osteo

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Author:
britsands
ID:
150743
Filename:
osteo
Updated:
2012-04-28 23:39:56
Tags:
Brittany
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Description:
osteoporosis, casts/ tractions, hip fractures, total joint replacements (both knee and hip replacements), amputations, lower back pain, osteomyelitis
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  1. Risk factors of Osteoporosis
    • Lower calcium intake than men
    • less bone mass because smaller frame
    • bone reporption begins ealier and accelerates after menopause
    • pregnancy and bresast feeding deplete ca reserves
    • longevity increases likelihood , women live longer than men
    • hyperthyroidism
    • hyperparathyroidism
    • prolonged use of steroids
  2. Assessment for osteoporosis
    • Lower back pain
    • kyphosis
    • decrease in height
    • Sudden strain
    • Fractures
    • Spinal deformities
  3. Diagnosis for osteoporosis
    • X-ray
    • history and physical exams
    • Bone mineral density (BMD)
    • -osteoporosis is bmd of at least 2.5 standard deviations below that of a young adult bmd
    • - osteopenia is more than normal bone loss but not yeat at the level of osteoporosis
    • Quantitiative ultrasound
    • Dual-energy x-ray absorptiometry (DEXA)
  4. Osteoporosis nursing interventions
    • High calcium, protein and vitamin D
    • Teach medications
    • Promote mobility and strength
    • -encourage weight bearing on the long bones
    • -rom exercise
    • -physiotherapy
    • Saftey precautions
    • Bedrest
    • Use of back brace or splint for support
    • Use of bedboards or hard mattress
    • No smoking or alcohol
  5. Osteoporosis medical management
    • Proper nutrition
    • Supplemental calcium
    • Supplemental vit D
    • Weight bearing exercises
    • drug therapy
  6. Food high in calcium
    • milk
    • yogurt
    • turnip greens
    • spinach
    • cottage cheese
    • ice cream
    • sardines
  7. Drugs for osteoporosis
    • Estrogen therapy
    • Calcitonin- thyroid hormone that slows bone loss
    • Biphosphonates-inhibit osteoclast-mediated bone resorption
    • *etidronate (Didronel)
    • *Alendronate (Fosamax)
    • Teriparatide (Forteo)- portion of parathyroid hormone, first drug to stimulate new bone formation
  8. Fosamax
    Things to remember
    • Take in AM at least 30 min before other medication, food, water, or other liquids
    • Should sit up for 30 min after taking medication
    • Use sunscreen and wear protective clothing
  9. Purpose of traction
    • immobilize fracture
    • alleviate pain and muscle spasm
    • Prevent or correct deformitis
    • Promote healing
  10. Non-invasive traction
    • Bucks traction
    • Balanced suspension
    • russell's
    • pelvic traction
  11. Invasive traction
    • Halo fixation device
    • Crutchfield tongs
  12. Nursing care for tractions
    • Maintain straight alighnment of ropes and pulleys
    • Assure the weights hang free
    • Frequent checks for skin breakdown
    • Maintain position for countertraction
    • Encourage movement of unaffected areas
    • Investigate every complaint immediately and thoroughly
    • Maintain coninuous pull
    • Clean pins with half-strength peroxide and sterile swabs 1-2 times/day
  13. Traction that is used for hips and femors
    Keeps foot up in dorsi flex
    Casts assist in reduction, maintain alignment, and help diminish muscle spasm
    Bucks traction
  14. Skin traction weight
    5-10 lbs
  15. Skeletal traction
    5-45 lbs
  16. Cast care
    • 24 hours to dry once applied
    • Keep clean and dry
    • rough edges padded
    • DON'T place anything inside cast
    • prevent constipation
    • *high fluid intake (>2500 mg/day)
    • *diet high in bulk and roughage
    • *stool softners, laxatives (coliase is drug of choice)

