Osteoporosis/Osteomyelitis

osteoporosis

low bone mass and deterioration of bone tissue

bone loss

breakdown greater than the build up

fragile bones

clinical manifestations of osteoporosis

back pain

spontaneous fractures 

vertebral fractures/deformity 

loss of height 

kyphosis 

hip fracture 

colle’s fracture 

risk factors for osteoporosis

women >65 years

low body weight

sedentary 

smoking 

vitamin D deficiency 

alcohol 

medications that increase risk for osteoporosis 

long-term steroids

thyroid 

heparin 

antiseizure 

diseases that increase risk for osteoporosis

IBD

malabsorption 

kidney disease 

Rheumatoid arthritis 

cirrhosis 

diabetes 

dowager’s hump

kyphosis

colle’s fracture

break in radius bone near wrist

common with osteoporosis 

how is osteoporosis diagnosed

annual height measurement

bone mineral density (GMD) measurements

DEXA scan - spine & hips 

Quantitative ultrasound - heel, kneecap, shin 

Z score - compare GMD to someone of the same age, gender, and ethnic group 

T score for osteoporosis

Low T score: -2.5 SD or more below the mean of healthy, young people

what increases bone mass

calcium

exercise

high protein diet 

vitamin D 

osteoporosis management

proper nutrition - calcium & vitamin D

weight loss / muscle strengthening - reduce falls and fractures

weight-bearing exercise (walking, hiking, stair climbing)

avoid smoking and alcohol 

is osteoporosis familial?

yes

what race/gender is more likely to have osteoporosis?

white or asian women

how much calcium should a pt be consuming

1200 mg/day via diet

include supplement

what foods are high in calcium

milk

yogurt 

cottage cheese 

sardines 

spinach 

medications to treat osteoporosis 

calcium 

vitamin D

Biphosphonates

calcitonin (nasal spray, SQ) hormone, lowers serum calcium and get it back into bone

estrogen

paraythroid hormone

how much vitamin D should a pt be consuming per day? why is it important?

800-1000 mg/day

20 minutes of sunlight each day 

helps the body absorb calcium

two examples of bisphosphonates

fosamax

boniva 

inhibits bone resorption and slows the cycle of bone remodeling

what fracture commonly leads to loss of height

veterbral fractures

normal bone density 

-1 to + 2 

osteomyelitis

infection of bone, bone marrow, and surrounding soft tissue

what bacteria is commonly a cause of osteomyelitis?

staphylocooccus aureus

two types of causes of osteomyelitis 

hematogenous (endogenous) or nonhematogenous (exogenous) 

hematogenous (endogenous) 

spread via bloodstream from another part of the body 

what age group is most likely to experience hematogenous (endogenous) osteomyelitis?

children

nonhematogenous (exogenous) osteomyelitis 

from open fracture/trauma to bone 

implanted surgical devices 

puncture wounds 

what age group is more susceptible to nonhematogenous (exogenous) osteomyelitis?

adults

clinical manifestations of acute osteomyelitis

constant pain (worsens with activity, unrelieved by rest) 

swelling 

tenderness 

warmth 

restricted movement 

fever 

night sweats

chills

nausea 

malaise 

acute vs chronic osteomyelitis

acute = < 1 month

chronic = > 1 month

clinical manifestations of chronic osteomyelitis

bone pain

swelling 

warmth 

granulation → avascular scar tissue 

complications of osteomyelitis

septicemia - pathogens in bloodstream/organs

septic arthritis - infection in joints

pathologic fractures -

amyloidosis - deposition of amyloid (protein deposited in liver, kidney, and spleen) in the body

what causes pain in osteomyelitis

increased pressure

how is osteomyelitis diagnosed

bone/soft tissue biopsy

blood cultures 

increased WBC count

increased erythrocyte sedimentation rate (ESR) 

increased C-reactve protein (CRP) 

CT

MRI

x-rays are inconclusive for osteomyelitis for…

2-4 weeks after symptoms begin 

CT vs MRI for osteomyelitis

CT - extent of the infection

MRI - bone marrow edema 

what levels would be increased with osteomyelitis

increased WBC count

increased erythrocyte sedimentation rate (ESR) 

increased C-reactve protein (CRP) 

treatment for osteomyelitis

antibiotic therapy (if bone ischemia has not occured) 

cultures/bone biopsy 

debridement & wound vac

hyperbaric O2

implanted antibiotic beads

remove prosthesis

muscle flaps/skin grafts/bone grafts

amputation

what antibiotics should be given if culture results are not available yet

broad spectrum

CVAD for osteomyelitis

4-6 weeks of central line antibiotics

what medications may be given for osteomyelitis

oxacillin

nafcillin 

clindamycin 

vancomycin 

ceftriaxone 

ciprofloxacin 

linezolid 

what medication is given PO after IV ABX is completed? how long?

6-8 weeks 

ciprofloxacin 

why is hyperbaric O2 given for chronic osteomyelitis?

new blood growth & healing

nursing interventions for osteomyelitis

administer IV antibiotics

neurovascular assessment

splint/traction 

administer analgesics 

administer muscle relaxants 

handle limb gently/carefully 

thermal therapy 

ROM 

assistive devices

nutritional support

bedrest

what should you monitor for when giving IV antibiotics

adverse reactions

hypersensitivity

peak & trough levels

what should you assess with a splint/traction

neurovascular assessment

why would you administer muscle relaxants for osteomyelitis

muscle spasms

why should you practice contact precautions for osteomyelitis?

it is an infection 

why is thermal therapy (hot/cold) beneficial for osteomyelitis

improves pain and function

why is ROM to joints above and below the site important for osteomyelitis

prevents contractures

nutritional support for osteomyelitis

high protein diet

vitamin C

zinc 

iron 

thiamine 

folic acid 

multivitamin 

what should you do if a pt is on bedrest

maintain alignment

prevent flexion contractures 

what does bedrest increase the risk of?

DVT

Pressure ulcers

Constipation

Atelectasis - collapse of lung