary

  
• Malignant bone tumors


  Sarcomas that can develop in bone, muscle, fat, nerve, or cartilage

  
• Osteosarcoma


  Most common malignant bone tumor, often associated with Paget's disease or prior radiation

  
• Clinical manifestations of osteosarcoma

  • Gradual onset of pain and swelling, especially around the knee

  
• Treatment of osteosarcoma


  Preoperative chemotherapy, limb salvage procedure

  
• Metastatic bone cancer


  Metastatic cancer cells travel from primary tumor to bone via lymph and blood supply

  
• Common sites of metastatic bone lesions

  • Vertebrae
  • Pelvis
  • Femur
  • Humerus
  • Ribs

  
• Treatment of metastatic bone cancer

  Palliative, consisting of radiation and pain management, surgical stabilization of bone

  
• Nursing management of bone cancer

  • Assess location and severity of pain
  • Note weakness from anemia and decreased mobility
  • Monitor tumor site for swelling, circulation changes, decreased movement/sensation/joint function
  • Support affected extremity
  • Provide regular rest periods
  • Assist patient and caregiver in accepting poor prognosis
  • Stress importance of follow-up exams

  
• Muscular dystrophy


  Group of genetic diseases characterized by progressive symmetric wasting of skeletal muscles without neurologic involvement

  
• Duchenne and Becker muscular dystrophy

  1. linked recessive disorders with mutation in dystrophin gene leading to muscle fiber degeneration
• Diagnosis of muscular dystrophy

  Muscle biopsy

  
• Medical management of muscular dystrophy

  • Exercise, physical therapy, orthopedic appliances
  • Orthotic jacket for stability and deformity
  • Tracheostomy and mechanical ventilation for respiratory function
  • Corticosteroid therapy
  • Communication among family members to cope with strains
  • Teach range-of-motion exercises, nutrition, and progression
  • Avoid prolonged bedrest
• Osteomalacia


  Caused by vitamin D deficiency, resulting in decalcification and softening of bones

  
• Causes of osteomalacia


  • Lack of UV exposure
  • GI malabsorption
  • Extensive burns
  • Chronic diarrhea
  • Pregnancy
  • Kidney disease
  • Drugs like Phenytoin

  
• Clinical manifestations of osteomalacia

  • Bone pain
  • Difficulty rising and walking
  • Muscular weakness
  • Weight loss
  • Progressive deformities
  • Fractures
  • Delayed bone healing

  
• Management of osteomalacia


  • Calcium and phosphorus supplements
  • Dietary sources of vitamin D
  • Exposure to sunlight
• Osteoporosis


  Chronic, progressive metabolic bone disease characterized by low bone mass and structural deterioration, leading to increased fragility

  
• Clinical manifestations of osteoporosis


  • Back pain
  • Spontaneous fractures
  • Gradual loss of height
  • Kyphosis ("dowager's hump")
• Nursing and collaborative management of osteoporosis

  • Teach importance of calcium supplements
  • Recommend vitamin D supplements
  • Encourage regular physical activity and exercise
  • Teach use of gait aids
• Paget's disease


  Chronic skeletal disorder characterized by abnormal bone remodeling

  
• Osteomalacia


  Vitamin D deficiency
• Collaborative care of osteomalacia

  1. Correction of Vitamin D deficiency

  2. Calcium salts and phosphorus supplements

  3. Encourage dietary ingestion of eggs, meat, oily fish, and milk, cereals

  4. Exposure to sunlight
• Osteoporosis


  Porous bone (fragile bone disease), a chronic, progressive metabolic bone disease characterized by low bone mass and structural deterioration of bone tissue, leading to increased bone fragility

  
• Osteoporosis


  • Back pain or spontaneous fractures
  • Gradual loss of height
  • Kyphosis or "dowager's hump"
• Nursing and Collaborative management of osteoporosis

  1. Teach patient the importance of taking supplemental calcium

  2. Supplemental vitamin D (800 to 1000 IU) is recommended for postmenopausal women, older men, and those who get minimal sun exposure

  3. Encourage regular physical activity and exercise

  4. Teach patient the use of gait aid as needed