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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
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
Diagnostics for osteoporosis?
- Bone density tests (usually through the hips).
- Calcium, phosphorus,
- Vitamin D levels usually wnl
Rx treatment for osteoporosis?
- Vitamin D
- Biphosphates (Fosamax)
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
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).
What are the pathogens involved in osteomyelitis?
- Staphylococcus aureus and...
- Streptococcus pyogenes
- Pseudomonas aeruginosa
- E. coli
- Proteus vulgaris
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
Types of fxr
- closed, open, comminuted, displaced,
- oblique, spiral, impacted, greenstick
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.
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.
- 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.
Nursing diagnosis for fxr
- risk for peripheral neurovasc dysfunction
- risk for infection
- Impaired physical mobility
- Altered nutrition
- Activity intolerance
Peripheral neurovascualr dysfunction
- Pain in affected extremity unrelieved by drugs
- Pain on passive movement
- Cool temperature
- Diminished pulses
Complications associated with fxr?
- Acute compartment syndrome
- Fat embolism syndrome (FES)
- Complications from thromboembolism
- Deep venous thrombosis (DVT)-->Pulmonary embolism
- Avascular necrosis (AVN)
- Delayed union (take forever), nonunion (never heals), and
- NIT 5/26
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
Read about compartment syndrome
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)
Nursing care for compartment syndrome?
- – Do not elevate extremity above heart level because...
- ...Raises venous pressure and slows arterial perfusion
- – Do not use ice
- • Vasoconstricts
- Diagnose promptly
- – Notify MD
Nursing care for ORIF?
Early ROM via CPM-->faster healing and earlier ambulation-->v risk of DVT, PE, etc.