osteomyelitis, tjr, bone cancer, scoliosis

What is osteomyelitis?

An infection of bone tissue, typically bacterial, leading to inflammation, necrosis, and bone destruction.

How do pathogens typically enter the bone to cause osteomyelitis?

Pathogens can enter via hematogenous spread, contiguous spread from adjacent tissue, or direct inoculation.

What pathological processes occur in the bone during osteomyelitis?

Infection leads to inflammation, edema, vascular compromise, necrosis (sequestrum formation), and possibly new bone formation (involucrum) around necrotic tissue.

Which populations have an increased incidence of osteomyelitis?

Children, older adults, and immunocompromised patients.

Name some risk factors for developing osteomyelitis.

Open fractures, orthopedic surgery, prosthetic implants, diabetes mellitus, peripheral vascular disease, immune suppression, and IV drug use.

What are the common clinical manifestations of osteomyelitis?

Bone pain, fever, chills, localized swelling, redness, warmth, drainage, and limited movement of the affected limb.

How might chronic osteomyelitis present differently from acute infection?

Chronic osteomyelitis may present with sinus tracts and persistent drainage.

What laboratory findings are indicative of osteomyelitis?

Elevated WBC count, ESR, and CRP. Blood cultures may identify the pathogen.

What imaging techniques are sensitive for diagnosing osteomyelitis?

MRI and bone scans are more sensitive than X-rays, which show bone changes later.

What is considered the gold standard for diagnosing osteomyelitis?

Bone biopsy.

What are key nursing care interventions for a patient with osteomyelitis?

Monitor for sepsis, manage pain, provide wound care with sterile dressing changes, maintain mobility and safety, and administer IV antibiotics as prescribed.

What is a typical pharmacological consideration for osteomyelitis treatment regarding antibiotics?

Long-term IV antibiotics, typically 4–6 weeks or longer.

What dietary and lifestyle considerations are important for patients with osteomyelitis?

A high-protein, high-calorie diet for healing, adequate hydration, and smoking cessation to improve circulation.

What is crucial client education regarding antibiotic treatment for osteomyelitis?

The importance of completing the full antibiotic course and monitoring for recurrence of infection.

What therapeutic procedures might be necessary for osteomyelitis?

Surgical debridement of necrotic bone, drainage of abscesses, and possible amputation if the infection is uncontrolled.

Which healthcare professionals are typically involved in the interprofessional management of osteomyelitis?

Nursing, an infectious disease specialist, orthopedics, physical therapy, a wound care team, and a dietitian.

What are some potential complications of osteomyelitis?

Chronic osteomyelitis, sepsis, pathologic fractures, squamous cell carcinoma in chronic draining sinus tracts, and impaired mobility.

What is scoliosis?

Scoliosis is a lateral curvature of the spine with rotation of the vertebrae, leading to deformity.

What is the primary pathophysiology of scoliosis?

Asymmetric growth of vertebrae or idiopathic structural changes lead to lateral curvature, which can cause cardiopulmonary compromise in severe cases.

In which population is scoliosis most common?

Adolescents, especially females.

What are the common origins of scoliosis?

Idiopathic (most common), congenital, or neuromuscular in origin.

Name some risk factors for scoliosis.

Family history, female gender, rapid growth during puberty, and neuromuscular disorders (e.g., cerebral palsy, muscular dystrophy).

What are common clinical manifestations of scoliosis?

Uneven shoulders, one scapula more prominent, rib hump, uneven waist or hips, and possible back pain. Severe cases may impair lung function.

What physical exam test is used to screen for scoliosis?

Adam

's forward bend test.

What diagnostic imaging is used to confirm scoliosis and measure its severity?

X-ray, for Cobb angle measurement.

What Cobb angle measurement is diagnostic for scoliosis?

Greater than 10°.

What is a key nursing intervention for an adolescent undergoing brace therapy for scoliosis?

Encourage adherence to brace therapy and support self-image.

What pharmacological agents are used in scoliosis management?

Analgesics for pain management. There is no specific drug therapy for scoliosis itself.

What dietary and lifestyle recommendations are important for scoliosis patients?

Balanced nutrition to support growth and bone health, and encouraging exercise and activity within limits of curvature severity.

What is crucial client education regarding brace therapy for scoliosis?

Teaching proper brace application and skin care, stressing the importance of adherence to therapy, and supporting psychosocial well-being.

Which therapeutic procedure is recommended for moderate scoliosis (Cobb angle 25°-45°)?

Bracing.

When is spinal fusion surgery typically recommended for scoliosis?

For severe scoliosis (>45°–50° or progressive curvature).

