last MS of nursing care

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last MS of nursing care
2015-09-05 22:41:07

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  1. Osteomyelitis
    • osteomyelitis is an infection in the bone or bone marrow. infections can reach a bone by traveling thru the bloodstream or spreading from nearby tissue. osteomyelitis can also begin in the bone itself if an injury exposes the bone to germs
    • infection in the bone
    • difficult to treat
    • can become chronic
  2. Risk factors of osteomyelitis
    • recent injury/trauma/orthopedic
    • - severe bone fracture, surgery, deep animal bites
    • circulation disorders
    • - poorly controlled, perpheral arterial dx
    • Problems requring IV lines/catheters (JACHO trying to correct)
    • - central lines, dialysis machine, IVD abuse
    • Condition of immune system
    • - long term high dose steriods or immunosuppressive therapy, chemo, organ translant
  3. Causative Organisms
    • organisms
    • S. aureus, streptococci, e. coli, pseudomonas, virus, fungus
    • CLassification
    • hematogenous spread
    • contigous spread
    • vascular insufficiency-ischemia
  4. Path of Osteomyelitis
    • infection followed by inflammatory effects
    • Thrombosis occurs can lead to ischemia with bone necrosis- bc the blood is not able to get in
    • abscess formation with dead bone tissue may occur (sequestrum)
    • new bone growth (involcucrum) around the dead bone tissue- if treatment is not strong enough
    • can lead to chronic osteomyelitis
    • Priority of care is infection control
  5. Signs and symptoms osteomyel
    • Acute: onset sudden
    • manifestation of sepsis (origin in blood)
    • bone becomes painful, swollen, tender
    • pain incr with movement
    • Chronic
    • - non healing ulcer, may be a sinus with drainage
    • take care of infection order for antibiotic
    • skin integrity
    • tough infection to treat bc u dont things will get worst
  6. Diagnostics osteomyel
    • Physical exam
    • elevated WBC (5-11), ESR cbc w/diff
    • wound and blood cultures- pathogen
    • x-ray- how far has it effected the bone
    • bone scans
    • bone biopsy- to make sure no cancer
    • MRI
    • hard to treat
  7. Management of osteomyelitis
    • early identification and treatment- goes fast
    • IV antibiotics, pain management, diet (high protein to help with blding of tissue and cells)
    • Immobilization
    • surgical debridement- taking dead tissue out
    • closed wound drainage system
    • home care/referrals/PT
    • teaching/prevention- pathologic fracture
    • emotional support
  8. Complication of osteomyelitis
    • bone death- osteonecrosis
    • impaired growth
    • skin cancer- low %
    • pathological fracture
    • septic arthritis
  9. General complication of fracture septic arthritis
    • invasion of joint cavity with microbes (large bones, in between spaces)
    • occurs hematogenesis or direct trauma or surgical incision
    • risk factors: previous trauma, surgery, R/A, diabetes, elders, treatment with glucocorticoids, immunosuppression (steriods can suppress the immune system)
    • most affected: large joints, (knee, hip, shoulder)
  10. Patho of septic arthritis
    • microbial invasion of synovial membranes
    • inflammatory reaction
    • end result: swelling, tissue destruction
  11. s/s septic arthritis
    • extreme painful swollen joint
    • decrease range of motion
    • systemic s/s: fever, chills, warm
    • careful assessment patients on steriods (weak immune system)
  12. risk factor of septic arthritis
    • joint surgery & injury
    • existing joint injury problems- OA gout
    • poor immune system
  13. Dx septic arthritis
    • H&P- not that helpful
    • Aspiration of joint- pathogen causing this
    • blood culture
    • CT/MRI MRI done more
  14. Management of septic arthritis
    • careful assessment
    • IV broad spectrum antibiotics initially until cultures are returned - vanco
    • IVAB maybe required up to 8 weeks (8-12)
    • analgesics
    • arthroscopy
    • immobilization of joint
    • PT
    • document what u see in the wound
    • send home PICC
  15. Other important nursing managements septic arthritis
    • IVAB
    • wounds irrigation with debridement
    • wound packings saturated with antibiotics
