Adult Health Lecture 4
What is osteoarthritis?
-degenerative joint disease ❖Primary (idiopathic), no prior event or disease related to the OA ❖Secondary, resulting from previous joint injury or inflammatory disease ❖Limited to the affected joints; no systemic symptoms ❖Risk Factors: o Older age, female gender, and obesity o history of previous injuries, muscle weakness, genetic predisposition, and certain diseases
What is a ganglion cyst?
-round cystic nontender nodule overlying a tendon sheath or joint capsule -benign flexion makes it more prominent
A client is seen in the orthopedic clinic for complaints of severe pain in the left hip. After a series of diagnostic tests, the client is diagnosed with severe degenerative joint disease of the left hip and suggested to have the hip reconstructed. What procedure will the nurse schedule the client for?
Left hip arthroplasty -Clients with arthritis, trauma, hip fracture, or a congenital deformity may have an arthroplasty, or reconstruction of the joint. This procedure uses an artificial joint that restores previously lost function and relieves pain. An arthroscopy is not used to reconstruct a diseased hip. A closed reduction is not an invasive surgical procedure and would not be used to reconstruct the hip. An open reduction and internal fixation is not the treatment for reconstruction of the hip related to a diseased hip.
Which term refers to the failure of fragments of a fractured bone to heal together?
Nonunion -When nonunion occurs, the client reports persistent discomfort and movement at the fracture site. Dislocation refers to the separation of joint surfaces. Subluxation refers to partial separation or dislocation of joint surfaces. Malunion refers to growth of the fragments of a fractured bone in a faulty position, forming an imperfect union.
What are ingrown toenails?
Onychocryptosis Leading edge of nail grows into nearby soft tissue -too tight cleats -do not cut on own, have clipped by a pediatrist and have education on how to clip (clip straight across and file edges) -can cause infections
This condition consists of thick/unhealthy bone and excessive breakdown and production of bone.
Paget's disease
Elderly clients who fall are most at risk for which injuries?
Pelvic fractures
These fractures have a high mortality rate for unstable fractures related to hemorrhage, fat emboli, infection.
Pelvic fractures
What is clawfoot?
Pes cavus -Abnormal elevated arch
What is flatfoot?
Pes planus -the arches decrease or "fall"
A nurse is caring for a client who underwent a total hip replacement. What should the nurse and other caregivers do to prevent dislocation of the new prosthesis?
Prevent internal rotation of the affected leg. -The nurse and other caregivers should prevent internal rotation of the affected leg. However, external rotation and abduction of the hip will help prevent dislocation of a new hip joint. Postoperative total hip replacement clients may be turned onto the unaffected side. The hip may be flexed slightly, but it shouldn't exceed 90 degrees. Maintenance of flexion isn't necessary.
What is a strain?
Pulled muscle injury to the musculotendinous unit o Pain, edema, muscle spasm, ecchymosis, and loss of function are on a continuum graded first, second, and third degree
What is one way that RA differs from osteoarthritis?
RA has systemic effects whereas osteoarthritis has local effects
Rheumatoid arthritis vs Osteoarthritis
RA: - Inflammatory (autoantibody) - Synovial proliferation - Symmetric OA: - Noninflammatory - Degeneration of articular cartilage - Asymmetric - Osteophytes
A nurse is providing discharge education to a client who is going home with a cast on his leg. What topic should the nurse emphasize in the teaching session?
Reporting signs of impaired circulation -Reporting signs of impaired circulation is critical; signs of impaired circulation must be reported to the physician immediately to prevent permanent damage. For this reason, this education is a priority over exercise and crutch use. The client does not independently remove the cast.
What is important to monitor in patients with elbow fractures?
S/S of compartment syndrome
A client reports pain in the right knee, stating, "My knee got twisted when I was going down the stairs." The client was diagnosed with an injury to the ligaments and tendons of the right knee. Which terminology, documented by the nurse, best reflects the injury?
Sprain -A sprain is an injury to the ligaments and tendons surrounding a joint, usually caused by a wrenching or twisting motion. Dislocation refers to the separation of joint surfaces. Subluxation refers to partial separation or dislocation of joint surfaces. Strain refers to a muscle pull or tear.
