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90 Cards in this Set
- Front
- Back
- 3rd side (hint)
Functions of the Bones
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-Form structure and provide support
-Protect vital organs from injury -Store minerals -Site for hematopoiesis -Serves to move body parts by providing points of attachment for muscles |
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Bone Cells
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-Osteoblasts
-Osteocytes -Osteoclasts |
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Osteoblasts
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cells that form bone
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Osteocytes
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-Cells that maintain bone matrix.
-Mature bone cells |
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Osteoclasts
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-Cells that resorb bone.
-Responsible for bone modeling |
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Gerontological Considerations
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-Many of the functional problems of the adult are related to changes of the musculoskeletal system
-Alterations may affect the older adult's ability to complete self-care tasks and pursue customary activities -Effects of musculoskeletal changes may range from mild discomfort and decreased ability to perform activities of daily living to severe, chronic pain and immobility -Risks for falls increases |
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Bone remodeling
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-Removal of old bones by osteoclasts (resorption) and the deposition of new bone by osteoblasts
-Adult bones do not normally increase in size but instead undergo constant remodeling - 1500 ml of calcium daily needed |
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Bone Remodeling Process
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-Bone reabsorption and bone deposits occur
-Involves combined action of osteocytes, osteoclasts, osteoblasts -Hormonal stimulus controlled by negative feedback mechanism that regulates bone calcium level |
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Hormone Regulation
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-When blood calcium decreases, parathyroid hormone (PTH) released
-Osteoclast activity stimulated and bone reabsorption so calcium released from bone matrix -Calcium levels rise and PTH release ends -When blood calcium rises, secretion of calcitonin from thyroid gland, inhibits bone reabsorption -Causes deposits of calcium salts in bone matrix |
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Classification of Bones by Type
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-Long bones
-Short bones -Flat bones -Irregular bones |
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Long bones
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arms, legs, fingers, toes
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Short bones
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wrist and ankle
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Flat bones
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skull, sternum, ribs
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Irregular bones
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vertebrae, scapulae, pelvic girdle
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Soft Tissue Injury
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-Sprain
-Strain -Joint dislocation -Subluxation |
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Sprain
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-injury to ligaments and other soft tissue at a joint
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Strain
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-a musculotendenious injury which is excessive stretching of a muscle. leads to edema, swelling, pain, decrease in function and bruising
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Joint dislocation
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-loss of articulation where the joint ends in the bone capsule following tissue trauma. could be congenital. causes pain, limited motion, and the diagnosis test is an Xray
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Subluxation
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-partial separation or dislocation of joint surfaces
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Nursing Care of Soft Tissue Injury
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-Pain relief
-Correction of dislocation -Prevention of complications -Immobilization with sling for several weeks -Rehabilitation -Hip: Usually requires immediate reduction in emergency room to prevent necrosis to head of femur and sciatic and femoral nerve damage |
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Nursing Diagnosis of Soft Tissue Injury
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-Acute Pain
-Impaired Physical Mobility -Risk for Injury |
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Fractures
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Disruptions in the continuity of bone as a result of trauma or disease
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Types of Fractures
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-Simple or Closed
-Compound or Open -Complete Fracture -Incomplete -Impacted Fracture -Comminuted -Transverse -Oblique -Spiral |
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Simple or Closed Fracture
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-does not cause a break in the skin
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Compound or Open Fracture
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-a fracture in which damage also involves the skin or mucous membranes
Grade 1=clean wound less than 1c long Grade 2- larger wound without extensive tissue damage Grade 3= highly extensive tissue damage, most severe |
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Complete Fracture
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-involves a break across the entire cross-section of bone, and is displaced from its normal position.
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Incomplete Fracture
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-partial break, no break in skin (greenstick) also called Greenstick - one side of the bone may be broken and the other side bent
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Impacted Fracture
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-fracture of the bone fragment is driven into another bone fragment.
