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Osteoarthritis (OA) -

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non inflammatory degenerative joint disease characterized by degeneration of the articular cartilage, hypertrophy of bone at margins, and changes in synovial membrane.

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Osteoarthritis occurs because..

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of damage to articular cartilage and the metabolic response that results at the chondrocyte level. As a result of articular cartilage damage, enzymes are released that break down the cartilage.

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OA usually happens to..

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one joint assymetrical

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OA signs and symptoms

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Pain and stiffness usually after activity

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OA assessment..

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Patients described as aching. We must put focus on assessing the joints when examining. Always compare affected joints opposite and distal to proximal (knee pain could be from OA of the hip). Tenderness, crepitus and limited ROM are symptoms.

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Planning for OA -

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rest, surgical joint replacement, distraction techniques, analgesics or narcotics. Encourage ROM exercises (passive and active)

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OA exercises performed

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Aerobic exercise can be done by the client at home but physical therapist can help to strengthen muscle, joint stability and when to apply heat and ice therapies as well as walking devices.

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Osteoarthritis Patient Teaching

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advice and education about healthy lifestyles, pain management techniques, joint protection, and developing problem solving skills. Integrated rehabilitation programs focus on exercises to improve strength, flexibility, mobility, balance, and coordination. The goal of combining these modalities is to promote behavioral changes that lead to adherence of treatment (Hurley & Walsh, 2009).

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OA Risk Factor

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Particularly of the knee is overweight and obesity. Weight loss has shown promising results.

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Nutrients that keep bones healthy are

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Calcium, phosphate, vitamin D, selenium, proteins and iron.

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OA's first priority is...

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Pain Control. Acetaminophen first in line

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Second suggested Medication for OA

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NSAIDS - motrin, naproxen sodium, methicin, piroxican, nabumetone. Celecoxib widely used as well.

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Ibuprofen can cause

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GI bleeds

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COX 2 was developed to

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help relieve pain without GI complications NSAIDS deliver.

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Opoids are administered to OA patients if..

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No other meds work (acetaminophine, NSAIDS, COX 2) however they do nothing to combat inflammation in joint and surrounding tissue.

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Intraarticular Injections

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used to replace lost synovial fluid and decrease local inflammation.

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Steroid Injections may be used to

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Manage MS disorders. They last 2 to 6 weeks and have effects within 24 hours.

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Topical steroid used for MS disorders is

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Lidocaine

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Arthroscopy is used..

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for removal of loose bodies and resection of torn tissue when joint space is sufficiently wide yet causing pain and mobility issues.

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Tibial Osteotomy

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employed when the patient has knee OA with a relatively small varus (inward) angle and stable ligament support.

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Osteoarthritis Care Plans

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- Acute pain -Chronic pain - impaired physical mobility -Activity Intolerance - bathing / hygiene self-care deficit - Dressing grooming self care deficit

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Gout is

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A metabolic disorder that primarily affects men and stems from elevated urate levels in the body. It is hereditary.

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Gout Epidemiology

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Mostly found in Pacific Islanders. 90% of patients with secondary gout are men over 30. Women who develop gout are usually menopausal.

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Primary gout is a

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result of excessive purine synthesis, increased nucleic acid.

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Secondary Gout is

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result of a known cause. Cause can be from acquired diseases such as hyperuricemia (abnormal amount of uric acid in urine), obesity, starvation, lead toxicity, use of certain drugs, organ transplant.

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The main cause of Gout is...

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Hyperuricemia

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Gout occurs in..

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One joint only. Usually big toe

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Develops from gout and contains uric acid crystals that cause foreign body reaction leading to acute arthritic attack

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Tophus

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Elevated uric acid can develop..

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Kidney Stones

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When assessing a gout client..

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Patient is likely to report rapid development (within hours) of pain, edema in affected joint only.

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Contributing factors of gout..

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trauma, alcohol, medication, acute illness, family history.

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Gout physical exam will reveal..

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swelling, pain, and decreased ROM in affected joint, fever headache and hypertension may also be present.

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Lab findings for Gout reveal..

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reveal uric acids elevated. Urine albumin greater than 100 mg/24 hours, urinary uric acid will be elevated and leukocytosis will be present. 80% of gout patients can be diagnosed using physical exam, synovial fluid aspiration is controversial but at times have therapeutic effect due to fluid withdrawal.

