Unit VII part 2 COPY Flashcards by B -

Initial infection or an infection lasting less than one month

Acute infection

How well did you know this?

Not at all

Perfectly

What classification of infection has a high incidence with children less than 12 years old

Acute infection

How well did you know this?

Not at all

Perfectly

Infection lasting longer than one month or that has failed the initial course of antibiotic therapy for acute osteomyelitis

Chronic infection

How well did you know this?

Not at all

Perfectly

What classification of infection is seen mostly in adults

Chronic infection

How well did you know this?

Not at all

Perfectly

What is the most common single pathogen

Staphylococcus aureus

How well did you know this?

Not at all

Perfectly

What kind of invasion by an organism is caused by open fx, surgery, trauma, GSW?

Direct or exogenous invasion

How well did you know this?

Not at all

Perfectly

What kind of invasion by an organism is caused by hematogenous, infection from a distal site, usually sen in long bones

Indirect or endogenous invasion

How well did you know this?

Not at all

Perfectly

What kind of invasion by an organism is caused by soft tissue, decubitus or diabetic ulcers
(surrounding areas)

Extension or contiguous invasion

How well did you know this?

Not at all

Perfectly

What type of invasion most frequently affects growing bones in young boys (

Indirect

How well did you know this?

Not at all

Perfectly

What are the most common sites of indirect injury in children

Distal femur
Proximal tibia
Humerus
Radius

How well did you know this?

Not at all

Perfectly

What are the most common sites of infection because they are vascular

Pelvis & vertebrae

How well did you know this?

Not at all

Perfectly

Direct entry can occur at any age when there is?

An open wound

How well did you know this?

Not at all

Perfectly

Metaphysis

Growth plate

How well did you know this?

Not at all

Perfectly

Where do the microorganisms lodge themselves in the bone

Metaphysics

How well did you know this?

Not at all

Perfectly

Area of devitalized bone seperates from living bone and forms

Sequestra

How well did you know this?

Not at all

Perfectly

Part of the periosteum that continues to have blood supply forms new bone

Involucrum

How well did you know this?

Not at all

Perfectly

Sequestrum

Dead bone

How well did you know this?

Not at all

Perfectly

Pathophysiology of osteomyelitis

Bacteria enters bone
Inflammation occurs 
Purulent material collects within bone
Increased pressure ->pain
Ischemia &amp; vascular 
compromise->decrease O2
Bone dies &amp; Sequestrum form
Involucrum grows around Sequestrum

How well did you know this?

Not at all

Perfectly

Why is Sequestra a haven for bacteria

Unreadable by antibiotics or leukocytes due to pus enclosure

How well did you know this?

Not at all

Perfectly

Complications of osteomyelitis

Fractures
Chronic infection 
Sepsis
Deformities 
Brodie's abscess 
Amputation

How well did you know this?

Not at all

Perfectly

What can develop at the epipysis of the bone

Brodie’s abscess

How well did you know this?

Not at all

Perfectly

Where is the most common place for a Brodie’s abscess

Tibia

How well did you know this?

Not at all

Perfectly

S/S acute osteomyelitis

Fever
Chills
Malaise nausea
Restlessness 
Bone pain that's unrelieved with rest
Swelling, tenderness &amp; warmth at infection site 
Restricted movement of affected part

How well did you know this?

Not at all

Perfectly

S/S of chronic osteomyelitis

Constant bone pain & swelling
Drainage sinus tract
Local signs more common

How well did you know this?

