Bone Fractures and Osteoporosis Overview

Fractures

• Open fracture: Bone breaks through the skin.
• Closed fracture: Bone does not break through the skin.
• Transverse fracture: Horizontal fracture line across the bone.
• Oblique fracture: Angled fracture line.
• Spiral fracture: Twisting motion causes a helical break.
• Greenstick fracture: Incomplete fracture, bone bends and cracks (common in children).
• Comminuted fracture: Bone shatters into multiple pieces.

Osteoporosis

• Prevention: Weight-bearing exercise and a high calcium diet (dairy products).
• Mechanism: Bone reabsorption exceeds bone deposition (more osteoclasts than osteoblasts).
• Characteristics: Lower bone mass/mineral density and fragility.

Osteomyelitis

• Cause: Most commonly caused by Staphylococcus bacteria (sta ph).
• Occurrence: Comorbidities (other health problems) can increase risk.
• Diagnosis: Complex, involving physical exam, medical history, imaging, blood tests, and biopsies.
• Complications: Fat embolism can be fatal.

Gout

• Dietary Management: Follow a diet low in purines. Avoid foods high in purines (red meat, shellfish).
• Definition: Arthritis caused by uric acid crystal deposits in joints.
• Symptoms: Sudden severe pain accompanied by common arthritis symptoms.

Compartment Syndrome

• Clinical Presentation: Pain, pallor, paresthesia, paralysis, pressure, pulselessness.
• Cause: Increased pressure in compartments around bones, often due to fractured bones (like ORIF - open reduction internal fixation).
• Consequence: Cuts off circulation causing tissue death.

Rhabdomyolysis

• Mechanism: Muscle wasting/breakdown releases myoglobin into the urine (blood-colored urine).
• Lab Finding: Increased creatinine kinase levels.

Deep Vein Thrombosis (DVT)

• Diagnosis: Doppler ultrasound of the affected leg.
• Treatment: Anticoagulants, compression stockings (SCDs), early ambulation, and leg/foot exercises.

Perioperative Care

• Patient Education (pre-op/post-op/discharge):
  • Pre-op: NPO status before surgery, smoking cessation, concerning signs/symptoms.
  • Post-op (inpatient): Pain management, bowel movements, nausea, ambulation, coughing, deep breathing, incentive spirometer.
  • Discharge: Start discharge teaching before surgery and right away.
• Post-op Complications (Prevention/Management): Pneumonia, DVTs - Encourage early ambulation, use of incentive spirometer, coughing, and repositioning.
• Pain Management: IV medications (faster onset), oral medications (slower onset). Administer IV meds 30 mins after administration, oral 1 hour.
• Informed Consent: Nurse can witness consent signing, but the doctor must obtain consent. Patient must be involved in the decision.

Sleep Apnea

• Signs/Symptoms: Snoring, daytime sleepiness, stopping breathing, waking during night gasping for air, high blood pressure.
• Treatment: Positional therapy, oral appliances, weight loss, CPAP, BiPAP.

Sleep Deprivation

• Signs/Symptoms: Impaired immune system, irritability, trouble thinking/focusing/remembering, headache, slow reaction time.

Sleep Hygiene

• Best Practices: Avoid caffeine and alcohol 4-6 hours before bed.

Heart Rate Changes (Age/Fitness)

• More in shape = slower resting heart rate, irrespective of age.

Nutrition (Parenteral & Enteral Feedings)

• Parenteral Feedings (PPN/TPN):
  • Safety: Aspiration prevention: Keep head of bed elevated 30+ degrees, educate on why, cap for 30-60 minutes.
  • PPN: Peripheral Parenteral Nutrition, short-term, given through normal IV, normal protein/calorie requirements, supplements oral intake.
  • **TPN (total/central):**Long-term, central line, higher infection risk, high calorie/protein needs.

Metabolic Syndrome

• Diagnosis: Lab values: fasting glucose, vital signs, HDL.
• Criteria: Elevated blood pressure (>130/85), high triglycerides (>150), large waist circumference (men >40 inches, women >35 inches), low HDL (men).