In this condition muscle tendon sheaths become inflamed with repetitive stretching
Tendonitis o Treatment - NSAID, corticosteroid injections
What is skeletal traction?
There are breaks in the skin
What is Buck's traction?
There are no breaks in the skin
What is a callus?
Thickened are of skin; from pressure/friction
Why are MRIs used in patients with back pain?
To inspect the vertebral discs -bursitis- limited ROM "feel like a nail"
T/F: Malignant primary tumors can metastasize to the lungs.
True
T/F: smaller framed women are especially at risk for osteoarthritis (Caucasian/Asian women)
True
T/F: It is important to avoid NSAIDS in patients with stomach ulcers or that are taking blood thinners.
True: use muscle relaxers or opioids if necessary -massage (chronic back pain) -yoga
What is it important to pay attention to in patients who are immobile?
Watch for blood clots; warmness, redness, calf pain because clot can result in pulmonary embolism -apply compression stocking, ROM exercises
After surgery to treat a hip fracture, a client returns from the postanesthesia care unit to the medical-surgical unit. Postoperatively, how should the nurse position the client?
With the leg on the affected side abducted -The nurse must keep the leg on the affected side abducted at all times after hip surgery to prevent accidental dislodgment of the affected hip joint. Placing a pillow or an A-frame between the legs helps maintain abduction and reminds the client not to cross the legs. The nurse should avoid acutely flexing the client's affected hip (for example, by elevating the head of the bed excessively), adducting the leg on the affected side (such as by moving it toward the midline), or externally rotating the affected hip (such as by removing support along the outer side of the leg) because these positions may cause dislocation of the injured hip joint.
What is a corn?
a callus on a toe -from pressure/ill fitting shoes -usual the 5th toe (pink toe) -soak and scrap off (pediatrist)
What is plantar fasciitis?
inflammation of the plantar fascia -heel pain -do foot stretches -use shoes with special cushion to support the arch -night splint -corticosteroid infection -can develop heel spores
What is a sprain?
injury to ligaments and supporting muscle fiber around a joint o Pain (may increase with motion), edema, tenderness; severity graded according to ligament damage and joint stability
What should a nurse pay close attention to in patients taking acetaminophen?
liver function
What profession ranks number 10 in occupation related injuries?
nursing
What are pharmacologic management measures are to be taken in patients with Paget's disease?
o Antineoplastic therapy-severe o NSAIDs o Calcitonin o Bisphosphonates (etidronate) o Plicamycin: a cytotoxic antibiotic may be used for severe disease resistant to other therapy
What are ways to prevent osteoporosis?
o Balanced diet high in calcium and vitamin D throughout life o Regular weight-bearing exercises: 20 to 30 minutes a day; weight training stimulates bone mineral density (BMD)
What are some diagnostic measures used to diagnose osteoporosis?
o DEXA- baseline for all women >65 o Lab and X-ray: rule out other possible disorders that cause bone loss
How can osteoarthritis be medically managed?
o Exercise, weight loss, occupational and physical therapy o Orthotic devices, walking aids o Acetaminophen 1st; NSAIDS, COX-2 enzyme blockers (use with caution)
What are some clinical manifestations of osteoarthritis?
o Joint pain, morning stiffness is present, decreased ROM in weight bearing joints (hips, knees, cervical and lumbar spine)
What are ways to prevent occupation?
o Safe patient handling training and proper use of equipment o Correct use of body mechanics
What are some occupation related injuries?
o Strains, sprains, tears o Cuts, lacerations, contusions, bruises
What are ways to prevent common sport related injuries?
o Use of proper equipment; running shoes for runners, wrist guards for skaters, and so on o Effective training and conditioning o Stretching, hydration, proper nutrition
What are some manifestations of fractures?
o acute pain, loss of function o Deformity, shortening of the extremity o Crepitus, localized edema and ecchymosis, muscle spasm, and tenderness
What is the biggest modifiable risk factor for osteoarthritis?
obesity
What is Paget's disease?
osteitis deformans ❖Disorder of localized bone turnover: skull, femur, tibia, pelvic bones, and vertebrae ❖Incidence: 2% to 3% of the population older than age 50 years ❖More common in men, and risk increases with aging; familial predisposition has been noted ❖Cause is unknown
What is a subluxation injury?