Not at all

Perfectly

What are some diagnostic tests done for osteomyelitis

``` Wound and blood cultures H & P Increase WBC (infection) Increase ESR (inflammation) Bone scan X-ray MRI CT ```

What is the best tool to use for early diagnosis of osteomyelitis

Bone scan

What is the best treatment for osteomyelitis

Vigorous & prolonged IV antibiotic therapy

Decompression surgery

Saucerization

Use of one drain coming in one going out for continuous or intermittent irritations

Closed wound

What kind of wound would you use dressing changes for Debridement Used for invasion of anerobic organisms

Open wound

Are amputations more common in males or females

Males

Most puts toons occur where

Lower extremity

Lower extremity amputations are caused by ?

PVD (diabetes, atherosclerosis)

Upper extremity amputations are caused by?

Trauma Accidents Burns Frostbite

Goal of prosthesis

To preserve the most distal level that will heal, try to preserve elbow & knee joints

Goal of prosthesis

The level of amputation is determined by

Amount of circulation and presence of infection

Are all pt's candidates for prosthesis ?

Who expends more energy for ambulation amputees or non amputees

Amputees

The longer the residual limb, the _______ the energy costs for the amputee

Lower

Amputation through a joint

Disarticulation

Occurs through ankle @ level of foot, take both malleoli

Syme's amputation

BKA

Below knee amputation

AKA

Above knee amputation

Lower extremity amputation including half of pelvis is removed

Hemipelvectomy

Entire shoulder & arm amputated

Forequarter amputation

Type of amputation that has actual or potential infection, stump left open for drainage

Open or guillotine

Type of amputation that allows weight bearing, no infection present, may or may not have drains

Closed or myoplastic or flap

When is a total contact rigid dressing placed on pt

During surgery

Aluminum rod that is attached to the ankle piece which is attached to a rigid dressing

Pylon

What is a disadvantage of immediate post op prosthesis

Unable to visualize operative site | infection risk

Delayed prosthesis that decreases edema & begins stump molding for prosthesis

Compression dressing

Aching, tingling, or itch in a amputated limb

Phantom sensation

Phantom sensation is more frequent in

AKA

4 stages of adjustment to loss of body part

Impact Retreat Acknowledgement Reconstruction

In what stage does the pt show despair, discouragement, passive acceptance

Impact

In what stage of loss does the reality of the amputation become apparent & acute grief is seen

Retreat

In what stage does the pt show a willingness to participate in care & rehab

Acknowledgement

In what stage does the pt try to reach maximum rehab potential

Reconstruction

Most frequent complication of amputations is

Contracture for above the joint amputations

What would you do to help prevent deformities

Place the pt prone 3-4 times a day for 30 minutes

How long does it take to shrink the stump for a permanent prosthesis

2-3 months

What do you want to avoid with amputations to avoid contractures

Dangling | Elevating limb after first 24 hours

What are complications of amputations

Injury Skin breakdown Pneumonia Thrombophlebitis

More Bone cancer cases each year are found in?

Men

More deaths per year from bone cancer occur in

Men

Bone cancer effects who more often?

More children then adults

Arise in a particular tissue | Originates in the bone

Primary tumor

Cancer that spreads to another tissue from the original site

Secondary tumor

Is primary or secondary tumor the most common bone cancer?

Secondary tumor

What is the most common malignant primary bone tumor seen in adults

Osteosarcoma

Osteosarcoma is usually seen in what bones

Distal femur, proximal tibia & proximal humerus (long bones)

S/S of osteosarcoma

Pain Local tenderness Enlargement of part affected Limited joint movement

Diagnostic studies for osteosarcoma

MRI shows sunburst Bone scan Biopsy Increased calcium & alkaline phosphatase

Treatment of osteosarcoma

Radiation Chemotherapy Possible amputation

Osteosarcoma can metastasis to?

Lungs

Tumor of cartilage

Chondrosarcoma

Common age group for those diagnosed with chondrosarcoma

30-60 years

Chondrosarcoma is usually found where

Pelvis Proximal femur Proximal humerus

Diagnostic tests for chondrosarcoma

X ray or CT will show thinned bone cortex, bone destruction

S/S of chondrosarcoma

Dull pain Edema Deformity

Treatment for chondrosarcoma

Surgery | Occasional radiation

What is the most malignant bone tumor

Ewings sarcoma

Rapid growth within the medullary cavity of long bones

Ewings sarcoma

Malignant giant cell tumor | Bone destruction & expansion of bone ends

Osteoclastoma

Tumor bearing bone is resected & replaced with a cadaver allograft or a custom made prosthesis

Limb salvage

Treatment for primary tumors

Chemotherapy

Plasma cell myeloma White blood cell cancer Produces osteolytic lesions throughout the skeletal system

Multiple myeloma

What is common in metastatic cancer to bone Excessive calcium release as tumor destroys bone Can lead to heart dysrythmias

Hypercalcemia

What is the treatment for hypercalcemia

Diuresis | Flush extra Ca+ out of the body

Study of rheumatology

Study of rheumatic disease

Any disease or condition involving the muscular skeletal system

Rheumatic disease

Inflammation of joint

Arthritis

3 types of arthritis

Inflammatory Degenerative Metabolic

Osteoarthritis