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Gout management goals

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First Pain and edema Secondarily treat hyperuricemia

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During gout attack ..

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bed rest is recommended. Heat, ice and elevation relieve pain and edema during an attack.

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Gout Nutrition teaching

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diet low in purines to reduce serum uric acid. Low purine foods are refined cereals, white bread, pasta, and flour; milk and milk products, sugar and sweets, gelatin, all fats, nuts and peanut butter, vegetables, and cream soups. High purine foods to avoid include: alcoholic beverages, anchovies, sardines, cod, trout, mussels, scallops, and oysters, turkey, veal, organ meats and bacon.

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Medications for Gout

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1. NSAIDS 2. Specific gout medications 3. corticosteroids 4. Analgesics

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Complications of Gout

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soft tissue damage and deformity, joint destruction, nerve compression syndrome, nephrolithiasis, and gout nephropathy

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Lyme Disease (LD) is..

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multisystem inflammatory process with devastating long term effects if not treated early. It is a bacterial infection that happens after a bite from an infected tick. The disease is linked to spirochete bacterium which spread to humans by tiny ticks of the ixodidae family.

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Tick must remain on skin for...

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36 to 48 hours

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Symptoms of LD

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Patients will generally present with flu-like symptoms. Low grade fevers, fatigue, muscle and bone aches, chills, and malaise. 90% of people develop a rash called bullseye (circular red spot) Second stage of symptoms spread throughout the body. Symptoms include numbness and pain in arms and legs, paralysis of face muscle, meningitis, and rarely abnormal heart rhythm. 3rd stage can occur weeks or even years after infection in patients who never received antibiotic early on.

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Tests for Lyme Disease

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ELISA and western blot are used to diagnose Lyme disease. Elisa is taken 2 to 6 week. Then the western blot is used to confirm.

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Nursing Diagnosis LD

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activity intolerance related to fatigue or weakness; risk for infection related examples of nursing diagnoses for the patient with all stages of LD include activity intolerance related to fatigue or weakness; risk for infection related to longer term antibiotic use; and anxiety related to unknown progression of the disease.

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Early illness of LD is treated with

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oral drugs, doxycycline, amoxicillin, or cefuroxime.

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Later illness for LD medication

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Later illness such as nervous-system disease might require IV such as ceftriaxone and penicillin G.

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Spondyloarthropathies are a

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a group of systemic, inflammatory, rheumatic-type syndromes. These syndromes have common symptoms. The symptoms can make initial diagnosis challenging. The nurse's responsibility is to assess accurately the patient's complaints or lack thereof to assist in making a specific diagnosis and to provide education and support to the patient and family.

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The arthritic symptoms like RA usually occur ..

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in the morning with pain and stiffness. Tend to lessen out as day progresses. Recognizing timing of symptoms helps identify correct diagnosis.

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RA physically presents...

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sausage toes and complaints or arthritis symptoms in knees and ankles, Urethritis symptoms, such as edema and redness at, and purulent drainage from, the urethral meatus may be present.

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AS is determined by

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XRAY revealing squaring of vertabrae

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Psoriatic arthritis (PA) erosions may be seen ...

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in the distal interphalangeal joints of hands and feet.

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The goals of care for patients with the spondyloarthropathies involve..

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minimizing inflammation, maintaining. Functional ability, controlling pain, and minimizing the effects of systemic complications.

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Maintaining an erect posture during daily activities and sleeping on a firm mat- tress with a thin pillow reduce the tendency toward

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thoracic kyphosis

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rest does not decrease the symptoms with

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spondyloarthropathies

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spondylarthropies First line of treatment plan is administration of

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NSAIDS! This is followed up by the use of sulfasalazine when NSAIDS are no longer effective in relief. Disease-modifying antirheumatic drugs (methotrexate and cyclosporine) have shown some effectiveness against inflammation. Corticosteroid injections can decrease local inflammation.

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Ankylosing spondylitis (AS) is a

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a chronic, progressive, inflammatory arthritis that primarily affects the synovial joints of the spine and soft tissue surrounding the spine (Brown, 2009). AS refers to fusion (ankylosis) of inflamed vertebrae (spondylitis)

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AS signs and symptoms..