partial or incomplete dislocation o Does not cause as much deformity as a complete dislocation
What is amputation?
removal of a body part ❖May be congenital or traumatic or caused by conditions such as progressive peripheral vascular disease, infection, malignant tumor, trauma ❖Performed to control pain or disease process, improve function, and improve quality of life
What are the clinical manifestations of Paget's disease?
skeletal deformities, mild to moderate aching pain, and tenderness and warmth over bones ❖Symptoms may be insidious and may be attributed to old age or arthritis; most patients do not have symptoms
What is Dupuytren Disease?
slowly progressive contractures of palmar fascia rendering fingers useless. often associated with arthritis, diabetes, gout, cigarette smoking, and alcoholism. starts as a nodule producing a contracture of fingers and palmar skin changes. Treatment includes finger-stretching exercises, intra-nodular injections of corticosteroids and Palmar and digital fasciotomies
What is a contusion?
soft tissue injury produced by blunt force o Pain, swelling, and discoloration: ecchymosis
Which device is designed specifically to initially support and immobilize a body part in a desired position until swelling subsides?
splint -A splint may be applied to a fractured extremity initially until swelling subsides. A brace is an externally applied device to support a body part, control movement, and prevent injury. A CPM device is an instrument that moves a body part to promote healing and circulation. A trapeze is an overhead device to promote client mobility in bed.
What joints does osteoarthritis affect?
weight bearing joints (feet, ankles, hips, knees, vertebrae)
What are factors that affect fracture healing?
❖ Inadequate fracture immobilization ❖ Inadequate blood supply to the fracture site or adjacent tissue ❖ Multiple trauma ❖ Extensive bone loss ❖ Infection ❖ Poor adherence to prescribed restrictions ❖ Malignancy ❖ Certain medications (e.g., corticosteroids) ❖ Age >40 years ❖ Comorbidities (e.g., diabetes, rheumatoid arthritis)
What assessments should a nurse perform in a patient with a total hip arthroplasty?
❖Aimed at having the patient in optimal health for surgery ❖Risks for bleeding, VTE, infection, and pain are managed proactively. See Chart 36-6 ❖Major goals: pain relief; achievement of a functional, stable joint; absence of long-term post op complications (heterotopic ossification)
How can a nurse manage a patient with traction devices?
❖Assessing anxiety ❖Assisting with self-care ❖Monitor and manage complications o Atelectasis and pneumonia o Constipation o Anorexia o Urinary stasis o Infection o VTE
A client has a cast applied to the leg for treatment of a tibia fracture and also has a wound on the leg that requires dressing changes due to drainage. For what should the nurse prepare the client?
Cutting a cast window -After the cast dries, a cast window, or opening, may be cut. This usually is done when the client reports discomfort under the cast or has a wound that requires a dressing change. The window permits direct inspection of the skin, a means to check the pulse in a casted arm or leg, or a way to change a dressing. A bivalve cast is when the cast is cut in two if the leg swells or if the client is being weaned from a cast, when a sharp x-ray is needed, or as a splint for immobilizing painful joints when a client has arthritis. The cast should not be removed due to the instability of a fracture. The client's condition does not indicate an external fixator is required.
What is compartment syndrome?
Damage to nerves and vasculature of an extremity due to compression -extreme pain and swelling
A client is being discharged from the Emergency Department after being diagnosed with a sprained ankle. Which client statement indicates the client understands the discharge teaching?
"I'll make sure to keep my ankle elevated as much as possible." -Treatment consists of applying ice or a chemical cold pack to the area to reduce swelling and relieve pain for the first 24 to 48 hours. Elevation of the part and compression with an elastic bandage also may be recommended. After 2 days, when swelling no longer is likely to increase, applying heat reduces pain and relieves local edema by improving circulation. Full use of the injured joint is discouraged temporarily, not necessarily three to four weeks. Nonsteroidal anti-inflammatory drugs (NSAIDs) are typically recommended; narcotic analgesics typically are not prescribed.
When discussing physical activities with the client who has just undergone a right total hip replacement, which instruction should the nurse provide?
"Limit hip flexion to 90 degrees." -The client should avoid all activities that can result in dislocation of the hip. The affected leg should not cross midline or be turned inward. The hip should not bend more than 90 degrees. Ambulation begins the day following surgery, and weight bearing ambulation may not be restricted, depending on the type of prosthesis.
