Osteoporosis

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Author:
alyn217
ID:
203336
Filename:
Osteoporosis
Updated:
2013-02-28 22:47:36
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AMS2T3
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Description:
Adult MedSurg 2
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  1. What are some risk factors for developing osteoporosis?
    • –  Age over 60 years
    • –  Family history
    • –  Caucasian or Asian race
    • –  Thin, lean body build
    • –  Low lifetime calcium intake
    • –  Estrogen deficiency/androgen deficiency
    • –  Smoking history/high alcohol intake
    • –  Lack of physical exercise/prolonged immobility
  2. What are some not so obvious SnSs of osteoporosis?
    • –  Constipation/abdominal distention/reflux esophagitis: Spine can compress so much-->compartment syndrome on GI. 
    • –  Respiratory compromise
  3. Diagnostics for osteoporosis?
    • X-rays
    • 􏰁  Bone density tests (usually through the hips). 
    • 􏰁  Calcium, phosphorus,
    • Vitamin D levels usually wnl
  4. Rx treatment for osteoporosis?
    • Estrogen
    • 􏰁 Calcium
    • 􏰁 Vitamin D
    • 􏰁 Biphosphates (Fosamax)
    • 􏰁 Calcitonin
  5. What is osteomyelitis?
    • pyogenic bone infection
    • 􏰁  Chronic or acute
    • 􏰁  Commonly results from a combination of local trauma (hematoma) and acute infection originating elsewhere in the body
    • 􏰁  Usually remains localized but can spread through bone to marrow, cortex, and periosteum
  6. Characteristics of osteomyelitis?
    • 􏰁  Usually a blood-borne disease or trauma to the area. 
    • 􏰁  Most often affects rapidly growing children (lower end of femur and upper end of tibia, humerus, and radius)
    • 􏰁  Most common sites in adults are pelvis and vertebrae (contamination assoc w/surgery or trauma)
    • 􏰁  Chronic osteomyelitis (rare) is characterized by multiple draining sinus tracts and metastatic lesions
    • Incidence of both chronic and acute osteomyelitis is declining, except in drug abusers
    • 􏰁  Prognosis is good for acute osteomyelitis  with prompt treatment
    • 􏰁  Prognosis is poor for chronic osteomyelitis (more prevalent in adults).
  7. What are the pathogens involved in osteomyelitis?
    • Staphylococcus aureus and...
    • Streptococcus pyogenes
    • Pneumococcus
    • Pseudomonas aeruginosa 
    • E. coli
    • Proteus vulgaris
  8. What are the SnSs of osteomyelitis?
    • Rapid onset of sudden pain in affected bone
    • 􏰁  Tenderness, heat, swelling, and restricted movement over bone
    • 􏰁  May have tachycardia, sudden fever, N, malaise
    • 􏰁  Chronic infection can persist intermittently for years
    • Flare-up after minor trauma
    • Persistent draining of pus from old pocket in a sinus tract
  9. Types of fxr
    • closed, open, comminuted, displaced, 
    • oblique, spiral, impacted, greenstick
  10. Read about cast care
  11. How do you get a fat emboli?
    • Develops from fxr, travels through venous system-->lung vasculature = PE. 
    • Tx is minimal. Just hoping healthy lung tissue compensates for eschemic tissue. 
    • Often will have cardiac arrest as 1st symptom.
  12. Where would you typically get a hip fxr?
    • Vascular bed of head of femur is poorly vascularized-->avascular necrosis.
    • When fxr is in proximal 1/3, there really isn't much medical intervention possible because of poor vascularization.
    • In other areas, screws n such can be helpful.
    • ORIF: Open Reduction Internal Fixation. Look it up.
  13. Why traction?
    • The weight and pull fatigues the muscle and it will not spasm. 
    • Skin care beneath traction is a nursing priority, but need MD order to remove it.
  14. Nursing diagnosis for fxr
    • risk for peripheral neurovasc dysfunction
    • pain
    • risk for infection
    • 􏰀Impaired physical mobility
    • 􏰀Altered nutrition
    • 􏰀Activity intolerance
    • 􏰀Constipation
  15. Peripheral neurovascualr dysfunction
    • Pain in affected extremity unrelieved by drugs
    • 􏰁 Paresthesias
    • 􏰁 Pain on passive movement
    • 􏰁 Weakness
    • 􏰁 Cool temperature
    • 􏰁 Pallor
    • 􏰁 Diminished pulses
  16. Complications associated with fxr?
    • Acute compartment syndrome
    • 􏰀Shock
    • 􏰀Fat embolism syndrome (FES)
    • 􏰀Complications from thromboembolism
    • 􏰀Deep venous thrombosis (DVT)-->Pulmonary embolism
    •  􏰀Infection
    •  􏰀Avascular necrosis (AVN)
    •  Delayed union (take forever), nonunion (never heals), and
    • NIT 5/26
    • malunion
  17. What is cast syndrome?
    • 􏰁  Body cast applied too tightly
    • 􏰁  Cast compresses the superior mesenteric artery against the duodenum
    • 􏰁  Patient complains of abdominal pain and pressure, N/V
    • – NG tube and suction
    • – May need to remove or split cast
  18. Read about compartment syndrome
  19. What are the 6 ps of compartment syndrome?
    • -- Paresthesia (numbness and tingling)
    • –  Pain (distal to the injury)
    • –  Pressure (rises)
    • –  Pallor (coolness and loss of color)
    • –  Paralysis (loss of function)
    • –  Pulselessness (diminished or absent)
  20. Nursing care for compartment syndrome?
    • Prevent
    •  – Do not elevate extremity above heart level because...
    • ...Raises venous pressure and slows arterial perfusion
    • – Do not use ice
    • • Vasoconstricts
    • 􏰁 Diagnose promptly
    • – Notify MD
  21. Nursing care for ORIF?
    Early ROM via CPM-->faster healing and earlier ambulation-->v risk of DVT, PE, etc.

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