WHAT IS BURSAE?

Bursae are flattened fluid-filled sacs that function as cushions between your bones and the muscles (deep bursae) or bones and tendons (superficial bursae). They reduce friction and allow your soft tissue to slide over bone effortlessly during muscle contraction. They are lined with synovial cells that secret fluid that is rich in protein and collagen and act as the lubricant between areas in your body where friction (rubbing) is greatest. These sacs form in areas where 2 surfaces in your body, most often where a bone and tendon or a bone and muscle, rub together during movement. When pressure or friction is too great, excess fluid can build up in the bursa sac causing inflammation. When a bursa becomes inflamed, moving the affected area becomes very painful and movement can be difficult. When a bursa becomes swollen and inflamed, the condition is known as BURSITIS. Bursitis is the inflammation of one or more bursae (small sacs) of synovial fluid in the body. Approximately 3% of the adult population has been estimated to have BURSITIS. ETIOLOGY AND RISK FACTOR: Chronic trauma bursitis refers to repeated minor injuries to the bursa that occurs in one spot over time. Acute trauma bursitis refers to bursitis caused by a direct blow to or twisting of the joint. Septic bursitis is usually caused by a bacteria know as staphylococcus epidermis (or staphylococcus aureus) that is commonly found on the surface of the skin. ABNORMAL DEPOSITS- Medical conditions such as rheumatoid arthritis, osteoarthritis, scleroderma, gout, thyroid disease and diabetes can increase the risk of developing bursitis. These conditions can cause crystal deposits (gout) or calcific loose bodies (rheumatoid arthritis) to form within the joint causing irritation and inflammation in the bursa and surrounding tissue.

PATHOPHYSIOLOGY: TOO GREAT PRESSURE OR FRICTION/ BACTERIAL ACCUMULATION BURSAL ADHESION INFLAMMATION SWELLING, WARTH OVER THE AFFECTED JOINT, AND EXCESSIVE PRODUCTION OF FLUID IN THE SAC. EXCESSIVE FLUID FORMATION BURSA SAC BECOMING DISTENDED AND PRESSING ON THE SENSORY NERVE ENDING, CAUSING SUDDEN OR GRADUAL ONSET OF PAIN AND LIMITED MOVEMENT.

SIGNS AND SYMPTOMS: Stiffness and pain around a local joint Red and swollen joints Interrupted sleep Difficulty walking Soreness radiating to tendons site Stinging pain that surrounds the joint around the inflamed bursa Parts of the Body Does Bursitis Affect? Elbow Shoulder Hip Knee Achilles tendon

MEDICATIONS: Cortisone NSAIDs Anti-inflammatory Analgesic DIAGNOSIS: Generally based on the results of the history of the

MEDICAL MANAGEMENT: The best way to treat bursitis is rest and ice compression. One may be advice use of antiinflammatory drugs as well as pain medication. If there is an infection of the bursa involved, the patient may be given antibiotics. Massage therapy or physiotherapy will help in reducing the inflammation and pain. Surgery is only required if the inflammation does not reduce. The affected bursa is removed, which can regrow itself in a few weeks.

One should avoid carrying out repetitive movements for a long time. If required, one should take regular breaks to reduce the stress on the bursa. Speak to your doctor, if the inflammation makes your daily activities difficult.

Bursitis can be treated in: Avoiding activities that aggravate the problem Resting the injured area Icing the area the day of the injury Taking over-the-counter anti-inflammatory medicines

NURSING CARE PLAN Outcomes: DIAGNOSIS Acute pain related to inflammation and swelling of the tendon.

INTERVENTION & TREATMENT: First-line therapy is often pharmacologic. Applications of heat, cold, ice, or ultrasound may be indicated to promote relief of pain and inflammation. The physician may also prescribe immobilization using a sling, splint, or cast. Fluid removal by aspiration and physical therapy to prevent frozen joints and preserve motion constitute supplementary treatment. In extremely rare situations, surgery may be necessary to loosen calcification. Focus on symptom relief. Encourage the patient to elevate the affected joint as often as possible to promote venous drainage and decrease the swelling. After the patient has received an intraarticular injection, apply ice for about 4 hours to help control the pain. Teach the patient how to apply ice and heat properly to prevent burning or chilling. Explain to the patient the need to rest and reduce stress on the affected joints by modifying his or her lifestyle or activities until the condition has improved. If a sling is prescribed, teach the patient how to wear it properly. Instruct the patient to wear a splint during sleep to protect an affected shoulder. Explain the importance of anti-inflammatory medications, and teach the patient to take them with milk to minimize gastrointestinal (GI) distress. Also caution the patient to report distress, GI upset, nausea, and vomiting. Explain the seriousness of vomiting coffee-groundlike material and the need to seek medical help immediately. Encourage the patient to take medications with food to minimize gastric distress.

Discharge and Home health care guidelines: Help the patient find alternatives to repetitive or stressful joint movement. Be sure the patient understands any medications prescribed, including dosage, route, action, and side effects. Caution the patient not to take aspirin with other nonsteroidal anti-inflammatory drugs (NSAIDs). Encourage the patient to use heat or cold therapy as prescribed. Teach the patient to use a barrier between the skin and heat or to use cold therapy to prevent burning or frostbite. Remind the patient to keep follow-up appointments with the physician.