``` Degenerative disease Wear & tear disease Ages 50-70 Disease of articulate cartilage Cartilage becomes thinner Joint pain/stiffness 30 min/asymmetrical ```

Osteophyte formation on DIP joints

Heberden's nodes

Red, swollen tender nodes on the PIP joints

Bouchard's nodes

Remove bits of broken cartilage or bone

Arthroscopy

Realignment

Osteotomy

Fusion

Arthrodesis

Joint replacement

Arthroplasty

Rheumatoid arthritis

Inflammatory Symmetrically Stiffness 60 minutes

Inflammation of the tendon and it's sheath

Tenosynovitis

A chronic systematic disease characterized by inflammation of connective tissue in the diarthrodial joints

Deformity of hand towards ulnar side

Ulnar drift

Flexing of fingers

Boutonnière deformity

Deformity of great toe

Hallux vagus | Bunion

Hyper extension of joint in fingers

Swan neck deformity

Diminished lacrimal and salivary gland secretion

Sjögren syndrome

Inflammatory eye disorders, splenomegaly, lymphadenopathy, pulmonary disease, blood dyscrasias

Felty syndrome

Tissue biopsy

Arthroscopy

Anti inflammatory analgesic

Corticosteroid

Why can you not stop corticosteroids suddenly

Cause adrenal crisis

Anti inflammatory drug | Inhibits synethesid of prostaglandin

NSAIDS

Cytoxic agents | Suppression of bone marrow to decrease immune response

Immunosuppressants

Decrease inflammatory response | Prevents progression of RA

Disease modifying anti rheumatic drugs (DMARDs)

Used for prestant RA Slows progression of RA 4-6 months to work

Antimalarials

Deposit in the pigment layer of retina cause irreversible rental degeneration

Retinopathy

Anti inflammatory | IM injection given 5 months

Gold salts

Chronic progressive metabolic bone disease characterized by porous bone, low bone mass, structural deterioration of bone tissue

Osteoporosis

Why is osteoporosis more common in women than men

``` Lower calcium intake Loss body mass Bone reabsorption begins earlier & increase with menopause Pregnancy/breast feeding Women live longer than men ```

Patho of osteoporosis

Bone reabsorption exceeds bone deposition

What's the most common osteoporosis diagnostic study

Duel energy X-ray absorptiometry | DEXA

T score

1.0- to -1.0 normal bone density -1.0 to -2.5 low bone density Osteopenia -2.5 to -4.0 osteoporosis

Measures trabecular & cortical bones at hip & lumbar spine

DEXA | DUAL ENERGY X-RAY ABSORPTIOMETRY

Low dose radiation scanner

Single photon absorptiometry

How much Ca is needed for Pre menopausal women

1000mg/day

How much Ca is needed for post menopausal women

1500mg/day

If too much Ca is taken what can happen

Kidney stones

Inhibit osteoclasts activity | Mediated bone reabsorption

Biophosphonates

Good for pt's with fx helps decrease pain

Calcitonin

Treatment for vertebral compression fx