What is cauda equina syndrome?
"Saddle anesthesia": can't feel butt, thighs, perineum -numbness/tingling -bladder dysfunction -radiculopathy- radiates down the leg -sciatica- nerve pain/inflammation
What is Tinel's sign?
"pins and needles" sensation felt when an injured nerve site is tapped -used to diagnose carpal tunnel
What are some red flags for back pain?
(notify physician immediately) Bowel or bladder dysfunction, saddle anesthesia, severe neurologic weakness, suspected infection, new onset back pain in a pt/ with cancer
Proper and Improper Standing Postures and Lifting Techniques
(picture)
What are some patient education tips for patients with osteoporosis?
- 15-30 mins of sunlight exposure every day (vitamin D) -calcium intake- oranges, cheese, broccoli, salmon, milk -weight bearing exercise decreases risk for fall -pg. 1140 for nursing process
Types of Fractures:
1. Comminuted: the bone is crushed and/or shattered. 2. Compression: the fractured area of the bone collapses on itself. 3. Colles: the break of the distal end of the radius at the epiphysis often occurs when the patient has attempted to break his/her fall. 4. Complicated: the bone is broken and pierces an internal organ. 5. Impacted: the bone is broken and the ends are driven into each other. 6. Hairline: a minor fracture appears as a thin line on an x-ray and may not extend completely through the bone. 7. Greenstick: the bone is partially bent and partially broken; common in children because the bones are still soft. 8. Pathologic: any fracture occurring spontaneously as a result of disease. 9. Salter-Harris: a fracture of the epiphyseal plate in children. 10. Sprain: traumatic injury to a joint involving the soft tissue. Includes muscles, tendons, and ligaments. Usually as a result of overuse or overstretching.
How should a nurse administer oral/parental meds in managing osteomyelitis?
6-12 weeks of antibiotic IV therapy and then switch to oral meds
A patient had a total hip replacement. What recommended leg position should the nurse ensure is maintained to prevent prosthesis dislocation?
Abduction -The nurse educates the patient about protective positioning, which includes maintaining abduction and avoiding internal and external rotation, hyperextension, and acute flexion.
A patient sustains a fracture of the arm. When does the nurse anticipate pendulum exercise should begin?
As soon as tolerated, after a reasonable period of immobilization
Which action would be most important postoperatively for a client who has had a knee or hip replacement?
Assisting in early ambulation. -An anticoagulant therapy and early ambulation are important for clients who undergo a knee or hip replacement. A CPM machine or crutches may be provided when prescribed. It is important to encourage clients to express their feelings of anxiety or depression. This is more crucial for clients who undergo an amputation rather than for clients who undergo a replacement surgery.
The orthopedic surgeon has prescribed balanced skeletal traction for a client. What advantage is conferred by balanced traction?
Balanced traction allows for greater client movement and independence than other forms of traction.
These are more common bone tumors, slow growing, and present few symptoms.
Benign tumors: Most common is osteochondroma o Bone cysts: expanding lesions within the bone o Osteoid osteoma: Painful tumor in children and young adults o Osteoclastomas: benign for long periods but may invade local tissue and cause destruction; can become malignant
A group of students are reviewing information about cast composition in preparation for a discussion on the advantages and disadvantages of each. The students demonstrate understanding of the topic when they cite which of the following as an advantage of a plaster cast?
Better molding to the client
A patient has stepped in a hole in the yard, causing an ankle injury. The ankle is edematous and painful to palpation. How long should the nurse inform the patient that the acute inflammatory stage will last?
Between 24 and 48 hours -After the acute inflammatory stage (e.g., 24 to 48 hours after injury), intermittent heat application (for 15 to 30 minutes, four times a day) relieves muscle spasm and promotes vasodilation, absorption, and repair.
This is described as inflammation of the bursae sac.
Bursitis
A client's left leg is in skeletal traction with a Thomas leg splint and Pearson attachment. Which intervention should the nurse include in this client's care plan?
By teaching the client about prevention measures, the nurse can help prevent problems caused by immobility, such as hypostatic pneumonia, muscle contracture, and atrophy. The nurse applies traction straps for skin traction — not skeletal traction. For a client in skeletal traction, the nurse should assess the affected limb, rather than assess the level of consciousness. Removing skeletal traction is the physician's responsibility — not the nurse's.
