orthopedics inflammatory process l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Orthopedics Inflammatory Process PowerPoint Presentation
Download Presentation
Orthopedics Inflammatory Process

Loading in 2 Seconds...

play fullscreen
1 / 31

Orthopedics Inflammatory Process - PowerPoint PPT Presentation


  • 244 Views
  • Uploaded on

Orthopedics Inflammatory Process. Jan Bazner-Chandler RN, MSN, CNS, CPNP. Inflammatory Process. Osteomyelitis Septic arthritis Juvenile arthritis. Osteomyelitis. Webmd.lycos.com. Osteomyelitis. Infection of bone and tissue around bone. Requires immediate treatment

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Orthopedics Inflammatory Process' - albert


Download Now An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
orthopedics inflammatory process

Orthopedics Inflammatory Process

Jan Bazner-Chandler

RN, MSN, CNS, CPNP

inflammatory process
Inflammatory Process
  • Osteomyelitis
  • Septic arthritis
  • Juvenile arthritis
osteomyelitis
Osteomyelitis

Webmd.lycos.com

osteomyelitis4
Osteomyelitis
  • Infection of bone and tissue around bone.
  • Requires immediate treatment
  • Can cause massive bone destruction and life-threatening sepsis
pathogenesis of acute osteo
Pathogenesis of Acute Osteo

In children 1 year

to 15 years the

infection is restricted

to below the

epiphysis.

Under 1 year

the epiphysis is

nourished by

arteries.

clinical manifestation
Clinical Manifestation
  • Localized pain
  • Decreased movement of area
  • With spread of infection
    • Redness
    • Swelling
    • Warm to touch
diagnostic tests
Diagnostic Tests:
  • X-ray
  • CBC
  • ESR / erythrocyte sedimentation rate
  • C-reactive protein
  • Bone scan – most definitive test for osteomyelitis
x ray
X-Ray

18-year-old boy with painful right arm

management
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
goals of care
Goals of Care
  • To maintain integrity of infected joint / joints
septic arthritis
Septic Arthritis
  • Infection within a joint or synovial membrane
  • Infection transmitted by:
    • Bloodstream
    • Penetrating wound
    • Foreign body in joint
septic arthritis of hip
Septic Arthritis of Hip
  • Difficulty walking and fever
  • Diagnosis: x-ray, ESR, aspiration of fluid from joint
septic hip
Septic Hip

Flexed hip on affected

side is common presentation.

diagnostic tests15
Diagnostic Tests

X-ray

Needle aspiration

under fluoroscopy

erythrocyte sedimentation rate
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
c reactive protein
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
management19
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
juvenile rheumatoid arthritis
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
clinical manifestations
Clinical Manifestations
  • Swelling or effusion of one or more joints
  • Limited ROM
  • Warmth
  • Tenderness
  • Pain with movement
diagnostic evaluation
Diagnostic Evaluation
  • Elevated ESR / erythrocyte sedimentation rate
  • + genetic marker / HLA b27
  • + RF 9 antinuclear antibodies
  • Bone scan
  • MRI
  • Arthroscopic exam
goals of therapy
Goals of Therapy
  • To prevent deformities
  • To keep discomfort to a minimum
  • To preserve ability to do ADL
management24
Management
  • First line drugs:
    • ASA
    • NSAIDs
  • Immunosuppressive drugs (oral): azulvadine or methotrexate
  • Disease modifying drugs
    • Enbrel - IM
    • Remicade - IV
asa therapy
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.
management26
Management
  • Physical therapy
  • Exercise program
  • Monitor ESR levels
  • Regular eye exams: Iriditis
  • Cardiac involvement: early studies show some correlation due to inflammatory process
iriditis
Iriditis
  • Intraocular inflammation of iris and ciliary body
  • 2% to 21% in children with arthritis
  • Highest incidence in children with multi joint involvement disease.
clinical manifestations28
Clinical Manifestations
  • Deep eye pain
  • Photophobia
  • Often report decrease in color perception
  • Redness no drainage
  • Treatment: prednisone eye drops or PO prednisone
muscular dystrophy
Muscular Dystrophy
  • A group of more than 30 genetic diseases characterized by progressive weakness and degeneration of the skeletal muscles that control movement.
duchenne
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.
treatment
Treatment
  • No cure
  • Physical therapy
  • Respiratory therapy
  • Speech therapy
  • Orthopedic appliances / corrective procedures
  • Meds: corticosteroids and immununosuppressants to slow progression of the disease.