Med Surg Ch 64

  1. Osteomyelitis
    a severe infection of the bone, bone marrow, and surrounding soft tissue.
  2. Indirect entry
    (hematogenous) microorganisms in osteomyelitis most frequently affects growing boys less than 12yrs associated with higher incidence of blunt trauma.
  3. Direct entry
    can occur at any age when there is an open wound (penetrating wounds, fractures). May also occur due to the presence of a foreign object (prosthesis)
  4. Sequestra
    Once ischemia occurs, the bone dies. The area of devitalized bone eventually separates from the living surrounding living bone, forming sequestra.
  5. Involucrum
    is the part of the periosteum that continues to have a blood supply forms new bone called involucrum.
  6. Drug Alert (Gentamicin-Garamycin)
    instruct pt to notify physician if any visual, hearing or urinary problems develop. Assess pt for dehydration before starting therapy.
  7. Ciprofloxacin (cipro)
    in adult pts with chronic osteomyelitis oral therapy with a fluoroquinolone for 6 to 8 wks may be prescribed instead of IV antibiotics.
  8. Dressings used
    • dry
    • sterile
    • saturated in saline or antibiotic solution
    • wet to dry
    • *when the dressing is changed, sterile technique is essential*
  9. The pt should avoid
    • exercise
    • heat application that increase circulation and swelling and serve as stimuli to the spread of infection.
  10. Potential adverse and toxic reactions associated with prolonged and high-dose antibiotic therapy
    • hearing deficit
    • fluid retention
    • neurotoxicity
    • jaundice
    • coltis
    • photosensitivity
    • overgrowth of Candida albicans (thrush)in genitals or oral cavity
  11. Benign bone tumors
    • Osteochondroma
    • Osteoclastoma
    • Endochroma
  12. Malignant bone tumors
    • Osteogenic sarcoma
    • Chondrosarcoma
    • Ewing's sarcoma
    • Chordoma
  13. Osteochondroma
    overgrowth of cartilage & bone near the end of the bone at the growth plate. Most commonly found in long bones of the leg, pelvis or scapula.
  14. Clinical manifestations for Osteochondroma
    painless, hard, and immobile mass, lower than normal height for age, soreness of muscles in close proximity to the tumor, one leg or arm longer than the other, and pressure or irritation with exercise.
  15. Osteogenic sarcoma
    is extremely aggressive & rapidly metastasizes to distant sites. Associated with Paget's disease.
  16. metastatic bone cancer
    high serum calcium levels result as calcium is released from damaged bones.
  17. Nursing assessment
    • assess for locations & severity of pain
    • swelling at the involved site
    • decreased joint function
    • weakness due to anemia
  18. Types of muscular dystrophy
    • Duchenne
    • Becker
    • Landouzy-Dejerine
    • Erb
  19. DDD (degenerative disk disease)
    intervertebral disks losing their elasticity, flexibility and shock-absorbing capabilities. Thinning of the disks occurs as the nucleus pulposus(gelatinous center of the disk) starts to dry out & shrink.
  20. Herniated intervertebral disk
    slipped disk. The result of natural degeneration with age or repeated stress & trauma to the spine.
  21. IDET
    (intradiscal electrothermoplasty) minimally invasive outpatient procedure that involves the insertion of a needle into the affected disk with guidance of an xray, the wire is then heated.
  22. CSF (cerebrospinal fluid)
    severe headache or leakage of CSF on the dressing should be reported immediately. CSF appears as clear or slightly yellow drainage on the dressing & will test positive for glucose on dipstick.
  23. Loss of sphincter tone or bladder
    may mean nerve damage, incontinence or difficulty evacuating the bowel or bladder must be monitored closely reported to the surgeon.
  24. Laminectomy
    involves the surgical excision of part of the posterior arch or the vertebra to gain access to part or the entire protruding disk to remove it.
  25. Hallux valgus (bunion)
    painful deformity of great toe consisting of lateral angulation of great toe toward 2nd toe, bony enlargement of medial side of 1st metatarsal head & formation of bursa or callus over bony enlargement.
  26. Hammer toe
    complaints related to hammer toe include burning on bottom of foot, and pain and difficult in walking when wearing shoes.
  27. Foot surgery
    The foot should be elevated with the heel off the bed to help reduce discomfort and prevent edema.
  28. Osteomalacia
    is a rare condition of adult bone associated with vitamin D deficiency resulting in decalcification & softenin of the bone.
  29. Osteoporosis
    or porous bone (fragile bone disease) is a chronic, progressive & structural deterioration of bone tissue, leading to increased bone fragility.
  30. Paget's Disease
    is a skeletal bone disorder in which there is excessive bone resorption followed by replacement of normal marrow by vascular, fibrous connective tissue.
  31. Salmon calcitonin
    is a subcutaneous or IM injection for treating Paget's disease.
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Med Surg Ch 64