Which term refers to a blunt force injury to soft tissue?
Contusion -A contusion is blunt force injury to soft tissue. A dislocation is a separation of joint surfaces. A strain is a musculotendinous injury. A fracture is a break in the continuity of the bone.
What do you call entrapment neuropathy that occurs when the median nerve at the wrist is compressed?
Carpal Tunnel Syndrome -numbness/pain Diagnostics: Tinel sign o Treatment - intra-articular injections of corticosteroids, NSAIDs
What are some causes of osteomalacia?
Causes include gastrointestinal disorders, severe renal insufficiency, hyperparathyroidism, and dietary deficiency
A client who has undergone a lower limb amputation is preparing to be discharged home. What outcome is necessary prior to discharge?
Client can demonstrate safe use of assistive devices. -A client should be able to use assistive devices appropriately term-9and safely prior to discharge. Scar formation will not be complete at the time of hospital discharge. It is anticipated that the client will require some assistance with ADLs postdischarge. Pain should be well managed, but may or may not be wholly absent.
o This is a serious complication o Occurs from increased pressure in a confined space o Compromises blood flow o Ischemia and irreversible damage can occur within hours
Compartment syndrome
The client who had a total hip replacement was discharged home and developed acute groin pain in the affected leg, shortening of the leg, and limited movement of the fractured leg. The nurse interprets these findings as indicating which complication?
Dislocation of the hip -Manifestations of a dislocated hip prosthesis are increased pain at the surgical site, acute groin pain in the affected leg, shortening of the leg, abnormal external or internal rotation, and limited movement of the fractured leg. The client may report a "popping" sensation in the hip.
A client with a fractured ankle is having a fiberglass cast applied. The client starts yelling, "My leg is burning, take it off." What action by the nurse is most appropriate?
Explain that the sensation being felt is normal and will not burn the client. -A fiberglass cast will give off heat when applied. The reaction is a normal, temporary sensation. Heat given off during the application phase of the cast does not burn the skin. By explaining these principles to the client, the nurse can alleviate any anxiety associated with the application of the cast. Because this is a known reaction to the application of the fiberglass cast, it is not necessary to remove the cast. Holding the client may cause more harm to the injury. Antianxiety medications are generally not needed when applying a cast.
T/F: It is important to promote bed rest for patients with back pain.
False: no bedrest; move as much as possible -limit sitting 20-50 minutes
A nurse is performing a shift assessment on an elderly client who is recovering after surgery for a hip fracture. The client reports chest pain, has an increased heart rate, and increased respiratory rate. The nurse further notes that the client is febrile and hypoxic, coughing, and producing large amounts of thick, white sputum. The nurse recognizes that this is a medical emergency and calls for assistance, recognizing that this client is likely demonstrating symptoms of what complication? Fat embolism syndrome Complex regional pain syndrome Avascular necrosis of bone Compartment syndrome
Fat embolism syndrome -Fat embolism syndrome occurs most frequently in young adults and elderly clients who experience fractures of the proximal femur (i.e., hip fracture). Presenting features of fat embolism syndrome include hypoxia, tachypnea, tachycardia, and pyrexia. The respiratory distress response includes tachypnea, dyspnea, wheezes, precordial chest pain, cough, large amounts of thick, white sputum, and tachycardia. Avascular necrosis (AVN) occurs when the bone loses its blood supply and dies. This does not cause coughing. Complex regional pain syndrome does not have cardiopulmonary involvement.
These fractures are usually from MVC or falls; can have significant blood loss leading to shock, traction and surgery indicated; active and passive ROM of the knee as soon as possible post-op.
Femoral Shaft fractures
These fractures exhibit significant pain with flexion or rotation of the hip; usually require surgery; care is similar to hip replacement surgery.
Hip fractures
What is hammer toe?
Hyperextension of MTP with flexion at the PIP -see how it alters gait -see if it causes calluses -open toed sandals
The nurse is monitoring a patient who sustained a fracture of the left hip. The nurse should be aware that which kind of shock can be a complication of this type of injury?
