4 Types of Bones PDF

4 types of bones - Osteoclast -- breakdown calcium reabsorption - Osteoblast -- build bone - Osteocytes -- maintain bone tissue - Osteogenic -- stem cells 7 medications for pain: 1 Lyrica or Neurotin (anticonvulsant): treats nerve pain 2 Calcitonin IV 3 Antispasmodics: Baclofen 4 Op...

4 types of bones - Osteoclast -- breakdown calcium reabsorption - Osteoblast -- build bone - Osteocytes -- maintain bone tissue - Osteogenic -- stem cells 7 medications for pain: 1 Lyrica or Neurotin (anticonvulsant): treats nerve pain 2 Calcitonin IV 3 Antispasmodics: Baclofen 4 Opioids -- these are last resorts! 5 Beta blockers: PROPANALOL: treats dull and aching pain 6 Antidepressants: Cymbolta 7 NMDA 2. 8 types of muscular dystrophy - Most critical: Becker/Ducheen which is the absence of dystrophy - Congenital - Distal - Emery diffuses - Myotonic - Humeral - Ocular pharyngeal - Limb girdne A kid is 50% likely to have disease if carrier from mother. Women carry disease but men are more likely to have it! 3. Most common complication after surgery \#1 Bleeding / Hemorrhage IE: Hypovolemic shock \#2 Infection IE: Osteomyelitis, PVD, DM, Elderly, Immunocompromised \#3 Flexion contractor This will increase mobility issues that are usually in the KNEE, HIP, ELBOW, and SHOULDER -- Ensure that no pillows are placed under joints to prevent contractor -- another method to prevent contractor is lying patient supine every 3 to 4 hours for 20 to 30 minute increments: this method is considered to be strength by stretching Some methods strength by stretching consist of: mobility, having a firm mattress which reduces restraint against object. \#4 Phantom limb pain \#5 Body image \#6 \*\*NEUROMA\*\* This can be diagnosed using a ultrasound IE: Nerve blocks that are painful and can be treated with hypnosis, gabapentin, steroid injections (though steroids cannot be used long term) \#7 Impaired mobility Number 1 prevention: early ambulation, along with PT, OT, use of aides and devices Lower extremities use more physical therapy that helps with ambulation verses Upper extremities use more occupational therapy such as assistance with ADL like eating 4. Classifications or Descriptions of Osteomyelitis 1. Exogenous -- this is from the outside of the body as in an open fracture 2. Endogenous -- this is from inside of the body like a bacterium that enters from the bloodstream into the bone (IV drug users) 3. Acute: in which symptoms typically last no longer than four weeks HOWEVER can be treated longer than chronic -- therefore stating that symptoms resolve and illness is still treated 4. Chronic: in which symptoms last longer than four weeks 5. Contagious -- like skin of adjacent tissue becomes infected 5. Prevention of flexion contractor - ROM Exercises - Splinting extremity - No pillows - Prone positioning Q4 for 30 mins - Firm mattress Remember that blood runs away from ice and runs to warmth, so be careful when applying heat due to increased risk of swelling -- be careful when applying cold because of constriction and loss of flow 6. Hypercalcemia verses Hypocalcemia - Bone build up causes hypocalcemia - Too much calcium = not enough phosphorus 7. Treatment for plantar fasciitis 1. Rest 2. Ice 3. Supportive shoes 4. Stretching 5. NSAIDS 6. Steroids 7. Massage 8. Endoscopic procedure - Surgery for fasciitis is called a fasciectomy also known as removing the inflamed part of extra tissue 9. Signs and symptoms of acute osteomyelitis rather than chronic: Number ONE SIGN IS TEMP OVER 100 degree 2 is swelling 3 is redness 4 is heat 5 is tenderness 6 is pulsating pain - Acute infection is 1. Tender to touch 2. Pulsating pain 3. Heat/ Warmth 4. Swelling/Edema - Constant localized intense, pulsating pain is a common s/s of acute infection - Chronic infection is: 1. Sinus tract formation 2. Ulceration 3. Weeping and drainage of site -to elaborate on this, a usual site that is not infected will drain serus drainage that usually is a little blood tinged or clear. However when an acute infection occurs drainage is often purulent and has a foul smell. Where as in chronic infection the drainage is more of a weeping Types of surgical interventions for osteomyelitis - Sequestrectomy: this is a debridement of necrotic issues for revascularization which is likely a big whole where a bone graft will be needed in order to cover area that was infected - PMMA beads: these are antibiotic beads that are inserted into a wound and then closed up with the wound. These antibiotic beads slowly release antibiotic into the wound which usually take about 6 weeks to fully dissolve. These beads do not need to be taken out as they dissolve and complete the