OSTEOMALACIA Is a metabolic bone disease characterized by inadequate mineralization of bone.

. A result of faulty mineralization, there is softening and weakening of the skeleton, causing pain, tenderness to touch, bowing of the bones and pathologic factors. Physical examination: Skeletal deformities (spinal kyphosis and bowed legs) give pt. an unusual appearance and waddling gait. A result of Calcium deficiency, muscle weakness, and unsteadiness, there is an increased risk to falls and fractures, particularly pathologic fractures of the distal radius and proximal femur RISKS FACTORS Softer bones seen in persons with osteomalacia have a normal amount of collagen, which gives the bones its structure, but lack of proper amount of Calcium In children, the condition is called Rickets and usually caused by low levels of Vitamin D. Other conditions that may lead to osteomalacia includes: Not enough Vitamin D in the diet

Not enough exposure to sunlight, which produces Vitamin D in the body Malabsorption of Vitamin D by the intestines

Use of very strong sunscreen, limited exposure of the body to sunlight, short days of sunlight, and smog are factors that reduce formation of Vitamin D in the body.

In elderly and those who avoid drinking milk are at increased risk of osteomalacia

SIGN & SYMPTOMS

Bone fractures that happen with very little injury Muscle weakness

Widespread bone pain, especially in the hips

Symptoms may also occur due to low calcium levels. These include:

Abnormal heart rhythms Numbness around the mouth Numbness of arms and legs Spasms of hands or feet

MEDICAL MANAGEMENT 1. Physical, psychological and pharmaceutical measures are used to reduce pts discomfort and pain. When assisting the patient to change position, handle the patient gently, and pillows are used to support the body. As the pt. responds to therapy the skeletal discomfort diminishes. 2. Increased doses of Vitamin D, along with Calcium as prescribed. Exposure to sunlight may be recommended; ultraviolet radiation transforms a cholesterol substance present in the skin into Vitamin D. 3. Diet with adequate protein and increased calcium and Vitamin D.
4. Long-term monitoring of the patient is appropriate to ensure stabilization of

reversal of osteomalacia. Some persistent orthopedic deformities may need to be treated with braces or surgery (osteotomy may be performed to correct long bone deformity).

OSTEOMYELITIS Inflammation of the bones caused by a bacterial infection.

Common caused by Staphylococcal infection

Is an uncommon infection that tends to occur most in the elderly or in children.

Most commonly in adults over the age of 50

RISK FACTORS

Gender Age Infection risk Patients with circulation problems Injuries Bone surgery

Classifications of osteomyelitis:
1. Hematogenous Osteomyelitis due to bloodborne spread of infection. 2. Contagious Osteomyelitis from contamination from bone surgery, open

fracture or traumatic injury (ex. Gunshot wound)

3. Osteomyelitis with peripheral vascular disease - a common and serious

problem in diabetic patients, results from diabetes complications, especially peripheral neuropathy.
4. Post-traumatic osteomyelitis - these are bone infections that occur after

trauma, such as a compound fracture (broken bone that breaks the skin), or an open wound to surrounding skin and muscle.
5. Vertebral osteomyelitis - this is osteomyelitis that occurs in the spine. It usually

starts with an infection in the bloodstream, but can also be the result of surgery or trauma. It generally affects older patients. Three types of osteomyelitis: Acute osteomyelitis - the infection develops within two weeks of an injury, initial infection, or the start of an underlying disease. 2. Sub-acute osteomyelitis - the infection develops within one or two months of an injury, initial infection, or the start of an underlying disease. 3. Chronic osteomyelitis - the bone infection starts at least two months after an injury, initial infection, or the start of an underlying disease.
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SIGNS & SYMPTOMS Signs and symptoms of acute osteomyelitis:

Affected area of bone is painful Affected area of bone is tender Affected area of bone is warmer than other areas Affected area of bone may be red Elevated body temperature (fever), which may be abrupt. Sometimes not present. In children may be mild. Sometimes there is loss of movement in the affected area Young children may be irritable or lethargic

Signs and symptoms of sub-acute and chronic osteomyelitis:

Affected area is tender Affected area may be red Affected area may look strange, possibly deformed Bone pain in the affected area Chronic fatigue Instability in the affected area Loss of movement in the affected area Near the area of infection there may be drainage from an open wound

DIAGNOSTIC EXAMINATION Blood Test (CBC, ESR, CRP) X-ray Bone scan CT scan or MRI Biopsy

MEDICAL MANAGEMENT

Antibiotics (4-6 weeks oral or IV antibiotics/antifungal) Bone drainage Drainage of affected area Bone Debridement Restoring blood flow to the bone Removal of foreign objects Stabilizing the affected bone

NURSING INTERVENTION 1. Focus care on controlling infection, protecting the bone from injury, and providing support. 2. Encourage the patient to verbalize his concerns about his disorder. 3. Encourage the patient to perform as much self-care as his conditions allows. 4. Help the patient identify care techniques and activities that promote rest and relaxation and encourage him to perform them. 5. Use strict aseptic technique when changing dressings and irrigating wounds. 6. Provide a well-balanced diet to promote healing. 7. Support the affected limb with firm pillows. 8. Provide thorough skin care. 9. Provide complete cast care. 10. Administer prescribed analgesics for pain. 11. Assess vital signs, observe wound appearance, and note any mew pain which may indicate secondary infection. 12. Watch for signs of pressure ulcer formation. 13. Look for sudden malpositioning of the affected limb, which may indicate fracture. 14. Explain all the test and treatment procedures.

Submitted by: Christine G. Calderon Group 1 BSN 4-A

Submitted to: Mary Ann L. Gan RN. MAN