Who are key members of the interprofessional management team for scoliosis?

Orthopedic surgeon, nurses, physical therapists, occupational therapists, psychologists, and school counselors.

What are potential complications of scoliosis?

Chronic pain, impaired mobility, cardiopulmonary compromise, cosmetic deformity, and low self-esteem in adolescents.

What is total joint replacement?

Surgical replacement of a diseased joint with a prosthesis, most commonly the hip or knee.

What are common causes leading to total joint replacement?

Degenerative joint disease (osteoarthritis), trauma, or other joint pathology.

How does joint replacement affect pain and function?

It restores function and reduces pain.

Who is most commonly affected by the need for total joint replacement?

Older adults, especially women, due to the prevalence of osteoarthritis.

What are some risk factors for needing a total joint replacement?

Osteoarthritis, rheumatoid arthritis, trauma, avascular necrosis, congenital deformities, obesity, advanced age.

What are clinical manifestations of joint issues that may lead to replacement?

Severe joint pain, stiffness, decreased range of motion, impaired mobility, functional limitations, reduced quality of life.

What diagnostic tools are used for assessing joint conditions?

X-rays show joint space narrowing and bone changes; MRI/CT may be used for surgical planning.

What preoperative care is important for patients undergoing joint replacement?

Pre-op education, pain management, and assessment of surgical risk through labs.

What are key nursing care considerations post-total joint replacement?

Monitor for complications (DVT, infection, dislocation), encourage early ambulation, maintain joint alignment, and monitor neurovascular status.

What pharmacological treatments are commonly used in total joint replacement?

Analgesics (opioids initially, then NSAIDs/acetaminophen), antibiotics perioperatively, and anticoagulants for DVT prophylaxis.

What dietary considerations should be made for patients post-joint replacement?

A balanced diet to promote healing, adequate protein intake, and weight reduction if obese to reduce joint stress.

What client education is important after total joint replacement?

Post-op activity restrictions, use of assistive devices, importance of physical therapy, and recognition of infection or DVT signs.

What are common therapeutic procedures related to joint replacement?

Total hip replacement, total knee replacement, and less common shoulder or elbow replacement.

Who are the key members of the interprofessional management team for joint replacement?

Nursing, orthopedic surgeon, physical therapy, occupational therapy, dietitian, and case management.

What are potential complications of total joint replacement?

Infection, prosthesis dislocation, DVT/PE, neurovascular compromise, and prosthesis loosening or failure.

What are primary malignant bone tumors?

Rare tumors such as osteosarcoma, chondrosarcoma, and Ewing's sarcoma.

What is the most common source of bone cancer?

Metastatic bone cancers from breast, lung, prostate, kidney, or thyroid.

What is the pathophysiology of bone cancer?

Uncontrolled proliferation of malignant cells leads to destruction of normal bone tissue, resulting in weakened bone, pain, and fractures.

At what age does osteosarcoma typically peak?

In adolescents and young adults.

What are some risk factors for developing osteosarcoma?

Adolescence, male gender, history of radiation or chemotherapy, Paget's disease, family history of certain cancers, and prior bone trauma.

What are common clinical manifestations of bone cancer?

Bone pain (worse at night and with activity), swelling or palpable mass, pathologic fractures, decreased range of motion, and systemic signs like fever and weight loss.

What imaging techniques are used for diagnosing bone cancer?

X-ray, MRI/CT for local extent, and bone scan for metastasis.

What laboratory findings may indicate bone cancer?

Elevated alkaline phosphatase or LDH levels.

What is required for a definitive diagnosis of bone cancer?

A biopsy.

What nursing care is essential for patients with bone cancer?

Monitor pain, mobility, and neurovascular status; provide emotional support; maintain a safe environment to prevent fractures.

What pharmacological treatments are used for osteosarcoma?

Chemotherapy, bisphosphonates or denosumab for bone metastases, and analgesics for pain control.

What dietary recommendations are suggested for bone cancer patients?

Adequate protein, calcium, and vitamin D; manage fatigue with rest and balanced activity.

What client education should be provided regarding treatment plans?

Explain treatment options (surgery, chemo, radiation), emphasize follow-up importance, and teach safety with mobility aids.

What are common therapeutic procedures for bone cancer?

Surgical resection (limb-sparing surgery preferred), amputation if necessary, and radiation therapy.

Who is involved in the interprofessional management of bone cancer?

Oncology team, orthopedic surgeons, nurses, physical therapists, nutritionists, social workers, and palliative care specialists.

What are potential complications of bone cancer?

Metastasis to lung, liver, brain, pathologic fractures, impaired mobility, and treatment-related complications.