job that they were inserted into the wound to complete. - Bone graft: the most important assessment to complete when having a patient that has had a bone graft is a neurovascular assessment to ensure perfusion of blood flow of all areas. The most common area for a bone graft to be taken when needed is from a patient's fibula. - Muscle flap: this skin flap is used for extra skin coverage when needed to cover/close a wound back - Amputation The most common risk factors for surgical amputation - Highest on the list \#1 is diabetes mellitus - Following PVD - Atherosclerosis - Osteomyelitis infection - Cancer - Dysfunction 3 types of amputation are: 1. Congenital 2. Traumatic 3. Surgical or Elective Calcitonin: This is a drug that is used for osteoporosis which puts calcium from the blood, back into the bone This drug can be delivered nasal spray or IV Classic manifestations of osteoporosis: \#1 FRACTURES: most common in HIP, WRIST, OR LOWER BACK \#2 loss of height: typically, 2 to 3 inches of height loss is a tale sign \#3 Dowager hump -- this is located in the cervical spine region and may need an Xray to diagnosis \#4 Reflux \#5 Respiratory problems \#6 Back pain \#7 Constipation - The number one medication for osteoporosis is Bisphosphorus - Diloxifen is a skeletal muscle relaxant that promotes estrogen that does not increase patients' risk of breast cancer - PTH analog stimulates the parathyroid: be cautious to give this medication in short burst because if used for long periods of time it will decrease calcium Emergency care for traumatic amputation - ABC's - Salvage body part - Precent hemorrhage - Promote perfusion - Hospital visit If the extremity is still attached, then stabilize and leave attached! This means avoiding a tunicate in order to promote perfusion to the area. Once stabilized it should be elevated, and patient should get to the hospital as quick as possible. So steps for a traumatic event in which an amputation occurs for a patient it is important to first clean the extremity then wrap it then put the body part that has been amputated in cool water and put that bag of cool water over ice to preserve/salvage limb. 6 Types of pain disorders 1. Carpal tunnel syndrome: this will need to be treated by compressing medial nerve like sleeping, typing, or holding in weird position for extended amount of time. Usually from repetition and sometimes even developed during pregnancy due to compression of baby on certain nerves Treatment for carpal tunnel is surgery that is either open which means open and endoscopic which is inside, so it does tend to cause more pain however has less risk for complications 2. Dupuytreus contractor: this happens when diabetics and is most common in males 3. Hallux valgus : this is most common in females and can be treated with a surgical removal called a bunectomy. Because of surgery this patient will be at increased risk for falls given the boot that they will need to wear in order to maintain safety 4. Hammer toe: also requires surgery for proper treatment 5. Plantar fasciitis : this is an inflammation in the foot and can be treated with ICE, NSAIDS, REST, STERIODS, SPLINTING, and STRETCHING 6. Gangean cyst: also known as a bible bump. This is a self limiting disease that can come back if not treated properly. It is important that during removal of such cyst to ensure that the root of the cyst has completely been removed or it will return and be an issue. A last resort for treatment if the cyst root can not be removed would be to try and aspirate what is inside the cyst. If this doesn't work an I&D will completed 4 Limb viability prior to surgery/amputation 1. Ankle brachial inspection (ABI) 2. Ultrasound doppler 3. Laser doppler flowmetry 4. Transmontanes optic pressure: also used to treat/diagnosis carpal tunnel syndrome - Its important to remember that increased TP02 means that there is a low risk for amputation whereas decreased TP02 means there is a high risk for amputation. 8 modifiable risk factors for osteoporosis: 1. CHRONIC LOW VITAMIN D or CALCIUM 2. Low body weight with thin frame 3. Sedentary lifestyle 4. Protein intake extremely high or extremely low 5. Sex hormone deficiency 6. Gender confirmation surgery 7. Caffeine or calorie intake that is really high 8. Tobacco use and smoking Most common is low body weight and thin build. Diet and supplementation like sunlight for vitamin D is very important for calcium reabsorption If low calcium, then high in parathyroid hormones Phosphorus binds to calcium Carbonated seltzers water is not high in sodium or phosphorus so it is safe to drink Estrogen and testosterone increased or decreased can play a huge risk factor