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One will have gradual onset of low back pain. Pain is worse in the morning and lessens with activity. Decrease in spine mobility likely.

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Reactive Arthritis also known and reiter's syndrome ..

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associated with infectious process, often chlamydia or enteritis secondary to gram-negative enterobacteria.

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Commonly seen with RA is..

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Sausage Toe - commonly seen in patients with RA. Heel pain is a distinguishing symptom to Reactive Arthritis. Usually an acute attack, symptoms present for five days to five months. Classic symptoms are a triad of problems that affect urethra, conjunctiva, and synovium. However some are treated with only two symptoms. Research focuses more on treatment then etiology of illness.

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Psoriatic Arthritis (PsA)

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develops in association with diagnosis of psoriasis. (silver thick layer developed on top of skin). PsA is progressive, chronic, inflammatory form of arthritis accompanied by fatigue, severe joint pain and swelling.

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With PsA nail lesions occur in about 80% of patients..

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These nail lesions are pitting and include onycholysis (loosening of the nails starting at the border). Uveitis may also be present and chronic. **Uveitis is a form of eye inflammation. It affects the middle layer of tissue in the eye wall (uvea).**

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Polymyositis (PM) and dermatomyositis (DM) are..

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are another set of autoimmune disorders that affect musculoskeletal system. These syndromes cause muscle weakness secondary to muscle inflammation, WHICH if left UNCHECKED leads to respiratory failure and death.

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The causes of PM and DM ..

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are not known. It is known that these autoimmune disorders cause extensive necrosis and destruction of muscle fibers. As with most autoimmune disorders, autoantibodies develop and start destroying target areas.

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DM is also associated with an increased risk of ..

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cancer, especially in older adults (Porth, 2009). The cancers seen are ovarian, in the GI tract, lung, breast, and non-Hodgkin's lymphomas.

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DM often presents a ..

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rash on upper eyelids with blue purple discoloration and edema. There may also be a reddish rash on face and chest in shape of a V or over back and shoulders. Another characteristic rash is known as Gottron rash or sign. This red rash appears on the knuckles of the hands and fingers.

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There are three hallmark tests that confirm the diagnosis of PM or DM:

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elevated muscle enzymes, an abnormal electro- myogram, and positive results in a muscle biopsy.

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PM and DM medications..

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First line of treatment is prednisone in doses of 40 to 100 mg per day. This is prescribed for several weeks to decrease inflammation that is causing the muscle weakness. Prednisone is eventually tapered to a dose that effectively treats symptoms and lowers serum enzyme levels. Usually switched to every other day.

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Fibromyalgia is..

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Syndrome that involvez widespread muscular stiffness, pain and tenderness.

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Signs and symptoms of fibromyalgia

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Lack of restorative or deep sleep has been described as a contributing factor and symptom. Fatigue and insomnia are frequently cited as symptoms also.

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Cause of fibromyalgia is..

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unknown those who experience pain in response to stimuli that are not normally perceived as pain. Studies show that a nerve chemical signal P, and nerve growth factor in the spinal fluid of fibromyalgia patients. Brain chemical serotonin is also low in the patients.

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Fibromyalgia patients

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do not experience rapid eye movement sleep (REM) which explains the insomnia and waking up fatigued.

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Signs and symptoms fibromyalgia

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Lack of sleep. Fatigue and insomnia

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Fibromyalgia studies show..

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A nerve signal P, and nerve growth factor in spinal fluid of fibromyalgia patients. Brain serotonin is also low and they do not experience REM sleep.

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Fibromyalgia has been subject to debate because of

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Its lack of evidence and definitive lab results

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Pharmacology and fibromyalgia

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Analgesics combined with antidepressents

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Osteoporosis

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Characterized by low bone mass, deterioration, compromised bone strength and increase risk of fractures.

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Declining estrogen levels at menopause..

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Cause increase bone turnover and loss of bone mass.

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Those at great risk for osetoporosis are..

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Personal history of fracture, history of fragility, low body weight less than 127, current smoking, use of oral corticosteroid therapy for more than 3 months, minor risks are impaired vision, estrogen deficiency, dementia, poor health, recent falls, low calcium intake, low physical activity, alcohol in great amounts.