Hypovolemic -In a client with a pelvic fracture, the nurse should be aware of the potential for hypovolemic shock resulting from hemorrhage. Cardiogenic shock, in which the heart cannot pump enough blood to meet the body's needs, often arises from severe myocardial infarction. Neurogenic shock is often a consequence of spinal cord injury and resulting loss of sympathetic nervous system function. Septic shock results from body-wide infection.
Radiographic evaluation of a client's fracture reveals that a bone fragment has been driven into another bone fragment. The nurse identifies this as which type of fracture?
Impacted -An impacted fracture is one in which a bone fragment is driven into another bone fragment. A comminuted fracture is one in which the bone has splintered into several fragments. A compression fracture is one in which bone has been compressed. A greenstick fracture is one in which one side of the bone is broken, and the other side is bent.
What is a dislocation?
articular surfaces of the joint are not in contact o A traumatic dislocation is an emergency with pain change in contour, axis, and length of the limb and loss of mobility
How should a nurse perform neurovascular assessments?
before and after surgery -compare to extremity that that is not affected -pain, paresthesia, paralysis, paleness -check pulses -elevate foot to decrease swelling -icepacks- first 24 h, swelling and pain relief -check incision site
How often should a patient's neurovascular be accessed?
every 15 mins -risk for compartment syndrome
What are some risk factors for osteoporosis?
female white/asian increase age low body weight smoking inactivity certain medications alcohol calcium/vitamin D deficiencies CO morbidities Estrogen deficiency ❖Risk factors, refer to Chart 36-11 > 3 mo. corticosteroid use, Men > 60, postmenopausal women small framed women
What are some nursing interventions for patients with casts, splints, and braces?
❖Assessment prior to application ❖Educate patient and family ❖Treat lacerations and abrasions before cast, brace, splint ❖Assessment and prevention of neurovascular dysfunction or compromise (assess for changes using the 5 Ps) o Neuro assessment q1h for the first 24h; Q1-4h thereafter o Elevate the extremity so that it is above the level of the heart during the first 24-48 hours o Pain evaluation and treatment ❖Assess for signs of infection and encourage ROM exercises
What are some pharmacologic measures that can be used in patient with osteoporosis?
❖Calcium-take in divided doses with vitamin C ❖Vitamin D ❖Bisphosphonates ❖Calcitonin ❖Estrogen agonists/antagonists ❖Parathyroid hormone ❖Receptor activator of nuclear factor kappa-B ligand inhibitors ❖Refer to Table 36-1
What are some complications of casts, splints, and braces?
❖Compartment syndrome -Clinical assessment of 5 Ps; pain is the early indicator -Treatment: Notify physician, cast may be removed, and emergent surgical fasciotomy may be necessary ❖Pressure Injuries: caused by inappropriately applied cast -Lower extremity sites most susceptible -Patient reports painful "hotspot" and tightness -Dx: May cut window in the cast for inspection and access o Treatment: dressing applied over exposed skin -Disuse Syndrome: muscle atrophy and loss of strength -Treatment: Isometric exercises, muscle setting exercises chart 37-4
What are some complications of fractures?
❖Early complications o Shock o Fat embolism o Compartment syndrome o VTE, PE ❖Delayed complications o Delayed union, malunion, and nonunion o Avascular necrosis of bone o Complex regional pain syndrome (CRPS) o Heterotrophic ossification
What are some nursing interventions for patients with skeletal traction devices?
❖Evaluate traction apparatus and patient position ❖Maintain alignment of body ❖Report pain promptly ❖Trapeze to help with movement ❖Assess pressure points in skin at least every 8 hours ❖Regular shifting of position ❖Special mattresses or other pressure reduction devices ❖Perform active foot exercises and leg exercises every hour ❖Anti-embolism stockings, compression devices, or anticoagulant therapy may be prescribed ❖Pin care ❖Exercises to maintain muscle tone and strength
What are ways to manage a fracture?
❖Fracture reduction: restoration of the fracture fragments to anatomic alignment and positioning ❖Closed o Uses manipulation and manual traction o Traction may be used (skin or skeletal) ❖Open o Internal fixation devices hold bone fragment in position (metallic pins, wires, screws, plates) ❖Immobilization o External (cast, splints) or internal fixations
What are some common sport related injuries?
