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64 Cards in this Set
- Front
- Back
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Function of MS system
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protects organs
supports body structures mobility thermoregulation supports return of deoxygenated blood to heart stores essential minerals blood cell production |
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Hematopoiesis
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Blood cell production
Takes place in bone marrow of flat bones (scapula/sternum) |
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Long bones
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weight bearing and movement
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flat bones
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protect organs
hematopoiesis |
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irregular bones
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shape unique for function (skull)
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osteoblasts
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secrete matrix for bone formation and framework for mineral deposition
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osteocytes
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mature bone cells; bone maintenance
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osteoclasts
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bone dissolving and resorption cells
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osteogenesis
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formation of bone
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ossification
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hardening of bone
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Buckwalter's 6 stages of bone maintenance and healing:
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1. hematoma and inflammation
2. angiogenesis and cartilage formation 3. cartilage calcification 4. cartilage removal 5. bone formation 6. remodeling |
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x-ray
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density, texture, erosion, and changes in bone relationships; serial views done for function
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CT scan
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specifies plane of bones involved; extent of injry in difficult to identify areas
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MRI
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tumors and narrowing of tissue pathways
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arthography
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acute and chronic tears around the joint, injection of radiopaque isotope or air into the joint
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What is the best way to prevent falls?
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Exercise
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2 leading causes of DJD/OA?
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1. Age (50% over 65)
2. obesity |
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Clinical manifestations of DJD/OA
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pain (mild to severe)
stiffness, crepitus affects joints assymetrically deformity of joints (Herberden's and Bouchard's nodes) bowlegged w/ knee joints |
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Ways to improve symptoms of OA?
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Pain is usually worse in morning after no activity all night...so, activity helps decrease pain
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Best way to diagnose DJD?
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X-Ray: confirms disease and shows progression of joint damage
Elevated end sedimentary rate (ESR) shows some kind of inflammation |
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DJD Treatment
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Rest and Protection
Heat and Cold Therapy Nutrition and Exercise Medications Alternative therapies Assistive devices Surgical |
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DJD: Rest and Protection
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rest periods and immobilization during acute episodes; modify activities
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DJD: Heat
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relief of pain and stiffness
CI in PVD or diabetics |
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DJD: cold
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for inflammation
15-20 min every 2-4 hours |
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DJD: exercise
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weight reduction
conditioning and strengthening |
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DJD: Alternative therapy
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yoga, massage, supplements, acupuncture
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DJD: surgical
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joint replacement
arthroscopic repair of cartilage |
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Synovectomy
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removal of the synovial membraine; prophylactic and palliative in RA
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Osteotomy
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surgical realignment of joints; shifts weight bearing and relieves pain
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Arthrodesis
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fusion of severely damaged or infected joints; pain relief w/ stable, immovable joints
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Open reduction
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for fractures w/ plates and screws
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Arthroplasty
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joint replacement surgeries (OA and RA); partial or total; elbow, shoulder, phalangeals, wrist, hip, ankle, knee, feet, hip, and knee
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Surgery for MS disorders contraindicated in what type of patients?
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immobile patients; used to restore mobility only
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What movements must be avoided post hip replacement?
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internal rotation, adduction, 90 degree flexion (4-6 wks)
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Priorities in THR?
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pain
infection DVT |
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When is a Hemovac removed?
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when drainage is down to 30 ml or < w/in 48 hrs post op
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How long is typical hospital stay after THR?
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3-5 days
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Foley catheter with THR?
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8-24 hours post op
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When should the patient move to the bed pain post THR?
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ASAP-once alert and awake
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When should patient switch to BSC?
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once ambulatory
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When should the patient walk to the bathroom?
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post op day 2 or 3
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When is the THR patient out of bed?
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Up with assistance from PT on post op day 1 (12-24 hours)
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How much is the maximum amount of drainage left in a hemovac? Why?
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Reservoir holds 500 cc
Empty when 1/2 full to ensure suction |
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When should a patient be switched to po opiate management or NSAIDS post op THR?
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24-48 hours
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Nursing interventions to prevent infection:
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hand washing, TCDB, incentive spirometer, early ambulation, care of comorbidities (DM), HTN, heart Dx
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Nursing interventions for safety and injury prevention:
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use of abductor pillow w/ THA, knee immobilizer, assistive equipment (BSC and walker)
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Nursing interventions for DVT prevention:
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neuro-circulatory checks, CSM (circulation, sensation, movement) of operative extremity
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Nursing interventions: anticoagulant therapy
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Lovenox or Arixtra (24-48 hrs post op for 2 wks)
OR Warfarin (requires PT/INR) continues for 3 weeks post op |
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Patient education: What should the patient report to physician?
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s/s of infection
unrelieved pain or function loss (may indicate dislocation) |
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Leading Cause of amputations
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Peripheral Vascular Disease (PVD)
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Other causes of amputations
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diabetes mellitus
trauma congenital deformities chronic osteomylitis malignant tumors |
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Diabetes is more associated with what type of amputations?
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Lower limbs (>95%)
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Trauma is more associated with what type of amputations?
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upper extremity
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What are the 2 primary factors in an amputation?
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circulation and function
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complications of amputations
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hemorrhage
infection-surgical incision prosthesis may cause skin breakdown phantom limb pain joint contracture |
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Wound care post-op
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handle gently
aseptic technique tight compression bandage at all times (Consistent-limb shaping) (sandbags may be used to relieve pain) |
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A closed rigid cast or elastic residual limb shrinker is used to:
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decrease edema
provide uniform compression support soft tissues control pain prevent joint contractures |
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Nutritional Status in amputations:
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protein and Vitamins
Vitamin C potentiates zinc which helps in wound healing |
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Comorbidities to watch for in amputations:
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PVD
diabetes |
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psychological status and coping in amputations:
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body image
grief function mobility |
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Nursing interventions for pain:
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analgesic as prescribed
change position sand bag on residual limb |
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Phantom Limb Pain:
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occurs 2-3 months post op
Treat with TENS unit, local anesthetic, beta blockers, anti-sz meds, tri-cyclic antidepressants BEST IS AGGRESSIVE REHAB |
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How can a nurse help to resolve grief and enhance body image?
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Encourage patient to look at, feel, and care for residual limb
Help patient set realistic goals |
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Proper positioning of residual limb:
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Do not elevate on a pillow
Avoid abduction, external rotation, flexion Turn frequently-prone position is best |