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Bone mass peaks in 20's..

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Then breakdown outpasses formation causing bone declines

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Assessing OP

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Often called the silent disease because its first indication of problem is usually a fracture. Kyphosis and decrease in height are also symptoms.

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After 45 age decrease in height is natural at a

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0.09% decrease.

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Labs done for op are..

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Calcium, phosphate, vitamin d, alkaline phosphate, and protein electrophoresis.

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Those newly diagnosed for osteoporosis priority diagnosis should be..

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Deficient knowledge r/t new diagnosis OP. Anxiety r/t fear of fracture may be another diagnosis.

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Potential nursing diagnosis for osteoporosis are:

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Impaired physical mobility (actual or high risk for) related to effects of osteoporosis • Potential for injury related to impaired physical mobility • Pain related to injury or effects of osteoporosis • Alteration in nutrition: less than body requirements related to poor appetite, change in taste or smell, nutritional intake imbalance or lack of funds. Constipation and ineffective breathing patterns may be an issue when kyphosis is present due to intrathoracic and abdominal pressure.

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Nutrition Osteoporosis

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- 1000 to 1500 mg of calcium a day to maintain good bone health. Equivalent to 5 , 8 ounce glasses of milk. Calcium supplementation is usually necessary.

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Pharmacology OP

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alendronate (Fosamax), risedronate (Actonel), and ibandronate (Boniva) are medications from the class of drugs called biphosphates are approved for both prevention and treatment of postmenopausal OP.

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Alendronate helps to

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helps bone loss when one take prednisone or cortisone approved for men.

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Risedronate is

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approved to prevent and treat glucocorticoid induced osteoporosis in men.

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Zoledronic acid (reclast) is

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approved for treatment of postmenopausal OP, prevention of fractures in patients who have recently had a low trauma hip fracture, and prevention of glucocorticoid-OP in men and women.

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Side effects of Bisphosphonates include

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GI problem, difficulty swallowing, inflammation of esophagus, and gastric ulcer.

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IV bisphosphate side effects

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flu like symptoms, fever, pain in muscles or joints and headache. Generally stop after 2 to 3 days.

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Biphosphates rarely linked to

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visual disturbances and osteonecrosis

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Raloxifene (evista) is approved for

answer

prevention and treatment of postmenopausal OP. it is part of the drug class estrogen agonists/anatagonists. Hot flashes and blood clots reported but not likely SE.

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Calcitonin (miacalcin, fortical) is a

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a naturally occurring hormone involved in calcium regulation and bone metabolism. Approved for women who are ATLEAST 5 years post menopause.

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If calcitonin is injected it ..

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could cause flushing, frequent urination, nausea and skin rash.

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Teriparatide (forteo) is

answer

an injectable form of human parathyroid hormone. Approved for postmenopausal women and men with osteoporosis who are at high risk for having a fracture. It works to stimulate new bone formation. SE: nausea, dizziness, and leg cramps. Approved for use up to 24 months.

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Exercise and occupational therapy OP

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Weight bearing exercises help fight against OP. Walking is an easy therapy also.

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Main focus of OP is

answer

PREVENTIONS

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Evaluation OP

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- management of OP is lifelong and prevention of further bone loss is vital to prevent the sequela of fractures. The diseases progression and regression can be monitored through a BMD scan and biochemical marks of bone turnover found in urine.

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Most frequent and serious complication of OP is

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Fractures, other problems include weakness, fatigue from pain, kyphosis, and risk for falls.

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Osteomalacia

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Is a metabolic disease that causes poor and delayed mineralization of the bone cells in mature bones. Related to vitamin D deficiency. Elderly and premature infants with low birth weights and some vegans on strict macrobiotic diet.

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Osteomalacia Risk factors include

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diet low in Vitamin D, low endogenous production of vitamin D (lack of sunlight), malabsorption, renal tubule disease and anticonvulsant therapy. Liver disease interferes with metabolism with Vitamin D. Diseases of pancreas and biliary system cause a deficiency of bile salts needed for vitamin D absorption.