    • assess for s/s of sepsis
    • - evolving process, may or may not have clear s/s
    • - pulse incr and bounds, b/p low, rr incre
    • - fever, flushed skin
    • - urinary output dec
    • - GI: n/v, anorexia- s/e of antibiotic
    • - changes in mental status- PE, fat emboli
    • - late: organ dysfunction and failure
  16. General complication of fracture
    hypovolemic shock
    • 2. Hypovolemic shock
    • related to bleeding (decr intravascular volume)
    • s/s see GI notes on hypovolemic shock
  17. Comp of fracture
    hypovolemic shock
    • inadequate circ, blood volume
    • s/s depend on rate of blood loss
    • - tachycardia, inc resp rate, diaphoresis, pulse thready/weak (over 100b/min)
    • - dec capillary refill
    • - dec b/p, narrow pulse pressure
    • - cool, pale extremities
    • - anxiety change MS
    • - dec urinary output- not enough to do its job
    • - dec H/H, late sign: cyanosis
  18. comp fracture
    tx of hypovolemic shock
    • 1. identify cause and treat
    • stabilize fracture
    • 2. assess vs/o2 stat
    • 3. LS, O2 therapy
    • 4. IV fluids, plasma expanders- LR
    • 5. I/O foley
    • 6. NPO
    • 7. HOB elevated, left side suction equipment/airway
    • 8. assess labs (CBC. ABG, BUN. Cr)- PaO2- 80-10, <60- tells u how much perfusion the cells and tissues are getting. less than 60 damage. BUN- 7-18, cre 0.6-1.2 (how much kidneys have to do its function
    • 9. transfuse PRBC
    • 10. bedrest
  19. general comp of fracture
    compartment syndrome
    • compartment: area encased by bone or fascia (thick ligament tissue)
    • four leg compartments: muscles, nerves, and blood vessels (arteries, veins)
    • compartment syndrome:
    • - limb threaten condition
    • - elevated intracompartmental pressure within a confined space compromises the neurovascular tissues
    • capillary perfusion is reduced and unable to maintain tissue ability
    • so much pressure on the blood vessels and nerve, blood cant go thru and nerve impulses don't happen
  20. comp of fracture
    patho compartment syndrome
    • incre compartment pressure (edema) decr cap perfusion- ischemia develops
    • ischemia causes histamine to be released - futher increases edema and pressure
    • increase in lactic acid production- increases tissue pressure
    • end result:ischemia and necrosis, loss of muscle and nerve function- can loss limb- severe pain and no meds can relieve
    • priority to dec infection
  21. Compartment syndrome causes
    • decrea compartment size from restrictive dressings, cast, splints, excessive traction
    • increased compartment content from bleeding, edema
    • associated with trauma, fractures, soft tissue injury, crush injuries, snake bites
    • most common site: upper arm, leg
    • cast bivalving: cut both sides, 1. to relieve pressure, 2. gives them chance to see what is going on.
  22. s/s compartment syndrome
    • 5 P's red flag
    • Pain: deep throbbing, unrelenting pain
    • - out of proportion to the injury
    • - non responsive to opiods
    • - pain incr with passive ROM
    • Paralysis
    • Paraesthesias (pins/needles)- early signs
    • pallor
    • pulselessness
  23. management compartment
    • medical emergency- notify MD
    • accurate assessments
    • loosen bandages, bivalve cast relieve pressure, may need to reduce traction
    • do not raise extremity above heart level (so u don't cause PE)
    • surgery
    • fasciotomy- surgical procedure where the fascia or fibrous tissue is cut to relieve tension or pressue commonly to treat the resulting loss of circulation to an area of tissue or muscle
    • usually left open, moist sterile dressing
    • assess infection- teach pt not touch so they don't introduce anything to it
  24. Post op fasciotomy
    • accurate assessments
    • - assess infection, bleeding, compartment syndrome (ask for an EBL estimated blood loss)
    • moist, sterile dressings
    • limb is splinted and raised no higher than heart level
    • passive rom
    • monitor urinary output and renal function
    • - release of myoglobin (goes to the kidney and blocks it, so the kidney doesnt get blood supply) from damage muscle
    • - obstruct renal tubles- renal failure
    • - assess I/O, increasing BUN/cr, brown urine
    • look at electrolytes