Med Surg Exam #5 -Osteoarthritis

Common Nursing Diagnosis for Osteoarthritis

-Chronic pain r/t cartilage deterioration -Impaired physical mobility r/t pain and degenerative changes -self care deficit

Management of pain for Post operative Hip and jOINT REPLACEMENT

-EPIDURAL ANALGESIA -pca

Preoperative Care for Joint Replacement

-Education -Risk factors for clotting problems are determined *History of previous clotting, obesity, and advanced age -Autogolous Blood tranfusions *Donate blood prior to surgery and then can be used during or after surgery *avoids the risk of blood transfusion reactions

Operative Procedures for both Total Hip and Knee Replacements

-Intravenous antibiotics are given 1 hour before surgical incision is made *Cefazolin (Ancef) *Vancomycin (Vancocin) or Clindamycin (Cleocin) may be used for those allergic to Ancef -May be done under general or epidural anesthesia -Cemented -Noncemented

Risk Factors for Osteoarthritis

-age -certain occupations -gender -obesity -genetic factors -trauma

Assessment for Neurovascular Compromise

-check and document color, temperature, distal pulses, capillary refill, movement and sensation -compare the operative leg with the non operative one (what is the nurse's best first action if he finds the post operative THR client's left leg to be cool with sluggish capillary refill?)

Progression of Activity for Postoperative Hip Placement Surgery

-client gets out of bed the day after surgery and physical therapy is iniitated -raised toilet seats, raised chairs and reclining wheelchairs help prevent hyperflexion -a client with cemented implant is allowed immediate partial weight bearing (PWB) or full weight bearing (FWB) -a client with noncemented implant cannot tolerate FWB until bony ingrowth occurs. Only PWB for the first few weeks unstil x-ray shows evidence of bony growth

Goals for Discharge

-client should be able to walk independently with a acane or walker -have close to 90 degrees of flexion in the operative knee

Interventions for Chronic Pain of Osteoarthritis

-comprehensive pain assessment should be performed before and after implementing interventions -Onset, location, duration, characteristics, aggravating factors, relieving factors, treatment -Pain control may be accomplished at home with drug and non pharmacological measures. -surgery may be done to reduce pain.

Best Practice for Use of CPM Device

-ensure that machine is well padded -check cycle and range of motion settings at least once per shift -ensure that the joint being moved is properly positioned on the machine -if client is confused place controls to the machine out of his or her reach -assess the clients response to the machine

Quadricep Setting Exercises

-four large muscles on the front of the thigh need to be stretched or "set" -enables the person to have better mobility with the new joint -client is instructed to straighten the lg and push the back of the knees into the mattress

Surgical Management for Arthritis for Total Joint Replacement (TJR)

-hips and knees are the joints most commonly replaced -replacement of finger and wrist joints, elbows, shoulders, toe joints, and ankles have become more popular in the past 20 years

Clinical Manifestations of Osteoarthritis

-joint pain -joint stiffness -crepitus (grating sound, popping) -joint enlargement *due to bone hypertrophy -rarely does joint appear to be hot and inflamed

Drain for Postoperative Hip/Joint replacement

-monitor and record output -use aseptic technique when handling -total amount of drainage is usually less than 50 mL's in 12 hours.

Nonpharmacologic Measures for Osteoarthritis

-rest -positioning -thermal modalities *use of heat instead of cold to reduce pain *application of cold is used for acutely inflamed joints -weight control *lessens the stress on weight bearing joints Transcutaenous electrical nerve Stimulation (TENS) *helpful for vertebral involvement Complementary and alternative therapies *acupuncture, tai chi, therapeutic touch, magnets, music therapy, and imagery

Post Operative care for TKR Client

-similar to that of THR client -maintain knee is a neutral position and not rotated internally or externally (knee brace) -use of continuous passive motion (CPM) device

Wound Care for Postoperative Hip Replacement and Joint Replacement

-stitches or staples running along the incision -stitches or staples will be removed 2 weeks after surgery -avoid getting the incision wet -bandage is placed over the incision (observe for bleeding)

Expected use of Total Knee Replacement is

1-15 years

Contraindications for Surgical Management for Total Joint Replacement

Infection in the body *the existence of any bacterial infection is a contraindcation to joint replacement surgery. The surgeon must be notified and the infection treated and resolved prior to surgery. Advanced Osteoporosis Severe inflammation

Physical Assessment for Osteoarthritis

JOINT PAIN (described as grating pain, diminishes after rest and intensifies after activity) JOINT STIFFNESS (after a period of inactivity, usually lasts less than 30 minutes) CREPITUS (grating sensation)

Complications with Surgical Total Joint Replacement

Joint Infection -wash ahnds and use aseptic technique for wound care and emptying of drain Blood Clots (DVT) -use of anticoagulants (Coumadin, Lovenox, Heparin) *have antidotes on hand for Coumadin and Heparin -Support hose and/or sequential compression devices (SCDs) -Teach leg exercises Dislocation -keep leg abducted *use of abduction pillow -prevent hip flexion beyond 90 degrees -observe for increased hip pain, shortening of the affected leg and leg roation Bleeding and Anemia (monitor H and H) -use of blood salvage *shed blood is returned to client via cell saver

Radiographic Assessment for Osteoarthritis

Routine X-Rays -useful in determining structural joint changes -specialized views are obtained when the disease cannot be visualized on standard x ray film but is suspected

What is Osteoarthitis also known as?

The wear and tear disease associated with age.

What is Osteoarthritis?

also known as degenerative joint disease and is a disorder characterized by progressive deterioration of the articular cartilage. It is a noninflammatory (unless localized), nonsystemic disease.

Nonsurgical Management for Osteoarthritis

ANALGESIC ADMINSTRATION -reduce pain and secondary joint inflammation -Tylenol: primary drug of choice for pain relief (should not take more than 4000 mg per day) -Topic salicylates (Aspercreme) -NSAIDS *observe for fluid retention *increased blood pressure *renal insuffiency/failure -Celebrex, Mobic *these drugs manage pain and inflammation with fewer side effects of GI distress and bleeding

Analgesic Administration

Cortisone injection -done on individual joints -frequently injected joints include *knees, base of thumb, shoulder and trochanteric bursae Muscle relaxants -used for painful muscle spasms, especially in the back (FLEXIRIL) Potent analgesics are usually nto appropriate for the client with Osteoarthritis because of the chronic nature of the pain