Orthopedics Inflammatory Process
-
Upload
hilda-sawyer -
Category
Documents
-
view
43 -
download
0
description
Transcript of Orthopedics Inflammatory Process
![Page 1: Orthopedics Inflammatory Process](https://reader035.fdocuments.us/reader035/viewer/2022081506/56812e38550346895d93a6ba/html5/thumbnails/1.jpg)
Orthopedics Inflammatory Process
Jan Bazner-Chandler RN, MSN, CNS, CPNP
![Page 2: Orthopedics Inflammatory Process](https://reader035.fdocuments.us/reader035/viewer/2022081506/56812e38550346895d93a6ba/html5/thumbnails/2.jpg)
Inflammatory Process Osteomyelitis
Septic arthritis
Juvenile arthritis
![Page 3: Orthopedics Inflammatory Process](https://reader035.fdocuments.us/reader035/viewer/2022081506/56812e38550346895d93a6ba/html5/thumbnails/3.jpg)
Osteomyelitis
Webmd.lycos.com
![Page 4: Orthopedics Inflammatory Process](https://reader035.fdocuments.us/reader035/viewer/2022081506/56812e38550346895d93a6ba/html5/thumbnails/4.jpg)
Osteomyelitis Infection of bone and tissue around bone.
Requires immediate treatment
Can cause massive bone destruction and life-threatening sepsis
![Page 5: Orthopedics Inflammatory Process](https://reader035.fdocuments.us/reader035/viewer/2022081506/56812e38550346895d93a6ba/html5/thumbnails/5.jpg)
Pathogenesis of Acute Osteo
Under 1 yearthe epiphysis is nourished byarteries.
In children 1 yearto 15 years theinfection is restrictedto below the epiphysis.
![Page 6: Orthopedics Inflammatory Process](https://reader035.fdocuments.us/reader035/viewer/2022081506/56812e38550346895d93a6ba/html5/thumbnails/6.jpg)
Clinical Manifestation Localized pain Decreased movement of area With spread of infection
Redness Swelling Warm to touch
![Page 7: Orthopedics Inflammatory Process](https://reader035.fdocuments.us/reader035/viewer/2022081506/56812e38550346895d93a6ba/html5/thumbnails/7.jpg)
Diagnostic Tests: X-ray CBC ESR / erythrocyte sedimentation rate C-reactive protein Bone scan – most definitive test for
osteomyelitis
![Page 8: Orthopedics Inflammatory Process](https://reader035.fdocuments.us/reader035/viewer/2022081506/56812e38550346895d93a6ba/html5/thumbnails/8.jpg)
X-Ray
18-year-old boy with painful right arm
![Page 9: Orthopedics Inflammatory Process](https://reader035.fdocuments.us/reader035/viewer/2022081506/56812e38550346895d93a6ba/html5/thumbnails/9.jpg)
Osteomyelitis
![Page 10: Orthopedics Inflammatory Process](https://reader035.fdocuments.us/reader035/viewer/2022081506/56812e38550346895d93a6ba/html5/thumbnails/10.jpg)
Management Culture of the blood Aspiration at site of infection Intravenous antibiotics x 4 weeks PO antibiotics if ESR rate going down Monitor ESR
Decrease in levels indicates improvement
![Page 11: Orthopedics Inflammatory Process](https://reader035.fdocuments.us/reader035/viewer/2022081506/56812e38550346895d93a6ba/html5/thumbnails/11.jpg)
Goals of Care To maintain integrity of infected joint / joints
![Page 12: Orthopedics Inflammatory Process](https://reader035.fdocuments.us/reader035/viewer/2022081506/56812e38550346895d93a6ba/html5/thumbnails/12.jpg)
Septic Arthritis Infection within a joint or synovial membrane Infection transmitted by:
Bloodstream Penetrating wound Foreign body in joint
![Page 13: Orthopedics Inflammatory Process](https://reader035.fdocuments.us/reader035/viewer/2022081506/56812e38550346895d93a6ba/html5/thumbnails/13.jpg)
Septic Arthritis of Hip Difficulty walking and fever Diagnosis: x-ray, ESR, aspiration of fluid from
joint
![Page 14: Orthopedics Inflammatory Process](https://reader035.fdocuments.us/reader035/viewer/2022081506/56812e38550346895d93a6ba/html5/thumbnails/14.jpg)
Septic Hip
Flexed hip on affectedside is common presentation.
![Page 15: Orthopedics Inflammatory Process](https://reader035.fdocuments.us/reader035/viewer/2022081506/56812e38550346895d93a6ba/html5/thumbnails/15.jpg)
Diagnostic Tests
X-ray
Needle aspirationunder fluoroscopy
![Page 16: Orthopedics Inflammatory Process](https://reader035.fdocuments.us/reader035/viewer/2022081506/56812e38550346895d93a6ba/html5/thumbnails/16.jpg)
Erythrocyte Sedimentation Rate ESR Used as a gauge for determining the
progress of an inflammatory disease. Rises within 24 hours after onset of
symptoms.
Men:0 - 15 mm./hr Women: 0 – 20 mm./hr Children: 0 – 10 mm./hr
![Page 17: Orthopedics Inflammatory Process](https://reader035.fdocuments.us/reader035/viewer/2022081506/56812e38550346895d93a6ba/html5/thumbnails/17.jpg)
C-Reactive Protein During the course of an inflammatory
process an abnormal specific protein, CRP, appears in the blood.
