Nursing Care of the Orthopedic Patient – Flashcards
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Sprain
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Injury to the ligamentous structure surrounding a joint
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Strain
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Excessive stretching of a muscle and/or tendon
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Nursing Management of Strain & Sprain
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**RICE** -Stop activity limit movement -Apply Ice -Compress -Elevate control pain
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Repetitive Strain Injury
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Cumulative overuse syndrome
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Carpal Tunnel Syndrome
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compression of median nerve (pressure from trauma/edema)
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Clinical Manifestation of Carpal Tunnel
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weakness pain numbness tingling
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Carpal Tunnel : Diagnosis
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Tinel's sign - phalen +, tap on inside of wrist over median nerve (tingling sensation) Phalen's sign - bend wrist for 1 minute (tingling sensation)
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Treatment of Carpal Tunnel
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Prevention Physical Therapy Corticosteroid injection Surgery (cut)
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Traction
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Reduce fracture immobilize a joint reduce pain / muscle spasm
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Nursing care of Traction
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Pounds / pressure / pull / pulleys / pin care *always obtain a baseline, bilateral neurovascular assessment
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Fractures - Nursing Management
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Neurovascular assessment - CMS Pain control Elevate Ice Prep for surgery Education
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Serious complications of Pelvis fracture
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Sepsis, fat embolus, thromboembolism High mortality rate
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Nursing care - Pelvic Fracture
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Assess neurovascular status of LEs *turn ONLY as ordered* Assess bowel/urinary fx (bowel sounds/I&O/Distention/hemorrhage) Skin care Ambulate as ordered
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Clinical manifestation of Hip Fracture
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External rotation Muscle spasm/severe pain Shortening of extremity
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Treatment for Hip Fracture
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Buck's traction Surgical repair
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Nursing care for Hip fracture - Pre-op
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Pain control Maintain traction Education
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Nursing care for Hip fracture - Post-op
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VS / I&O Respiratory status **Bowel sounds** Pain control Neurovascular checks Monitoring dressing / drains Ambulate as ordered Elevate leg when in chair Ice Exercise Precautions
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What are the hip precautions for posterior approach?
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Do Not cross leg Do Not bend more than 90 degrees Do Not turn Inward (pigeon toe) ABDUCT when turning
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Hip fracture - Post-op dislocation s/s
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Sudden severe pain Limb shortening External rotation Ball in butt
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Compartment Syndrome
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Excessive pressure built up - EDEMA or BLEEDING Interrupts blood flow to tissue - can cause necrosis Occurs w/ or w/o cast
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6 P's of Compartment Syndrome
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Pain not relieved by opioid analgesics (ischemic pain) Pressure Pallor Parenthesis (numbness & tingling) Pulselessness Paralysis
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Compartment Syndrome - Diagnosis
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**capillary refill** Physical exam Pressure measurement
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Intervention for Compartment Syndrome
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Do Not Ice or Elevate (cause vasoconstriction) Loosen splint or dressing Bivalve cast Fasciotomy
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VTE
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Blood clot in LEs - can lead to PE
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PE
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Blockage of Pulmonary artery From iliac or femoral vein
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Clinical manifestations of PE
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**Dyspnea** Tachypnea Cough Chest pain Hemoptysis Crackles *Mental status change* Hypoxemia Anxiety - "I can't breathe!"