    When applying cast use palms of hands, let dry, watch ciruculation, capillary refill, NEVER USE HAIRDRYER
  17. Complications of Fractures
    • Compartment syndrome!
    • Too tight and will have no ciruculation
    • Painfull
    • Must be cut of immediately! Medical emergency
    • Infection
    • Shock: hypovolemic
    • Fat embolism syndrome (long bone)
    • Venous thromboembolism: DVT
  18. Acute compartment syndrome
    • 5 P's
    • pallor
    • pain
    • pulses
    • paralysis
    • paresthesia
    • Treatment: fasciotomy or removal of limb
  19. Shock: hypovolemic
    • Decreased vascular volume: bleeding
    • Long and pelvic bones at risk
    • Signs and symptoms:
    • altered LOC, tachycardia, hypotension, tachypnea, pallor, low urine output, decreased hct and hgb
    • occur initially or after or
  20. Fat Emboli
    • Long bones or multiple fractures
    • Can travel to brain, heart, or lungs
    • Signs and symptoms:
    • Altered mental status, respiratory distress, tachycardia, fever, petechaie on chest
    • occurs within 48 hours
  21. Osteomyelitis
    Nursing management
    • Promote comfort, relieve pain
    • provide cool enviroment and lightweight clothing
    • avoid exercise and heat application to the affected area
    • encourage fluid intake
    • monitor I&O
    • Asepsic wound care
    • high protien with sufficient carbs, vit and minerals
    • small frequent meals
  22. medical management of osteomyelitis
    • takes 3-6 months to heal
    • debriement of bone with antibiotics
  23. Post op care for amputation
    • foot of bed up to promote circulation
    • prevent complications of immobility - ROM exercises, trapeze with overhead frame, prone position every 3-4 hours
    • Provide comfort and relieve pain- propranolol, antiseizure meds, and antispasmodics used for phantom limb pain
    • Provide psycholoical and emotional support
    • Teach residual limb care- inspect daily for abrasions, wash, expose to air, do not apply lotions, se only cotton or wool socks
  24. Medical management of lower back pain
    • Reduction in pain associated with daily activites
    • Rest and local heat application when cold, damp weather aggravates back pain
    • Mild analgesics to decrease pain and stiffness
    • Weight reduction
    • Exercise and activity throughout day
    • -keep muscle and joints mobilized
    • Traction
    • TENS
    • Medications
    • Surgical Interventions
  25. Medications for Lower back pain
    • Tricyclic antidepressants
    • SSRIs
    • NSAIDS
    • Muscle relaxants
    • Corticosteriod injections
  26. Surgical interventions for Lower Back Pain
    • Indicated in patients
    • -with severe chronic low back pain
    • -who do not respond to conservative care
    • -who have neurologic deficits
  27. Nursing management for Lower Back Pain
    1. to relieve pain
    2. regain normal elasticity of affected muscle
    3. To return joint to normal function
    4. Good body mechanics
    • To relieve pain
    • -administer meds
    • -moist heat 20-30 min 4 times a day
    • -bedrest, fowler's position with moderate hip and knee flexation
    • -firm mattress, bedboard, or floor for back support
    • Regain normal elasticity
    • Isometric exercises fro abdominal muscles
    • Daily exercise program
    • Return joint to normal function
    • assist with exercises for abdominal muscles
    • ROM exercises
    • Good body mechanics
    • Bend knees
    • exercise under direction of health care provider
    • Do not stand in one position for a prolong amount of time
    • Sleep in side-lying position with knees and hips bent
    • Avoid prone position
  28. Lower back pain
    Post operative
    (Postlaminectomy Care)
    • Maintain body alignment
    • log roll every 2 hours
    • calf exercises
    • assess for sensations and cirulatory status
    • Monitor elemination
  29. Nursing Implementation
    Fracture hips
    • Total hip replacements-
    • Abduction of affected extremity (2-3 pillows, splint)
    • Turn patient as ordered, keep heels off bed
    • ice to perative site
    • overbed trapeze to left self off fracture pan
    • Prevent DVT
    • Walker initally, then 3 point gait with crutches
    • chair with arms, wheelchair, semireclining toliet seat
    • Don't flex hip more than 45-60* (don't elevate the bed more than 45*)
    • Use shoehorn and extended handles
    • Report increase in pain to hcp immediately
    • cleans incision daily with mild soap and water; dry thoroughly
  30. Complications of hip replacement
    • Dislocation of prosthesis
    • Excessive would drainage
    • Thromboembolism
    • Infection

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