The presence of the protein can be detected within 6 hours of triggering stimulus.
More sensitive than ESR / more expensive
![Page 18: Orthopedics Inflammatory Process](https://reader035.fdocuments.us/reader035/viewer/2022081506/56812e38550346895d93a6ba/html5/thumbnails/18.jpg)
Joint Space Fluid
WBC 80,000
Segs 88%
Monos 1%
Lymphs 11%
RBC 16,000
Gram Stain Gram-positive cocci in chains
![Page 19: Orthopedics Inflammatory Process](https://reader035.fdocuments.us/reader035/viewer/2022081506/56812e38550346895d93a6ba/html5/thumbnails/19.jpg)
Management Administration of antibiotics for 4 to 6 weeks. Oral antibiotics have been found to be
effective if serum bactericidal levels are adequate.
Fever control Ibuprofen for anti-inflammatory effect
![Page 20: Orthopedics Inflammatory Process](https://reader035.fdocuments.us/reader035/viewer/2022081506/56812e38550346895d93a6ba/html5/thumbnails/20.jpg)
Juvenile Rheumatoid Arthritis Chronic inflammatory condition of the
joints and surrounding tissues.
Often triggered by a viral illness
1 in 1000 children will develop JRA
Higher incidence in girls
![Page 21: Orthopedics Inflammatory Process](https://reader035.fdocuments.us/reader035/viewer/2022081506/56812e38550346895d93a6ba/html5/thumbnails/21.jpg)
Clinical Manifestations Swelling or effusion of one or more joints Limited ROM Warmth Tenderness Pain with movement
![Page 22: Orthopedics Inflammatory Process](https://reader035.fdocuments.us/reader035/viewer/2022081506/56812e38550346895d93a6ba/html5/thumbnails/22.jpg)
Diagnostic Evaluation Elevated ESR / erythrocyte sedimentation rate + genetic marker / HLA b27 + RF 9 antinuclear antibodies Bone scan MRI Arthroscopic exam
![Page 23: Orthopedics Inflammatory Process](https://reader035.fdocuments.us/reader035/viewer/2022081506/56812e38550346895d93a6ba/html5/thumbnails/23.jpg)
Goals of Therapy To prevent deformities
To keep discomfort to a minimum
To preserve ability to do ADL
![Page 24: Orthopedics Inflammatory Process](https://reader035.fdocuments.us/reader035/viewer/2022081506/56812e38550346895d93a6ba/html5/thumbnails/24.jpg)
Management First line drugs:
ASA NSAIDs
Immunosuppressive drugs (oral): azulvadine or methotrexate
Disease modifying drugs Enbrel - IM Remicade - IV
![Page 25: Orthopedics Inflammatory Process](https://reader035.fdocuments.us/reader035/viewer/2022081506/56812e38550346895d93a6ba/html5/thumbnails/25.jpg)
ASA Therapy Alert: The use of aspirin has been highly
associated with the development of Reye’s syndrome in children who have had chickenpox or flu. Because aspirin may be an an ongoing p art of the regimen of the arthritic child, parents should be warned of the relationship between viral illnesses an aspirin, and be taught the symptoms of Reye’s syndrome.
![Page 26: Orthopedics Inflammatory Process](https://reader035.fdocuments.us/reader035/viewer/2022081506/56812e38550346895d93a6ba/html5/thumbnails/26.jpg)
Management Physical therapy Exercise program Monitor ESR levels Regular eye exams: Iriditis Cardiac involvement: early studies show some
correlation due to inflammatory process
![Page 27: Orthopedics Inflammatory Process](https://reader035.fdocuments.us/reader035/viewer/2022081506/56812e38550346895d93a6ba/html5/thumbnails/27.jpg)
Iriditis Intraocular inflammation of iris and ciliary
body
2% to 21% in children with arthritis
Highest incidence in children with multi joint involvement disease.
![Page 28: Orthopedics Inflammatory Process](https://reader035.fdocuments.us/reader035/viewer/2022081506/56812e38550346895d93a6ba/html5/thumbnails/28.jpg)
Clinical Manifestations Deep eye pain Photophobia Often report decrease in color perception Redness no drainage Treatment: prednisone eye drops or PO
prednisone
![Page 29: Orthopedics Inflammatory Process](https://reader035.fdocuments.us/reader035/viewer/2022081506/56812e38550346895d93a6ba/html5/thumbnails/29.jpg)
Muscular Dystrophy A group of more than 30 genetic diseases
characterized by progressive weakness and degeneration of the skeletal muscles that control movement.
![Page 30: Orthopedics Inflammatory Process](https://reader035.fdocuments.us/reader035/viewer/2022081506/56812e38550346895d93a6ba/html5/thumbnails/30.jpg)
Duchenne Most common form of MD and primarily
affects boys. Caused by absence of dystophin a protein
needed to maintain integrity of muscle. Onset between 3 and 5 years Rapid progression: unable to walk by age 12.
![Page 31: Orthopedics Inflammatory Process](https://reader035.fdocuments.us/reader035/viewer/2022081506/56812e38550346895d93a6ba/html5/thumbnails/31.jpg)
Treatment No cure Physical therapy Respiratory therapy Speech therapy Orthopedic appliances / corrective
procedures Meds: corticosteroids and
immununosuppressants to slow progression of the disease.