Osteomyelitis, osteomalacia,osteoprosis, bne tumor

1. osteomyelitis Prepared by Ms.mahalakshmi.l M,Sc nursing 1 st year

2. INTRODUCTION

3. OBJECTIVES OF OSTEOMYELITIS define osteomyelitis s tate the cause for osteomyelitis e xplain the pathophysiology for osteomyelitis e numerate the clinical manifestation for osteomyelitis d iscuss the diagnostic studies for osteomyelitis d escribe the management for osteomyelitis d iscuss the nursing diagnosis for osteomyelitis

4. DEFINITION Osteomyelitis is an acute infection of the bone and bone marrow. ACUTE <2weeks SUB ACUTE 2weeks-3weeks CHRONIC >3weeks

5. INCIDENCE Chronic osteomyelitis occurs in about 2 in 10,000 adults. Children have the acute form of the disease more often than adults do, at a rate of about 1 in 5,000

6. RISK FACTORS Age Obese and malnourished patients Patients have impaired immune system Chronic illness Prolonged use of corticosteroid therapy or immunosuppressive drugs Post operative surgical wound infection

7. CAUSTIVE ORGANISM Staphylococcus aureus E.coli Pseudomonas Klebsilla Salmonella

8. Diagnostic test WBC and ESR Blood and tissue cultures MRI and CT scans Radio nucleotides bone scans

9. MEDICAL MANAGEMENT Parenteral antibiotics Balance diet Immobilized the affected area to decrease discomfort Wet warm soaks for 20mins several times a day given to the patient for increasing circulation

10. SURGICAL MANANGEMENT Debridement Sequestrectomy

11. NURSING DAIGNOSIS Acute pain related to surgical wound as evidenced by pain scale score is 6. Immobilize the affect part by using splints Elevate the part Administer prescribed analgesic Avoid excessive manipulation of affected part handle with great care & gentleness Teach the patient to use non pharmacological strategies like relaxation techniques , guided imaginary & deep breathing Warm soaks, soaks , moist packs provided to patient

12. Impaired physical mobility related to surgery Maintain functional position of limb when immobilization provided . Teach the patient to perform ROM exercises 4hrly & participate in carrying out ADLS

13. Risk for infection Maintain strict asepsis while carrying out any procedure. Adhere to strict hand washing practices. Administer prescribed antibiotics. High protein & vitamin c rich diet.

14. OSTEOMALACIA

15. OBJECTIVES FOR OSTEOMALACIA define osteomalacia state the cause for osteomalacia l ist down the risk factors for osteomalacia explain the pathophysiology for osteomalacia enumerate the clinical manifestation for osteomalacia discuss the diagnostic studies for osteomalacia describe the management for osteomalacia discuss the nursing management for osteomalacia

16. osteomalacia Osteomalacia also called adult rickets. It is metabolic bone disorder characterized by inadequate or delayed mineralization of bone matrix in mature compact or spongy bone.

17. causes Vit D deficiency Phosphate depletion Chronic renal failure Calcium malabsorption

18. PATHOPHYSIOLOGY Decreased level of Decreased absorption of from intestines

19. Activate Results in continuous loss of

20. Diagnostic test Blood test-low serum calcium, increased alkaline phosphate, increased parathyroid hormone levels are present Urinary excretion of calcium & creatinine is low

21. Medical management Vit D , calcium & phosphorus supplements are prescribed. Exposure to sunlight Advice the patient to take vit D rich diet Safe use of vitamin D supplements recommended as higher doses are toxic as it increase the level of calcium

22. Nursing management Advice the patient about intake of diet rich in calcium & phosphorus. Teach about safety measures to prevent falls. Encourage the patient towards use of assistive devices. Teach the patient to observe anorexia, nausea/vomiting, frequent urination, muscle weakness & constipation as these are the systems of vit D toxicity.

23. OSTEOPOROSIS

24. OBJECTIVES FOR OSTEOPOROSIS define osteoporosis state the cause/risk factors for osteoporosis explain the pathophysiology for osteoporosis enumerate the clinical manifestation for osteoporosis discuss the diagnostic studies for osteoporosis describe the medical/dietary management for osteoporosis discuss the nursing diagnosis for osteoporosis

25. osteoporosis Osteoporosis means “ porous bone” . This is characterized by loss of bone density, change in bone structure and increased bone fragility and increase suceptivity to bone fractures

26. RISK FACTORS Un modifiable risk factors Sex Age Ethinicity Genetics Small body frame Female athletes Endocrine disorders Modifiable factors Calcium defiency

27. Clinical manifestation Progressive loss of curative of spine, decrease in height, low back pain & fracture of fore arm, spine or hip. Pain Dorsal kyphosis & cervical lordosis develops Dowager’s lump present. Impaired breathing , abdominal distension & constipation may occur.

28. Diagnostic test DEXA Blood analysis Urine analysis X-ray

29. MEDICAL MANAGEMENT Diet : calcium & vit d enrich diet should be taken. Calcium supplements given to all post menopausal females. Selective estrogen receptor modulator : raloxifene reduce the risk of osteoporosis .

30. (CONT….) Bisphosphonates increase bone density & reduce fractures. Advice the patient to take these medicines empty stomach and walk for atleast 1 hr after taking medicine. Calcitonin increase bone formation & decrease bone reabsorption. Sodium fluoride given as it stimulate osteoblast activity & increase formation of bone.

31. BONE TUMOR

32. OBJECTIVES FOR BONE TUMOR define bone tumor l ist down the types for bone tumor enumerate the clinical manifestation for bone tumor discuss the diagnostic studies for bone tumor describe the medical/surgical management for bone tumor discuss the nursing management for bone tumor

33. BONE TUMOUR Bone tumour may be benign or malignant (rapidly growing) & can affect any age.

34. CAUSES Unknown Past trauma Carcinogens Paget disease & hereditary predisposition

35. TYPES OF BONE TUMOUR Benign tumour Malignant bone tumour Osteosarcoma Ewing’s sarcoma Fibrosarcoma chondrosarcoma

36. CLINICAL MANIFESTATION Pain is the most common bone cancer symptom Weakned bone, sometimes leading to fracture Joint swelling & tenderness Fatigue fever Unintended weight loss anemia

37. INVESTIGATION Blood count & ESR Blood & urine calcium level Tumour markers e.g. Alkaline phosphatase for osteoblastic tumour & LDH for ewing’s sarcoma Radiological studies i.e. xray , ct scan,mri Bone biopsy is needed for confimation of the diagnosis

38. MANAGEMENT Chemotherapy Radiation therapy Surgery Wide excision of the tumour Amputation cryosurgery

39. ANY QUESTION?

40. THANK YOU ALL…