NUR 212 Unit 2 Part 3 PDF

NUR 212 Unit 2 Part 3 Osteomyelitis Amputation Scoliosis Cortney Maffett, MSN, FNP-BC Osteomyelitis Osteomyelitis Severe infections of the bone & surrounding tissues Requires immediate intervention  Osteomyelitis – Infection Cycle 1. Pathogen Invasion 2. Tissue inflammation 3. Edema f...

NUR 212 Unit 2 Part 3 Osteomyelitis Amputation Scoliosis Cortney Maffett, MSN, FNP-BC Osteomyelitis Osteomyelitis Severe infections of the bone & surrounding tissues Requires immediate intervention  Osteomyelitis – Infection Cycle 1. Pathogen Invasion 2. Tissue inflammation 3. Edema formation 4. Decreased blood flow to bone 5. Bone necrosis 6. Bone abscess Osteomyelitis - Classification Exogenous: from outside the body Endogenous: carried by blood stream Contiguous: from skin of adjacent tissue Acute vs. Chronic Osteomyelitis - Assessment Vital Signs, fever expected Pain, tenderness and inflammation S/S infection Vomiting and dehydration Limping or hesitation Malaise Drainage  Osteomyelitis – Acute vs. Chronic Acute Chronic Temperature above 101* F Ulceration of the skin (foot) Swelling Sinus tract formation Erythema/heat Constant localized pain Tenderness Drainage Bone pain that is constant, localized, pulsating, and intensifies with movement Osteomyelitis - Diagnostics Labs Blood Cultures Wound Cultures X-Ray Needle aspiration of the bone Open bone biopsy Radionuclide bone scans MRI Osteomyelitis - Treatment Antibiotic therapy ○ Home vs outpatient Contact Precautions/Infection Control Wound care Pain control Hyperbaric O2 Therapy Surgical intervention ○ Sequestrectomy ○ PMMA beads ○ Bone grafts ○ Muscle Flaps ○ Amputation Amputation Amputation Congenital Surgical vs Traumatic Risk Factors ○ DM ○ PVD ○ Arteriosclerosis ○ Infection ○ Cancer ○ Dysfunction Trauma Traumatic Amputations – Field Care Emergency care in the field: ABCs Salvage the body part if possible Promote Perfusion Prevent hemorrhage Hospital ASAP Traumatic Amputation - Surgery (Pre)Amputation - Assessment Health History Subjective Objective Psychosocial Knowledge deficits (Pre)Amputation - Diagnostics Ankle-brachial index (ABI) ○ Calculated by dividing ankle systolic pressure by brachial systolic pressure Doppler ultrasound Laser doppler flowmetry  ABI Value Interpretation Recommendation Greater than 1.4 Calcification/Vessel Refer to vascular specialist Hardening 1.0-1.4 Normal None 0.9-1.0 Acceptable None 0.8-0.9 Some Arterial Disease Treat risk factors 0.5-0.8 Moderate Arterial Disease Refer to vascular specialist Less than 0.5 Severe Arterial Disease Refer to vascular specialist Amputation Surgery Successful healing Function preservation Prosthetic ability Standard Amputation Osseointegration Interdisciplinary Amputations – Lower Extremity Partial foot amputation: removing part of the foot (toe, midfoot, syme) Syme Ankle disarticulation: removing the foot after separating it from the lower leg at the ankle Below-the-knee amputation: removing the foot and part of the lower leg by cutting across the bones of the lower leg (tibia and fibula) Knee disarticulation: removal of the lower leg by separating it from the upper leg at the knee Above-the-knee amputation: removal of the lower leg, the knee and part of the upper leg by cutting across the upper leg bone (femur) Hip disarticulation: removal of the entire leg by separating it from the pelvis at the hip joint Amputations – Upper Extremity Partial hand amputation: removing part of the hand Wrist disarticulation: removing the hand after separating it from the lower arm at the wrist Below-the-elbow amputation: removing part of the lower arm by cutting across the bones of the lower arm (radius and ulna) Elbow disarticulation: removing the lower arm after separating it from the upper arm at the elbow Above-the-elbow amputation: removing the lower arm, elbow and part of the upper arm by cutting across the upper arm bone (humerus) Shoulder disarticulation: removing the entire arm after separating it from the shoulder Forequarter amputation: removing the arm and part of the Amputation – Surgery Complications Hemorrhage Infection Impaired mobility Neuromas Flexion contractures Phantom limb pain  Phantom Limb Pain Occurs frequently Real pain! Multiple triggers Interference with ADL’s Treatment: ○ PT, massage, heat, TENS ○ Mirror therapy Pharmacological: ○ Calcitonin IV, Beta- blockers, Anticonvulsants, Antispasmodics, Opioids, Antidepressants, NMDA  Flexion Contractures Muscle or tendon shortening May prevent use of a prosthetic limb Prevention is key ○ Exercises ○ Splinting ○ No pillow under the knee Post-op Interventions Assess and maintain tissue perfusion Pain management Prevent infection, promote wound healing Improve mobility Prostheses preparation Promotion of body image Lifestyle adaptations Amputation - Prosthetics Preop ○ Preparation Postop ○ Prevent secondary disabilities ○ Proper fitting can take weeks ○ Stump conditioning/shrinking ○ Rehabilitation Education Scoliosis Scoliosis - Assessment Signs and symptoms of scoliosis may include: ○ Uneven shoulders ○ One shoulder blade appears more prominent ○ Uneven waist ○ One hip higher than the other ○ One side of the rib cage jutting forward ○ A prominence on one side of the back when bending forward Scoliosis - Diagnosis Physical Exam ○Adams forward bend test ○Plumb line test ○Scoliometer Confirmed with: ○X-ray ○Ultrasound ○MRI Scoliosis - Treatment Close monitoring with x-rays Brace Surgery ○ Spinal fusion ○ Expanding rod ○ Vertebral body tethering THANKS!