``` Bed rest Position of comfort Muscle relaxant Local heat Log roll OOB ASAP to decrease Ca loss ```

Inadequate mineralization of bone Vit D deficiency Bone become abnormally soft

Osteomalacia

Ribbons of decalcification in bone | Classic sign of osteomalacia

Loosers transformation zones

Chronic bone disease excessive bone reabsorption followed by excessive & abnormal bone replacement Increase vascularity with bone

Paget's disease

When you have an Increase of Alkaline phosphatase it is because of

Excessive bone building

Chronic progressive inflammatory disease of the spine & sacroiliac joint Found in men more

Ankylosing spondylitis

Inflammation of spine

Spondylitis

Fuse

Ankylosis

Kyphosis

Round back

A genetic marker found in AS

HLA B27 | Human leukocyte antigen

Treatment goal of Ankylosing spondylitis

Maintain maximal skeletal mobility

Self limiting disease associated with arthritis, urethritis & conjunctivitis

Reiters syndrome

Invasion of synovial membranes with micro organisms | Septic arthritis

Bacterial arthritis

Joint aspiration

Arthrocentesis

Result of prolonged hyperuricemia | Increase uric acid

Gout

Inflammation of great toe

Podagra

Multiple joint involvement with deposites of sodium irate crystals

Chronic gout

Irate crystals

Tophi

Prevent future gout attacks

Avoid etoh, high purine food Chicken, sardines, organ meats

Disorder of the connective tissue characterized by fibrotic degenerative & inflammatory changes in skin, blood vessels, synovium skeletal muscle & internal organs

Scleroderma

Skin thickening on the trunk face and proximal & distal extremities

Diffuse scleroderma

Thick skin limited to sites distal to the elbow & knees but also involves face & neck

Limited scleroderma

CREST

``` Calcinosis (Ca deposits) Raynauds phenomenon red white blue Esophageal desmotility Sclerodactyly scleroderma of digits Telangiectasis benign tumor of blood vessels ```

Chronic progressive inflammatory multi system disease of connective tissue

Lupus

Classic sign of lupus

Butterfly rash

Inflammatory disease involving voluntary muscles also a | Degeneration of muscle fibers

Polymyositis | Proximal muscles are affected first

Dusky red rash on face neck shoulders anterior chest upper back & arms

Dermatomyositis

Autoimmune response Inflammation & dysfunction of the exocrine glands Salivary & lacrimal glands

Sjögren syndrome

What allows for NWB ambulation

Crutches

What provides solid support helps with balance problems

Walkers

What hand do you hold the cane in

Opposite the involved extremity

Cane should be where?

Top of the greater trochanter

Crutches up/down the steps

Up with good | Down with bad

Joint movement

Isotonic

Muscle setting exercise

Isometric

Goals of surgery

Relieve pain Improve joint motion Remove debris Correct deformity

Insertion of endoscope into a joint for direct visualization of joint

Arthroscopy

Removal of synovial membrane

Synovectomy

Cutting a bone to change its alignment

Osteotomy

Removal of degenerative debris

Debridement

Surgical fusion of joint

Arthrodesis

Joint exploration

Arthrotomy

Cutting tendon

Tenotomy

Movement of a tendon insertion to improvement function

Tendon transfer

Reconstruction or replacement of joint

Arthroplasty

Replacement of part of a joint

Hemiarthroplasty

Peak time for fat embolus

4th post op day 72 hours

Closed wound drainage system

Hemovac

What is the most complex joint in the body

Ball & socket

A body part that has been totally severed from the body by trauma, surgery or a congenital abnormality

Amputation

What can help with arthritic joints

``` Exercise Balanced nutrition Weight loss Drug therapy Hot/cold therapy Rest Joint protection ```

Sublaxation

Partial dislocation

Infection of bone and/or bone marrow | Direct or indirect invasion by an organism

Osteomyelitis

Unit VII part 2 COPY Flashcards

(184 cards)