Schoenwald Flashcards
(109 cards)
1
Q
what do you think when you see bone/joint pan and elevated APR
A
osteomyelitis
2
Q
what are the 2 types of osteomyelitis
A
acute
chronic
3
Q
suspect osteomyelitis if (2)
A
- bone can be probed w. swab from wound site
- wound > 6 weeks duration
4
Q
what are 2 imaging choices for osteomyelitis
A
- plain film xray
- MRI if xray negative and high suspicion for osteomyelitis
5
Q
osteomyelitis is __ or
__ infxn of the bone
A
bacterial
fungal
6
Q
what are the 3 sources of osteomyelitis
A
- hematogenous
- invasion from contiguous focus of infxn
- skin breakdown
7
Q
what are 5 hematogenous sources of ostomyelitis
A
- bacteremia
- sickle cell anemia
- elderly
- IVD users
- DM
8
Q
a diabetic foot infxn is an example of which source of osteomyelitis
A
invasion from contiguous focus of infxn
9
Q
vascular insufficiency or trauma is an example of which type of osteomyelitis
A
skin breakdown
10
Q
what bacteria is associated w. SSA and osteomyelitis
A
salmonella
11
Q
what test do you order for definitive confirmation of osteomyelitis
A
bone culture
12
Q
what is the main organism associated w. osteomyelitis in non SSA patients
A
s. aureus
13
Q
osteomyelitis in DM pt’s is often
A
polymicrobial
14
Q
what bacteria would you suspect if a pt had osteomyelitis from a nail through the foot
A
pseudomonas
15
Q
MRI will usually show infxn how long after clinical symptoms
A
7-15 days
16
Q
what do you think when you see an MRI w. cortical erosion, periosteal rxn, lucency, or osteolysis
A
osteomyelitis
17
Q
what are the treatment steps for osteomyelitis
A
- debridement of bone
- minimum 6 weeks abx targeted to organism
18
Q
what is the minimum amt of time for abx in osteomyelitis
A
6 weeks
19
Q
what is the empiric abx of choice for osteomyelitis
A
vanco 1 gm IV q 12 hr +/- Rifampin
PLUS
Cefriaxone 2 gm IV q 24 hr
20
Q
after cultures, what abx should you use for MSSA
A
Nafcillin 2 gm iv q 4 hr
OR
Cefazolin 2 gm IV q 8 hr
21
Q
what is the abx of choice if culture shows MRSA
A
vanco 1 gm IV q 12 hr +/- rifampin 300-400 mg po tid
22
Q
what is the abx of choice if osteomyelitis culture shows pseudomonas
A
Cipro
must also check for foreign body and do tetanus prophylaxis if nail
23
Q
what is the abx of choice for mild osteomyelitis
A
doxycycline → good bone penetration
24
Q
how should you treat osteomyelitis in DM pt
A
- debride and get cultures
- no empiric therapy → wait for culture to preserve kidneys
25
what labs should you order for continued monitoring for osteomyelitis
1. CBC
2. CMP
3. APR
26
what is the mc affected bone in brodie's abscess
tibia
27
what is brodie's abscess
abscess walled off by body's immune system for years
28
what are 3 symptoms of brodie's abscess
1. pain
2. +/- outward drainage externally
3. red and swollen around bone
29
what is the pathogen associated w. brodie's abscess
s. aureus
30
what is this showing
brodie's abscess
31
what might brodie's abscess look like on xray
small luscent area
32
what are the 3 causes of infectious arthritis (septic arthritis)
1. direct inoculation of joint space by bacteria
2. contiguous spread
3. bacteremia
4. previously damaged joint
33
what is the most common cause of infectious (septic) arthritis
bacteremia
34
what 2 pt populations are vulnerable to infectious (septic) arthritis from a previously damaged joint
1. RA
2. prosthetic joint
35
what joints are mc in infectious (septic) arthritis
knee
hip
shoulder
36
spread of infectious arthritis is usually
monoarticular
37
what are 4 symptoms of infectious (septic) arthritis
1. fever
2. pain at joint
3. erythema of joint
4. impaired ROM
5. monoarticular
38
what is the most common cause of infectious (septic) arthritis in young, healthy, sexually active pt's
gonorrhea
39
what is the op tx for infectious (septic) arthritis
doxycycline
OR
Bactrim
→ to cover MSSA and MRSA
40
what is the tx for infectious (septic) arthritis if only MSSA isolated
Nafcillin
OR
Keflex
41
besides abx, how else should you treat infectious (septic) arthritis
fluid drainage
42
what is reactive arthritis
rxn to infectious arthritis outside of the active infxn
43
what kind of process is reactive arthritis
delayed inflammatory
44
reactive arthritis is more common in what pt population
HLAB27 (ankylosing spondylitis)
45
what are the 3 most common bacteria in reactive arthritis
1. chlamydia
2. trachomatis
3. various GI bugs
46
what GI bugs are commonly seen in reactive arthritis
salmonella
yersinia
campylobacter
c.diff
47
what are the 2 tx options for reactive arthritis
1. NSAIDs
2. smoldering infxn: continue abx
48
what are 4 cardinal symptoms of gonococcal septic arthritis
1. fever
2. arthralgias of multiple joints
3. asymmetric tenosynovitis
4. skin pustules
49
where doe infectious gonococcal arthritis usually begin
hands
50
what are 3 diagnostic tests for gonococcal septic arthritis
1. fluid aspirate and culture
2. blood cultures
3. xray
51
how is gonococcal septic arthritis spread
disseminated from bacteria from cervix, urethra, or pharynx
52
what is the tx for gonococcal septic arthritis
1. ceftriaxone
2. fluid drainage
53
what are the 6 considerations in wound assessment
1. tissue type
2. wound exudate
3. periwound condition
4. pain level
5. size
54
what are 4 wound tissue types
1. necrotic
2. infective
3. granulation
4. maceration
55
periwound area is any area that extends __ cm from the edge of the wound
4 cm
56
many people with wounds have __ wound sensation
poor
57
when documenting a wound, note the \_\_
and \_\_
size
depth
58
what does optimal wound tissue look like
beefy red granulation
59
escar around the edges of a wound may indicate
necrosis
60
what is wound maceration
lightening of skin
bumpy/wrinkled
61
epithelization means
tissue healing
62
slough is \_\_
and must be __ for healing
remnants of WBC
debrided
63
where do pressure ulcers occur
areas of bony prominences → ankles, elbows, tailbone
64
what are the stages of pressure ulcers
1-4-unstageable
65
stage 1 pressure ulcer
nonblanchable erythema of intact skin
66
stage 2 pressure ulcer
partial thickness skin loss w. exposed dermis
67
stage 3 pressure ulcer
full thickness w. skin loss
68
stage IV pressure ulcer
full thickness and tissue loss
69
unstageable pressure ulcer
obscure full thickness skin and tissue loss
70
deep tissue pressure injury
persistent, non blanchable
deep red, maroon, purple
71
what are 4 rf for nonhealing wounds
1. smoking!!