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Comminuted Fracture
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-the bone has splintered into several fragments
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Transverse Fracture
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- the break is straight across the bone shaft
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Oblique Fracture
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-occurs at an angle across the bone (less stable than a transverse fracture)
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Spiral Fracture
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-twist around the shaft of the bone
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Signs and Symptoms of Fractures
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-pain
-loss of limb function -obvious deformity -crepitus -swelling and ecchymosis -s/s shock - x-ray evidence |
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Crepitus
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Definition: a grating sound heard by rubbing bony fragments together or a grating sensation felt, also by rubbing bony fragments together
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Emergency Care of Fracture
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-Immobilization above and below deformity
-Splint to maintain normal anatomical alignment -Prevent further dislocation or damage -Maintenance of tissue perfusion -Control bleeding with pressure dressing -Assess pulses, movement, sensation -Infection - open wounds should be covered |
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Healing of Fracture
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-Age
-Physical condition of patient -Type of fracture -Uncomplicated fracture of arm or foot- 6-8 weeks -Hip- 12-16 weeks |
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Reduce / Immobilize fracture
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-closed reduction
-open reduction -traction |
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Closed reduction
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manual traction or manipulation
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Open reduction
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Operative procedure to achieve bone alignment - nails, wires, pins, prosthetic implants
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Traction
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Force applied in two directions to obtain alignment and to reduce muscle spasm
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Medications for Fractures
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-pain
-NSAIDS -Stool softeners -Antibiotics -Anticoagulants |
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Treatment of Fractures
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-external fixation
-internal fixation -traction -casting |
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External fixation
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frame connected to pins inserted into long axis of bone
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Internal fixation
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(ORIF) reducing fracture and applying hardware (pins, nails, screws, plates) to hold bones in place
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ORIF = Open Reduction Internal Fixation
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Traction
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Application of straightening or pulling force to maintain or return fractured bones in normal alignment; prevent muscle spasms
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Casting
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Rigid device applied to immobilize bones and promote healing
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2 types of Tractions
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-Skin Traction
-Skeletal Traction |
Skin Trac: used to control muscle spasms and to immobilize an area b4 surgery: types: Bucks, Surgical Head Halter, Pelvic Belt (for back pain)
Skeletal traction: applied directly to the bone with metal pins and wires-used to treat fractures of the cervical spine, femur or tibia Bucks traction: needs 2 people to put on - 5-10 lb wgts |
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For Patients Receiving Traction
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-Check correct body alignment
-Check ropes in pulley -Check weights hanging freely -Skin Assessment -Provide Pin Site Care |
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Casts (what it is made of)
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-Plaster: 48 hours needed to dry
-Fiberglass: dries within one hour |
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Types of Casts
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-short arm cast
-long arm cast -body jacket cast -single hip cast -double hip spica cast -long leg cast -short leg cast |
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QUESTION: Identify patient/family teaching instructions for a client discharged home with a cast
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-At the completion of the home care instruction, the patient or caregiver will be able to:
• Describe techniques to promote cast drying (eg, do not cover, leave exposed to circulating air; handle damp plaster cast with palms of hands and do not rest the cast on hard surfaces or sharp edges that can dent soft cast) • Describe approaches to controlling swelling and pain (eg, elevate casted extremity to heart level, apply intermittent ice bag if prescribed, take analgesics as prescribed) • Report pain uncontrolled by elevating the casted limb and by analgesics (may be an indicator of impaired tissue perfusion–compartment syndrome or pressure ulcer) • Demonstrate ability to transfer (eg, from a bed to a chair) • Use mobility aids safely • Avoid excessive use of injured extremity; observe prescribed weight-bearing limits • Manage minor irritations from cast (eg, for skin irritation from cast edge, pad rough edges with tape; to relieve itching, blow cool air from hair drier) • Demonstrate exercises to promote circulation and minimize disuse syndrome • State indicators of complications to report promptly to physician (eg, uncontrolled swelling and pain; cool, pale fingers or toes; paresthesia; paralysis; purulent drainage staining casts; signs of systemic infection; cast breaks) • Describe care of extremity following cast removal (eg, skin care; gradual resumption of normal activities to protect limb from undue stresses; management of swelling) |