❖Fracture: clavicle, wrist, ankle, metatarsal stress ❖Dislocations: shoulder, elbow ❖Sprains: wrist, ankle ❖Knee: sprain, strain, and meniscal tears
What is septic (infectious) arthritis?
❖High risk: older adults >80, and those with comorbid conditions such as diabetes, RA, skin infections ❖Most commonly single knee and hip joints ❖Presents with a warm, painful, swollen joint with decreased range of motion. Systemic chills, fever, and leukocytosis are sometimes present ❖Prompt recognition and treatment are key ❖Treatment includes aspiration of joint to remove fluid, exudate, and debris; immobilization of joint; pain relief; and antibiotics
What are some emergency management techniques for fractures?
❖Immobilize the body part ❖Splinting: joints distal and proximal to the suspected fracture site must be supported and immobilized ❖Assess neurovascular status before and after splinting ❖Open fracture: cover with sterile dressing to prevent contamination ❖Do not attempt to reduce the fracture
What is osteomyelitis?
❖Infection of the bone due to: o Extension of soft tissue infection o Direct bone contamination o Bloodborne spread from another site of infection ▪ This typically occurs in an area of bone that has been traumatized or has lowered resistance ❖Methicillin-resistant Staphylococcus aureus ❖Systemic: chills, high fever, rapid pulse, general malaise ❖Local: pain, swelling, and extreme tenderness
What are some causes of back pain?
❖Injury, vertebral fractures, overuse, spinal stenosis are common reasons for back pain. ❖Cauda Equina Syndrome ❖Back pain can be chronic or acute o Associated symptoms - radiculopathy, sciatica o Affect - gait, reflexes, strength, and sensation
What are some nursing planning and goals for a patient with an amputation?
❖Major goals include: o Relief of pain o Wound healing o Acceptance of altered body image o Resolution of grieving process o Independence in self-care o Restoration of physical mobility o Absence of complications
What are ways that a nurse can manage a patient with bone tumors?
❖Medical management o Primary: surgical excision, radiation therapy, chemotherapy o Secondary: palliative ❖Nursing management o Monitoring and managing potential complications ▪ Delayed wound healing ▪ Infection ▪ Hypercalcemia o Patient and family education regarding diagnosis, disease process, and treatment
What are some educational needs for a patient with a cast, splint, or brace?
❖Medications and s/s to report ❖Techniques for cast drying ❖Controlling of swelling and pain ❖Care of minor skin irritation o Pad rough edges with tape or moleskin o Blow with hair dryer to relieve itching o Do not stick foreign objects into the cast ❖Chart 37-5
What is osteomalacia?
❖Metabolic bone disease "soft bones"; rickets in adults; don't have adequate mineralization of bones/lack vitamin D ❖Soft, weak skeleton causing pain, tenderness to touch, skeletal deformities (spinal kyphosis and bowed legs), and pathologic fractures
What is osteoporosis?
❖Most prevalent bone disease in the world; more than 1.5 million osteoporotic fractures occur each year ❖Bone resorption > bone formation ❖Compression fractures of the spine, fractures of the neck or intertrochanteric region of the femur, and Colles fractures of the wrist
What are some things that a nurse should access in a patient with an amputation?
❖Neurovascular and functional status of affected and of unaffected extremity ❖S/S of infection, nutritional status, concurrent health problems ❖Psychological status, grief, and coping ❖Monitor for complications: o Postoperative hemorrhage, infection o Skin breakdown o Phantom limb pain o Joint contracture
What are some nursing interventions for a patient undergoing hand/foot surgery?
❖Neurovascular assessment is vital o Assess swelling and neurovascular status every 1 to 2 hours for the first 24 hours o Instruct patient in signs and symptoms to assess and report ❖Relieve pain related to inflammation and edema o Elevate foot o Use of intermittent ice packs o Medications; oral analgesics ❖Improving mobility o Instruction in weight-bearing restrictions as prescribed o Use of assistive devices (crutches or walker) o Measures to ensure patient safety ❖Measures to prevent infection o Wound or pin care o Keep dressing clean and dry o Signs and symptoms of infections ❖Patient education
What are some ways to manage a patient with osteomalacia?
