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OSTEOMYELITIS
• Osteomyelitis is a severe infection of bone, bone marrow, and surrounding soft tissue.
• Infecting microorganisms can invade by indirect or direct entry. After entering the blood,
they lodge in an area of bone and grow which results in increased pressure, eventually
leading to bone ischemia.
• Acute symptoms are fever, night sweats, malaise, and constant bone pain.
• Some immobilization of affected limb (e.g., splint, traction) is indicated to decrease pain.
The patient is frequently on bed rest in the early stages of the acute infection.
• Vigorous and prolonged IV antibiotic therapy is treatment of choice for acute osteomyelitis.
• Oral antibiotics, hyperbaric oxygen therapy, and surgery may be prescribed for chronic
disease.
SARCOMA
• Most primary bone cancer is called sarcoma.
• Sarcomas can also develop in cartilage, muscle fibers, fatty tissue, and nerve tissue.
• Common types are osteogenic sarcoma, chondrosarcoma, Ewing’s sarcoma, and chordoma.
OSTEOCHONDROMA
• Osteochondroma is a primary benign bone tumor characterized by overgrowth of cartilage
and bone near end of the bone at the growth plate.
• Manifestations include painless, hard, and immobile mass, one leg or arm longer than other,
and pressure or irritation with exercise.
• Nursing care does not differ significantly from the care given to patients with a malignant
disease of any other body system.
Osteogenic Sarcoma
• Osteogenic sarcoma (osteosarcoma) is a primary bone tumor that is extremely aggressive
and rapidly metastasizes to distant sites.
• Manifestations are usually associated with gradual onset of pain and swelling, especially
around the knee.
• Preoperative (neoadjuvant) chemotherapy is used to decrease tumor size.
• Metastatic bone lesion is commonly found in vertebrae, pelvis, femur, humerus, or ribs.
• Metastasis to bone may be suspected in patients with local bone pain and past cancer history.
• Acute low back pain is usually associated with activity that causes undue stress (often
hyperflexion) on the lower back.
o If muscle spasms and pain are not severe, treatment includes avoiding activities that
aggravate pain, analgesics, muscle relaxants, massage and back manipulation; and
heat and cold compresses.
o Most acute cases spontaneously improve.
• Chronic low back pain causes include degenerative disk disease, lack of physical exercise,
prior injury, obesity, and structural and postural abnormalities.
o Treatment can include weight reduction, analgesics, rest periods, heat or cold
application, and exercise and activity to keep muscles and joints mobilized.
o Surgery may be indicated for severe chronic low back pain that is not responding to
conservative care.
• This is a normal process of aging, and results in intervertebral disks losing their
elasticity, flexibility, and shock-absorbing capabilities.
• An acute herniated intervertebral disk (slipped disk) can be the result of DDD or
repeated stress and spinal trauma.
• Radicular pain, which radiates down buttock and below the knee, generally indicates
disk herniation.
• Once symptoms subside, back strengthening exercises are begun twice a day and
encouraged for a lifetime.
FOOT DISORDERS
• Most of the pain and disability is attributed to improperly fitting shoes, which cause toe
crowding and inhibition of normal foot muscle movement.
• The older adult is prone to foot problems because of poor circulation, atherosclerosis,
and decreased sensation in lower extremities.
OSTEOMALACIA
• Osteomalacia is a rare condition of adult bone associated with vitamin D deficiency,
resulting in decalcification and softening of bone.
• Common features are localized bone pain, difficulty rising from a chair, and walking.
• Exposure to sunlight (and ultraviolet rays) is also valuable, along with weight-bearing
exercise.
OSTEOPOROSIS
• Osteoporosis is a chronic, progressive metabolic bone disease characterized by low bone
mass and structural deterioration of bone tissue.
• Bones can eventually become so fragile that they cannot withstand normal mechanical
stress.
• At least 10 million persons in the United States (80% are women) have osteoporosis.
• Risk factors are female sex, increasing age, family history of osteoporosis, white or Asian
race, small stature, early menopause, sedentary lifestyle, and insufficient dietary calcium.
• People may not know they have osteoporosis until their bones become so weak that a
sudden fall causes a hip or vertebral fracture.
• Collapsed vertebrae may initially be manifested as back pain, loss of height, or spinal
deformities such as kyphosis or severely stooped posture.
• Dual-energy x-ray absorptiometry (DEXA) studies are used in diagnosis and to assess the
treatment effectiveness.
• Collaborative care focuses on proper nutrition, calcium supplementation, exercise,
prevention of fractures, and drugs.
PAGET’S DISEASE
• Paget’s disease is a skeletal bone disorder in which there is excessive bone resorption
followed by replacement of normal marrow by vascular, fibrous connective tissue.
• Initial manifestations are usually insidious development of bone pain (may progress to
severe intractable pain), fatigue, and progressive development of a waddling gait.
• X-rays may demonstrate that the normal contour of the affected bone is curved and the
cortex is thickened and irregular.
• Care is usually limited to symptomatic and supportive care and correction of secondary
deformities by either surgical intervention or braces.
• The nurse must use extreme caution when patient is turned or moved.