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Bone cell mineralization requires

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adequate of calcium and phosphate. Vitamin D regulates the absorption of calcium ions from intestine. Lack of VD interrupts this process.

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Osteomalacia assessment

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- history of generalized skeletal pain and tenderness with history of injury. Hips are most frequent for pain. Waddling gait.

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Diagnosis for osteomalacia include

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- impaired physical mobility related to osteomalacia, Risk for impaired skin integrity related to compromised tissue perfusion. Acute pain as related to osteomalacia.

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To prevent VD deficiency

answer

sunlight exposure and vitamin D supplementation are recommended. The RDA of VD is 400 IU/day and for those lacking VD 1000 IU/day.

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Osteomalacia patient teaching

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Teach the patient about disease itself, Medication and nutrition education will focus on prevention with vitamin d and sunlight exposure or correction of deficiencies of other causes of malacia. Sunblock does not stop the exposure to VD, always recommend wearing it.

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Complications of OM

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- fractures and bone growth but the disease is treatable so outcomes are good

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Paget's Disease

answer

Often undiagnosed, pain associated with paget's is similar to arthritis. It is chronic bone disorder with no definitive cure. Early diagnosis with effective treatment can lessen its impact.

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Paget's pathophysiology

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Begins with increase in bone absorption. To compensate bone formation increases along with bone remodeling. This new formed bone is weak which leads to deformity and fractures. Areas most often affected is long bones, pelvis, lumbar vertebrae, and skull.

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Assessment Pagets

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thorough history family incidence and previous fractures. Most common symptoms is pain in hips and pelvis. Pain is described as deep aching that worsens with weight bearing. Patient may have deficits in hearing, vision, swallowing, speech, eye movement, facial muscles and balance. Inspect skeleton for deformities. Bowing of long bones of the arms and legs is common finding. Bowing of tibia can cause increased pain to the knee and ankle and increased risk of fracture. Skull is often enlarged, spine may also have kyphosis or scoliosis. Palpation of the skin over areas of pagetic bone may reveal areas warm to touch because of increased blood flow to the new forming bone.

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Diagnostic Test Pagets's

answer

serum alkaline phosphate (ALP) often a first indicator that patients symptoms are associated with Pagets not arthritis. Normal serum ALP is 30 to 115 IU, slighty higher level indicates fracture. Values three times greater indicate pagets. An increase of ALP indicates increase in bone formation.

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Nursing diagnosis PD

answer

Acute pain • Chronic pain • Impaired physical mobility • Activity intolerance • Bathing/hygiene self-care deficit • Dressing/grooming self-care deficit

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Areas of focus for Nurse for Paget's Disease

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- Symptom management, limiting disability, and complication prevention. The goal is to prevent any further complications by restoring normal pattern of new bone formation.

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Four interventions for Paget's

answer

physical therapy, pharmacological therapy, analgesics and surgery.

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Pagets rarely kills patient but

answer

prescribed treatment is usually effective in decreasing pain and slowing progression of the disease.

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if pagetic bone presses on nerves ..

answer

Neuro Complications can occur. this could cause hearing loss, changes in vision, impairment of eye and facial muscles, and problems with swallowing, speech, and balance. Other neuro complications include - hydrocephalus, radicular neuropathies, and spinal stenosis.

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Pagetic bones are prone to

answer

bleeding. Hemorrhage and increase in blood loss during bone surgery may occur. Bisphosphates may be given prior to surgery to reduce bleeding of bone during surgery.

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Complication of Pagets

answer

Hypercalcemia. it is imperative patient continues weight bearing activities to keep bones strong. Any prolonged bed rest, especially after surgery will increase bone demineralization and hypercalcemia. Hypercalcemia can contribute to hypertension, weakness, urinary lithiasis or mild bowl disturbances.

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Pharmacology Pagets Disease

answer

- Antiresorptive agents inhibit osteoclastic activity therefore suppressing bone turnover. Calcitonin was once used via injection and expensive so it is not used as much anymore. Bisphophonates are other types antiresorptives agents used to slow progression of Paget's Disease and to treat bone pain associated with disease.

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Biphosphates

answer

Also used in surgery to prevent bleeding. They must be taken orally and waking with a full glass of water on empty stomach and patient must sit upright for 30 minutes. This must be followed to prevent reflux that may cause esophagitis. Food, milk and other dairy products prevent absorption of this drug therefore patients stomach must be empty.