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PE - Treatment
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***O2*** Intubation Vasopressor - ⬆️BP Diuretics Surgery Heparin / enoxaparin / warfarin IVC filter
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PE Prevention
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Early ambulation Compression devices Anticoagulation - prophylactic meds - Coumadin
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Fat Embolism Syndrome
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Fractures of:- long bones, ribs, tibia, pelvis
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Clinical manifestation of Fat Embolism
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**resp distress** **mental status** **petechial rash** - under eyelids, auxiliary, chest, neck Chest pain Tachycardia Cyanosis Apprehension - feeling of doom
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Fat Embolism treatment
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Supportive care - IV fluids, mechanical ventilation, blood products Prevention - immobilize & stabilize fracture/patient, corticosteroids
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Osteomyelitis
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Infectious process in bone - staph aureus
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Clinical manifestation of Osteomyelitis
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Fever, night sweats, chills Irritability, restlessness Lethargy, malaise Bone pain Warmth & swelling Tenderness ⬇️ ROM in limb
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Osteomyelitis - Treatment
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IV antibiotics (long term) - nafcillin, clindamycin, cephalosporin, vanco PO antibiotic Surgery Immobilization pain control
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Common Joint Surgeries
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Synovectomy - ball&socket - RA Osteotomy - Rickets - bent - cut - make it straight Debridement Arthroplasty - treating a joint
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Osteoporosis
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"Porous bones" Silent disease Resorption exceeds deposition ⬇️bone mass & structural deterioration ⬆️ bone fragility
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Osteoporosis can be exacerbated by
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Menopause Meds - corticosteroids, antiseizure, heparin, anticancer Chronic Diseases - inflammatory bowel, kidney disease, RA, Alcoholism Cigarettes smoking
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Treatment for Osteoporosis
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Nutrition - Ca & Vit D Exercise No Estrogen Calcitonin - hormone - only to women - give Ca supplement with it Bisphosphonates (alendronate - fosamax) Selective estrogen receptor modulator (raloxifene - evista)
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Osteoarthritis (OA)
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Wear & tear Breakdown of cartilage between joints Smooth cartilage becomes granular - bone on bone No single cause Hands, neck, lower back, knees, hips MC form of arthritis in north america
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Clinical manifestation of OA
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NO systemic s/s *asymmetrical involvement* Joint pain Morning joint stiffness (resolve 30 min after rising) Crepitation Joint deformity
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OA - diagnosis
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Bone scan CT scan MRI X Ray * NO BLOOD TESTs *
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Treatment for OA
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Balance rest/activity Assistive devices Heat(stiffness) & cold(inflammation) Weight management Exercise
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Meds for OA
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Salicylates NSAIDS Topical analgesics Corticosteroid injection Hyaluronic acid injection Glucosamine / chondroitin
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RA
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Chronic / systemic / autoimmune Exacerbation & remission Possibly genetic - rheumatoid factors Pannus formation - inflammatory process of RA
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Clinical manifestation of RA
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Nonspecific symptoms ⬆️ localized stiffness Pain, inflammation **Bilateral joint involvement** Joint deformities / subluxation Rheumatoid nodules Sjorgen's syndrome -WBC destroys exocrine glands (dry mouth/eyes) Felty's syndrome - swollen spleen - ⬇️wbc - repeated infections
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RA - diagnosis
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History & physical Blood work - cbc, esr, rf, Ana, crp Synovial joint analysis Bone scan MRI *X Ray NOT diagnostic*
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Treatment for RA
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Manage pain & inflammation DMARDS :- -Methotrexate(theumatrex) - monitor cbc, lfts -Hydroxychloroquine (plaquenil) - visual disturbances -Etanercept (Enbrel) - immunosupression - assess for s/s of infection -Infliximab (Remicade) - immunosupression - TB test & CXR before therapy Other Meds:- Immunosuppressants - Azathioprine (imuran) Penicillamine (cuprimine) Gold compounds Corticosteroids
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Gout
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Type of arthritis Build up of URIC ACID in blood & causes inflammation in joints ⬇️ in URIC acid excretion by kidneys ⬆️ intake of purines Purine catabolism ➡️ URIC acid URIC acid crystals ➡️ synovial fluid
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Clinical manifestation of Gout
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Dusky, cyanotic joints Pain (middle of night) Low grade fever Inflammation Tophi (chronic gout) - URIC acid buildup
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Rx factors for Gout
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HTN ALCOHOL DIABETES Rich Foods
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Treatment for GOUT
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Colchicine - ⬇️inflammation NSAIDS - ⬇️ pain & inflammation Allopurinol - ⬇️ URIC acid production