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Cast Care: DO NOT
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-Do not get plaster cast wet
-Do not remove any padding -Do not insert any foreign object inside cast -Do not bear weight on new cast for 48 hours -Do not cover cast with plastic for prolonged periods |
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Cast Care: DO
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-Apply ice directly over fracture site for first 24 hours (avoid getting cast wet)
-Check with healthcare provider before getting fiberglass cast wet -Dry cast thoroughly after exposure to water (blot dry; hair dryer at low setting) -Elevate extremity above heart for first 24 hours -Move joints above and below cast regularly -Keep appointment to have cast and fracture checked |
use Atarax for itching when wearing cast
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Cast Signs to Report
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-Increasing pain
-Swelling associated with and discoloration of toes or fingers -Pain during movement -Burning or tingling under cast -Sores or foul odor under cast |
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Nursing Care: Fracture
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-Pain relief measures
-Elevate -Nutrition -Prevent complications of immobility |
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Five P's
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Pallor
Pain Pulses Parasthesia Paralysis |
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Complications of Fractures
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-Compartment syndrome
-Shock -Fat embolism -DVT -Infection -delayed union -Nonunion -Disseminated Intravascular Coagulopathy -Avascular necrosis |
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Compartment Syndrome
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an anatomic compartment in an area of the body encased by bone or fascia that contains muscles, nerves, and blood vessels. human body has 46-when the pressure within is greater than normal-The result of Vascular insufficiency and nerve compression from a too tight cast- must monitor circulation, motion and sensation of the affected extremety
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3 types:
=Acute:sudden or severe decrease in bl. Flow in tissues distal to an area of injury that results in ischemic neucrosis. Pain occurs with passive ROM. =Chronic: pain, aching, tightness in muscle group that is subject to stress or exercise. =Crush: caused by massive external compression or crushing of a compartment-can lead to renal failure- when the cast is too tight, elevate extremety to heart level, cut or release cast if not relieved in 1 hr, then surgery is required |
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Shock
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-hypovolemic shock, resulting from hemorrage, trmt is to stabilize fracture to stop hemorraging, & to restore circulation
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Fat embolism
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-fat deposits in the circulation following fractures of the long bone so the emboli blocks the pulmonary or cerebral vessels. The onset of symptoms is rapid and occurs 24-72 hrs after surgery but can take up to 1 wk post surgery. s/s: hypoxia, tachycardia, tachypnea, resp. distress, crackles, wheezing, fever, resp. alkalosis into resp. acidosis. Xray will show snow storm filtrate that can lead to heart failure. Changes in mental status, delirium, agitation , coma. Mgmt: immobilize fracture immediately: infection can cause necrosis, sepsis, infection (fever, inflammation, elevated wbc, malaise, redness, tenderness)
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DVT
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-reduced skeletal muscle contractions and bed rest in pt with fractures of the lower extremities and pelvis are at high risk- In hip fractures this is the most common complication - Nursing Interventions are: encourage intake of fluids and ankle and foot exercises. Elastic compression stockings, etc assess at least every 4 hrs for signs of DVT, tenderness, warmth, redness and swelling
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Infection
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-In an open fracture there is a risk for osteomyelitis, tetanus, and gas gangrene. contaminated fractures are left unsutured and dressed with sterile gauze to permit edema and wound drainage.
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Delayed Union
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-when healing does not occur at a normal rate for the location and type of fracture. distraction of bone fragments, systemic or local infection, poor nutrition, or comorbiidity (ie. DM)-eventually heals
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Nonunion
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-results from failure of the ends of a fractured bone to unite
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Disseminated Intravascular Coagulopathy (DIC)
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-systemic disorder that results in widespread hemorrage. Unexpected bleeding after surgery
Nurse monitor for s/s of infection: tenderness, elevated temp, purilent drainage, etc. Trmt: antibiotics |
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Avascular necrosis
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-bone loses blood supply and dies. s.s.: pain, limited movement, trmt: bone graph prostetic replacement.