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Side effect of biphosphates is

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Hypocalcemia is a potential side effect so patient should be taking calcium and vitamin D.

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Exercise and Pagets Disease

answer

physical therapy is another vital component in treatment. Focus is to improve muscle strength. Occupational therapy along with physical therapy may help patient become more functional and independent.

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Surgery may be necessary for some Pagets patients remember..

answer

Remember to mobilize them right away to prevent bone demineralization and hypercalcemia, which increase patients risks for fractures.

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Patient Teaching Pagets

answer

Begins with education regarding the disease process and support for the patient and family as they cope with the impact of disease. Medication administration is also important, potential side effects, and correct way to take medications to decrease risk of side effects. Pain management is also important simple strategies like anti-inflammatory drugs and nonnarcotic analgesics may be all that is needed to reduce the patients bone pain. Positioning and following treatment modalities also decreases patients pain.

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Evaluation Paget's Disease -

answer

Acute pain: The patient's pain should be adequately controlled, as assessed by the patient on scale of 1 to 10. • Chronic pain: The patient's pain should be adequately controlled, so that the patient is able to minimize disruptive effects for day-to-day living. • Impaired physical mobility: The patient should demonstrate coordinated movement with active joint mobility. The patient should be able to perform self-care and manage activities of daily living. The patient should be able to demonstrate the proper way to transfer from bed to chair, chair to standing. The patient should be able to verbalize knowledge of prescribed activity level. • Activity intolerance: The patient should be able to tolerate activity within normal limits and verbalize knowledge of endurance. • Bathing/hygiene self-care deficit: The patient should demonstrate the ability to perform activities of daily living, bathing, toileting, and personal hygiene, using mobility aids if needed. • Dressing/grooming self-care deficit: The patient should demonstrate the ability to dress.

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Osteomyelitis -

answer

Serious infection of the bone that is often difficult to treat. OM can be categorized as acute or chronic which occurs when symptoms last longer than 3 months.

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Epidemiology Osteomyelitis

answer

- Acute myelitis is common in children under 13, sickle cell patients and diabetics.

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Osteomyelitis Etiology

answer

can stem from an infection that has spread through the blood to site of infection, also be caused by soft tissue infection that spreads to the bone. Associate with patients with diabetes and vascular problems. Site of infection for these patients is often foot or ankle.

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Pathophysiology Osteomyelitis

answer

infection invades inner layers of the bone through the medullary canal. Until it spreads to periosteum leading to necrosis and devascularization of cortex of bone.

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Assessment OM

answer

- May be report of recent infection, puncture wound, mild trauma, or obvious fracture. Adults may have diabetes. Infants present symptoms from irritability to signs of sepsis. Most children complain of localized pain. Chronic OM patients have mild symptoms with periods of exacerbations.

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Complications of OM

answer

- loss of function of joint above or below infection, leg length discrepancies or deformities, and renal insufficiency or hearing loss related to nephrotoxic or ototoxic antibiotics.

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Diagnosis Osteomyelitis -

answer

Acute or chronic pain due to the osteomyelitis • Fear due to the diagnosis of osteomyelitis • Impaired physical mobility due to the osteomyelitis • Risk for impaired skin integrity related to compromised tissue perfusion • Deficient knowledge related to self-care and risk prevention

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OM PLAN

answer

- eliminate the infection and prevent complications. Administer appropriate antibiotics and use nursing strategy to prevent complication. Carefully provide hydration assist patient to meet nutritional needs and attend to potential physical mobility challenges.

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PHARMACOLOGY OM

answer

four to six weeks of IV antibiotic based on the results of wound cultures. Chronic takes six to eight weeks of oral antibiotic therapy based on wound culture results.

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Acute Osteomyelitis Testing

answer

• X-rays will not show changes until 10-14 days after the infection occurs • Sedimentation rate and white blood cells will be elevated • Blood cultures are positive in about half of the samples • Bone scans will be positive in the area of the infection • Bone wound cultures will need to be taken to identify the microorganism present

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Chronic Osteomyelitis testing

answer

• X-rays will show bone and soft tissue changes • Sedimentation rate will be mildly to moderately elevated • May see a minimal elevation of white blood count and mild anemia • C-reactive protein will be elevated • CT scans will show changes in the bone and can show pockets of exudates • Wound cultures will need to be take

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Tumors of MS system

answer

Benign or malignant. Malignant neoplasm of MS system is called sarcoma.