2. endocrinology problems → DM, hypothyroidism
3. hematologic problems → polycythemia
4. CVD issues → CVD, COPD
72
what is the mc location for venous ulcerations (venous stasis)
gaiter area of leg → 95%
*usually medial*
73
venous ulceration usually have __ edges
sloping
74
what are 5 characteristics of venous ulcerations (venous stasis)
1. edema
2. hemosiderin staining
3. hair loss of extremity
4. weeping → exudate
5. itching
75
what are 5 rf for venous ulcerations (venous stasis)
1. varicose veins
2. DVT
3. chronic venous insufficiency
4. poor calf muscle fxn
5. obesity
76
when should compression stockings be used for venous ulceration/stasis
if caused by edema
77
when should compression stockings be avoided for venous ulcerations/stasis
if arterial flow is compromised → poor pulse
78
what is the mc location for arterial ulcers
toes, foot, ankle
79
what do the edges of an arterial ulcer look like
punched out
80
what are 3 characteristics of arterial ulcers
1. painful even w.o inflammation
2. exudate rare
3. edema uncommon
81
what are 3 rf for arterial ulcers
1. PVD
2. DM
3. SSA
82
ulcer appears punched out w. well demarcated edges; pale, necrotic base; surrounding skin dusky or shiny; hairless
arterial ulcer
83
what is hyperemia
pinkish-red skin
84
what type of ulcer is caused by decreased arterial blood supply to LE, tissue hypoxemia, and damage
arterial ulcer
85
what are 5 tx for arterial ulcers
1. restore arterial fxn if possible
2. usually surgery
3. medications not helpful
4. wound tx
5. smoking cessation
86
what test is useful to determine the extent of PVD
ankle brachial index (ABI)
87
how do you measure ABI
measure systolic bp in both brachial and then both dorsal pedis/posterior tibial arteries → then divide
88
what should the pt do for 10 min before ABI
rest
supine
89
what is nl for ABI
1.0 - 1.4
90
what does an ABI \>4 indicate
noncompressible calcified vessel
91
what does an ABI \<0.9 indicate
dx of PAD
92
what does an ABI 0.5-0.8 indicate
moderate arterial dz → refer to specialist
93
what does an ABI \< 0.5 indicate
severe arterial dz → refer to specialist
94
you should refer pt to specialist if ABI is
0.8 or lower
95
name 3 ways that negative pressure wound therapy (wound vac) enhances healing
1. reduces edema
2. increases rate of granulation tissue
3. stimulates circulation
96
wound vac is a __ system
that removes __ and
promotes \_\_
sealed
fluid
circulation
97
you should not use wound vac on
infected areas
98
what are 4 contraindications for wound vac
1. malignancy of wound → ex melanoma
2. untreated osteomyelitis
3. placement of dressings in contact w. exposed bv, organ, or nerve
4. nonenteric or unexplained fistulas
99
what are 7 indications for wound vac
1. chronic wounds
2. acute wounds
3. traumatic wounds
4. partial thickness
5. dehisced (open) wounds → reopened
6. diabetic ulcers
7. pressure ulcers
100
what are indications for growth factors/skin graft substitutions
small area
not much skin to use
101
what are 2 examples of growth factors
1. apligaf
2. dermagraft
102
what are 3 types of debridement
1. enzymatic
2. mechanical
3. sharp
103
what is enzymatic debridement
chemical agents that eat away dead tissue
104
most enzymatic debridement agents have been
taken off market
ex Santol
105
why are enzymatic debridement agents harmful
can't discern good tissue from bad tissue
106
what is mechanical debridement
wet to dry dressings (gauze) → applied to wound → takes away tissue when pulled off
107
peroxide and iodine are considered __ debridement
but can be __ to tissue
mechanical
destructive
108
what is sharp debridement
surgical/scalpel to remove tissue
109
what are 3 considerations for wound follow up
1. close monitoring
2. weekly visits
3. **careful documentation!!**