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Osteoarthritis (OA)/ Degenerative Joint Disease
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-Most common of all forms of arthritis
-Loss of articular cartilage in articulating joints and hypertrophy of bones at articular margins -affects more than 60 million adult Americans |
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Incidence of Osteoarthritis
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-Males more often than females until age 55 when incidence twice as high in females
-Men more likely to have OA in hips -Women in the hands |
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Risk Factors of OA
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-Age
-May be inherited -Excessive weight (hips and knees) -Inactivity -Strenuous, repetitive exercise (sports) -Hormonal factors (decreased estrogen) in post menopausal women |
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Pathophysiology of OA
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-Cartilage lining joints degenerates
-Loses tensile strength -loss of cartilage results in bone thickening -reduction in the ability to absorb energy in joint |
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Clinical Manifestations of OA
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-onset gradual, insidious, slowly progressive
-pain and stiffness in one or both joints -Deep pain aggravated by motion and relieved by rest -pain may be referred to other places -decreased range of motion -bony growth which causes joint enlargement |
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Diagnostic Tests of OA
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-History and physical examination
-Changes in x-rays -Synovial fluid analysis |
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Medications of OA
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-NSAIDS
-Celebrex / Vioxx? -Steroid injection |
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Conservative Treatment of OA
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-physical therapy
-rest of involved joint -weight loss -analgesic therapy -anti-inflammatory therapy |
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Addtitional treatments of OA
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-arthroscopy
-osteotomy -joint arthroplasty -nutritional supplements -total joint replacement -herbal therapy -yoga |
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Total Hip Replacement
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-the replacement of a severely damaged hip with an artificial joint. Nrsg Intvt: monitor for dislocation of the hip prosthesis, excessive wound drainage, thromboembolism, infection and heel pressure ulcer. also heterotopic ossification (formation of bone in the periprosthetic space), avascular necrosis and loosening of the prosthesis
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Hip Fractures
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-Common in Older Adults
-More than 200,000 hip fractures occur annually by age 80 -seen more frequently in females than men because of osteoporosis and low bone density |
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Pre-existing Medical Problems (hip fractures)
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-Diabetes mellitus
-HBP -cardiac decomposition -Pulmonary disease -Arthritis -Surgery often delayed until medical conditions stabilized |
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Clinical Manifestations (hip fractures)
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-external rotation
-muscle spasms -shortening of the affected extremity -severe pain -tenderness in the region of the fracture site |
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Treatment (hip fractures)
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-pain
-spasms -pre-operative teaching -over head trapeze bar -ORIF |
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QUESTION: Identify strategies for reducing hip fractures in the elderly.
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ANSWER:
-Calcium supplements -Vitamin D supplements -Estrogen replacement -Planned interventions |
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Joint Replacement
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A surgical procedure in which a mechanical device, designed to act as a joint, is used to replace diseased joint
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Commonly Replaced joints
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-hip
-knee -shoulder |
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Principles (joint replacement)
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-Prostheses may be ingrown or cemented
-Accurate fitting is essential -Must be healthy bone stock for adequate healing |
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Benefits (joint replacement)
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-Provides excellent pain relief in 85% to 90% of the clients who undergo the surgery
-Improved joint motion -Improves emotional well-being -Primary post operative problem is Infection |
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Clinical Manifestations (joint replacement)
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-joint pathology
-arthritis -fracture -pain not relieved with medication -poor range of motion in affected joint |
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Surgery (joint replacement)
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-problems originate from functional disability
-most common orthopedic surgery performed |
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Nursing Diagnosis (joint replacement)
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-Potential for infection related to
-Pain related to -Potential for injury to affected limb related to |
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Nursing Interventions (joint replacement)
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-Monitor incision site (bleeding, drainage, suture line, suction device, infection)
-Functioning of extremity - check circulation, sensation, movement of extremity distal to replacement -Proper alignment of affected extremity -Abductor appliance (hip replacement), CPM device -Monitor I&O every shift; include suction drainage -Encourage fluid intake -Encourage self-care activities |
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Coordinate Rehabilitation (joint replacement)
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-OOB ASAP
-Keep out of bed as much as possible -Keep abductor pillow in place while in bed (hip replacement) -Use elevated toilet seat and chairs with high seats (hip and knee replacements) prevents dislocation -Do not flex hip more than 90 degrees -Discharge planning (rehab) |
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