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Osteosarcoma is a common

answer

primary bone cancer, others are ewings sarcoma and chondrasarcoma. They are aggressive and can metastasize to the lungs

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Malignant soft tissue arise from

answer

muscle, fat, cartilage, fibrous tissue, tendosynovial tissue, vessels, and peripheral nerves. Considered low to moderate in mestasizing.

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Bony sarcoma are usually diagnosed

answer

in people 10 to 25 years old.

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Sarcoma grows into

answer

ball like mass then penetrates bony cortex. High grade tumors can quickly Metastasize to lungs.

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ASSESSMENT SARCOMA

answer

dull aching pain that worsens at night. Swelling, localized enlargement of extremity, fever, night sweats. Symptoms start to appear when sarcoma grows enough to put pressure on surrounding tissue.

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Tests done for sarcoma

answer

Biopsy is performed with percutaneous needle. It is minimally invasive and lower risk of infection. CT scans can be used to determine local extent of disease, and xrays of chest to check for metastases to the lungs. Bone marrow is also used to check metastases.

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Nursing Diagnosis with sarcomas -

answer

Acute or chronic pain due to the sarcoma • Fear due to the diagnosis of sarcoma • Impaired physical mobility due to the sarcoma • Risk for impaired skin integrity related to compromised tissue perfusion • Deficient knowledge related to self-care and risk prevention

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Sarcoma plan

answer

Overall goal is to destroy tumor. The current treatment of osteosarcoma involves a course of chemotherapy before surgery. This shrinks the size of the tumor and kills the microscopic metastases before they have a chance to multiply. A second round of chemotherapy is administered to the patient after surgery to ensure that any cells left behind are destroyed.

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OSTEOSARCOMA COMPLICATIONS -

answer

Complications of bony sarcoma include weakened bone and pathological fractures. Other complications are related to reconstructive surgery and can include prosthetic loosening, infection, and mechanical failure (Skubitz & D'Adamo, 2007). Infection can be a serious complication if it delays chemotherapy or radiation treatment. Delaying adjuvant therapy could increase the patient's risk of metastasis and local recurrence. Another complication for some patients who have undergone a resection involving the lymph system is lymphedema. Lymphedema may also be a complication of radiation therapy.

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OSTEOSARCOMA NURSE PLAN AND IMPLEMENTATION

answer

The nurse will plan and implement care aimed at the pain associated with the sarcoma, which will likely include narcotic analgesics. In addition, the nurse will provide interventions related to the chemotherapy. The nurse also will implement communication interventions relevant to the patient's potential fear of having this disorder and provide the patient and family education. Overall, the nurse will provide collaborative care with the health care team while the patient is in the acute care setting.

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METASTASIC TUMOR

answer

Metastatic tumors of the bone are detrimental consequences of cancer. Metastatic tumors greatly affect the patient's quality of life and increase morbidity (Hameed, 2007).

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The three most common sites of metastases in order of occurrence are

answer

the lung, liver, and bone

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Number one symptom of Metastatic tumor is

answer

Pain. described as dull, aching that increases at night and with weight bearing. Other complications that can be caused by metastatic bone disease include hypercalcemia, myelosuppression, pathological fractures and spinal cord compression.

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SCOLIOSIS

answer

Scoliosis is a spinal deformity that is characterized by a lateral curve, spinal rotation causing rib asymmetry, and thoracic hypokyphosis (less than normal curvature in the thoracic spine) (Kotwicki, 2008).

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ETIOLOGY SCOLIOSIS

answer

Scoliosis can be congenital, or it may develop during infancy or childhood. Most often it is detected early in adolescence. The cause of scoliosis is most often unknown, but it can be associated with a number of neuromuscular disorders.

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ASSESSMENT SCOLIOSIS

answer

adams bending forward test - patient wearing only panties bends forward at waist with both arms hanging toward the floor, palms together. Viewing patient from behind, health care worker observes the back for curvature by looking at symmetry of shoulders, scapulae, flank shapes, hip heights, and pelvis.