❖Pain management ❖Correct underlying cause ❖Kidney disease: supplement calcitriol ❖Malabsorption: Increased doses of vitamin D and calcium are usually recommended -calcitonin if the cause is kidney disease ❖Exposure to sunlight may be recommended; ultraviolet radiation transforms a cholesterol substance (7-dehydrocholesterol) present in the skin into vitamin D
What is nursing management criteria for a patient with back pain?
❖Physical Exam o Note leg length and shoulder height discrepancies, sensations and DTRs, pain on straight leg raises, spinal curvature ❖Interventions: o Pain management, exercise, body mechanics, work modifications, stress reduction, health promotion; activities to promote a healthy back o Dietary plan and encouragement of weight reduction (chart 36-2)
How should a patient with a total knee arthroplasty be cared for?
❖Postoperatively, the knee is dressed with a compression bandage ❖A wound suction drain may be used to remove fluid accumulating in the joint. ❖PT is started early ❖Mobilize and ambulate by the first postoperative day
What are ways to prevent osteomyelitis?
❖Prevention is key: surgical asepsis, prophylactic antibiotics, aseptic wound care
What are some characteristics of malignant bone tumors?
❖Primary tumors (rare) o Osteosarcoma—most common, most often fatal o Chondrosarcoma, Ewing sarcoma, fibrosarcoma o Soft tissue sarcomas (Liposarcoma, fibrosarcoma of soft tissue, rhabdomyosarcoma) ❖Prognosis depends on the type and whether the tumor has metastasized ❖Metastatic (Secondary) ❖More common than primary bone tumors ❖Common primary sites that metastasize: kidney, prostate, lung, breast, ovary, thyroid ❖Metastatic tumors are most frequently found in the skull, spine, pelvis, femur, and humerus and often involve more than one bone (polyostotic) ❖Treatment is palliative ❖Goal: relieve pain and promote quality of life
What are some nursing interventions for patients with skin traction devices?
❖Proper application and maintenance of traction ❖Monitor for complications of skin breakdown, nerve damage, and circulatory impairment o Inspect skin at least three times a day o Palpate traction tapes to assess for tenderness o Assess sensation and movement o Assess pulses, color, capillary refill, and temperature of fingers or toes o Assess for indicators of DVT o Assess for indicators of infection
What are nursing interventions for patients with osteomyelitis?
❖Relieving pain o Immobilization, elevation o Administer prescribed analgesics ❖Improving physical mobility o Activity is restricted o Gentle ROM to joints above and below the affected part o Participation in ADLs within limitations ❖Home Health Referral
What are ways to manage a spontaneous vertebral fracture in patients with osteoporosis?
❖Relieving pain o Short periods of rest o Supportive mattress o Intermittent local heat and back rubs ❖Improving bowel elimination o High fiber diet, increase fluids, stool softeners ❖Preventing injury o Physical activity to strengthen muscles, improve balance, and prevent disuse atrophy
What is traction?
❖The application of pulling force to a part of the body ❖Reduces muscle spasms and deformity ❖Reduces, aligns, and immobilizes fractures ❖All traction needs to be applied in two directions creating "vectors of force."
What is a joint arthroplasty?
❖Used for patients with OA; severe joint pain or loss of function; joint degeneration due to RA, trauma, congenital deformity, certain fractures
What are external fixator devices?
❖Used to manage open fractures with soft tissue damage ❖Provide support for complicated or comminuted fractures ❖Patient requires reassurance because of appearance of device ❖Discomfort is usually minimal, and early mobility may be anticipated with these devices ❖Elevate to reduce edema ❖Monitor for signs and symptoms of complications, including infection ❖Pin care ❖Patient education
What are the principles of effective traction?
❖Whenever traction is applied, a counterforce must be applied. Frequently, the patient's body weight and positioning in bed supply the counterforce ❖Traction must be continuous to reduce and immobilize fractures ❖Skeletal traction is never interrupted ❖Weights are not removed unless intermittent traction is prescribed ❖Any factor that reduces pull must be eliminated ❖Ropes must be unobstructed, and weights must hang freely ❖Knots or the footplate must not touch the foot of the bed
What are diagnostic measures for a patient with lower back pain?
❖X-ray - fracture, dislocation, etc ❖Bone scan - tumors ❖CT scan - Tissue lesion, vertebral discs ❖EMG - spinal nerve root disorders ❖Myelogram - visualize parts of spinal cord herniated