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A scoliometer is used to

answer

measure curves

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SCOLIOSIS DIAGNOSIS

answer

Acute or chronic pain due to the scoliosis • Fear due to the diagnosis of scoliosis • Impaired physical mobility due to the scoliosis • Risk for impaired skin integrity related to compromised tissue perfusion • Deficient knowledge related to self-care and risk prevention

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The goal of treatment in scoliosis

answer

whether surgical or nonsurgical, is to correct the deformity and prevent complications. Surgery is recommended for curves greater than 40 degrees.

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PATIENT AND FAMILY TEACHING

answer

Patient and family teaching includes defining the disorder, discussing of treatment for the level of severity (may include bracing and exercise or surgery options), and understanding developmental support (both social and emotional) for the child.

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KYPHOSIS

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(posterior curvature of the thoracic spine) is abnormal when the curvature of the thoracic spine is greater than 45°. Kyphosis often results from osteoporosis (hunchback) or AS. Treatment can be accomplished with bracing or spinal fusion should the defect cause cardiopulmonary problems or pain.

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SPINAL STENOSIS

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is a degeneration of the spine that causes narrowing of the spinal canal secondary to bony overgrowth (osteophytes) at the facet joints, hypertrophy of the ligaments supporting the spine, or protrusion of intervertebral disks (Owens, 2009). The most common site of stenosis is the lumbar region of the spine.

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ASSESSMENT KYPHOSIS AND STENOSIS

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gradual onset of difficulty walking. Pain radiating down one leg. Inability to sit or stand in one position for long because of pain or fatigue. Gait maybe unsteady or limp.

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DIAGNOSIS KYPHOSIS & STENOSIS

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• Chronic and acute pain related to spinal stenosis • Activity intolerance • Ineffective coping • Ineffective role performance

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Goals for Kyphosis and Stenosis

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The goals of treatment are to reduce pain and return the patient to normal physical activity. Exercises to strengthen back muscles and flexibility are often prescribed. These exercises can be done in conjunction with a therapist's or nurse's instruction or by simple written instructions.

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If pain is continuing with scoliosis or kyphosis

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a laminectomy may be performed. This relieves pressure within the spinal canal and reduces pain. Some patients have spinal fusion to stabilize spine.

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Patient and family teaching scoli and kyphosis

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Teaching will revolve around the disease process, the prescribed exercises and pain medications, and the importance of weight control. Teaching may also need to be done regarding potential surgical options.

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OA occurs because of ..

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damage to articular cartilage and the metabolic response that results at the chondrocyte level.

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Patients with gout will report ..

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a rapid development (within hours) of pain and edema in the one affected joint.

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LD is preventable by

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taking simple precautions

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The common features of the spondyloarthropathies are

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sacroilitis variable inflammatory peripheral arthritis, enthesitis, dactylitis, tendency for ocular inflammation, familial tendency, no rheumatoid factor, and strong association with the HLA-B27 gene.

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There are three hallmark tests that confirm the diagnosis of polymyositis or dermatomyositis -

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elevated muscle enzymes, an abnormal electromyogram, and positive results in a muscle biopsy.

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Fibromyalgia is most frequently defined as..

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a clinical syndrome or condition involving chronic widespread diffuse musculoskeletal pain, stiffness, and tenderness

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Osteoporosis is the most

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frequently diagnosed bone disease in humans.

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The main cause of osteomalacia is

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vitamin D deficiency and is rare in the United States.

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Paget's disease is a chronic bone disorder characterized by

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weakened bone structure with no definitive cause or cure.

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•Musculoskeletal infections can have

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have devastating results if not treated promptly or completely

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Primary bone cancers are rare...

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Metastatic tumors of the bone are detrimental consequences of cancer and are more common than primary bone cancers.

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For mild scoliosis curvature

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exercise and bracing are the treatments of choice. For greater curves, spinal fusion is used.

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Spinal stenosis causes ..

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causes impingement on the nerves and subsequent low back pain or leg pain, as well as leg fatigue and reduced physical activity tolerance.

Chapter 59 Med Surg – Flashcards

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