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OsteoarthritisHip ReplacementOsteoporosis
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OSTEOARTHRITISDegenerative joint disease
Pathophysiology:Deterioration of the articular cartilage Cartilage becomes stiff and loses elasticityBone spurs joint deformity, pain, and disability
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OSTEOARTHRITISDegenerative joint disease
Whos at risk?Obese - wt stress on the jointsRepetitive trauma bending, lifting, repetitive motionsAge incidence greatly increased after age 60, but it can develop in any ageGenetics
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Nursing Assessment of the Patient with OA
Joint stiffness, aching pain in the joint, and limited movement - Worse upon arising in the morning or after inactivity
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Nursing Interventions for Patients with Osteoarthritis
Weight reduction Aerobic exercise & flexibility routinesPharmacology:-Acetaminophen or Tylenol- NSAIDs - Opioids in severe casesOther options:- Use of braces - Oral glucosamine and chondroitin supplements- Capsaicin cream- Steroids - Acupuncture - Surgical procedures
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TOTAL HIP REPLACEMENT
Pre-op Teaching - Isometric Exercises- Transferring: bed to the chair w/o flexing the hip < 90 degrees- Bedpan use- Use of wedge pillow- C&DBPre-op Prep: Lab results: CBC, WBC, PT, PTT, UA, CXRTempSkin prepPre-op prophylactic antibioticsAssess for risk of DVT
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Post-operative Care for the Patient w/ a Hip Replacement General guidelines:Avoid hip flexionKeep legs in abduction prevents dislocationAnti-emboli measures - Sequential pneumatic stockings- IV Heparin or sub q Lovenox Coumadin- Exercises
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Post-operative Care for the Patient w/ a Hip ReplacementMedicate for pain Check circulation of legsCheck incision (may be lateral or anterior) Check for dislocation Neuro assessment of legPrevent external rotation of the hip Prevent skin impairment
Position:- OOB to chair w/in 24 hrs- Turn to unaffected sideAdminister antibiotics
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Post-operative Care for the Patient w/ a Hip ReplacementIf hemovac is usedInstructions to go home:- need toilet seat extension- NO crossing the legs sitting or standing
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OSTEOPOROSIS
PathophysiologyThere is a in bone density due to an in bone reabsorption.Calcitonin and Estrogen promotes bone formationBoth w/age bone loss - Parathyroid hormone w/ age in serum Ca - As Ca is lost from the bone brittle & porous bones
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OSTEOPOROSIS
Primary Osteoporosis:Postmenopausal womenDietaryLack of weight bearing exercisesOlder age
Actual Calcium need for adults
WomenMen25-50 yrs 1,000 mg25-65 yrs 1,000 mg50-65 yrs 1,000-1,500 mg> 65 yrs 1,500 mg> 65 yrs 1,500 mgPreg/lactating 1,200-1,500 mg
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OSTEOPOROSIS
Secondary Osteoporosis:2nd to renal failure, liver failure2nd to medications affects the bodys use of calcium- corticosteroids, heparin, INH, diuretics2nd to ETOH abuse2nd to malignancy, DM2nd to immobility
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OSTEOPOROSIS
Risk Factors:Small-framed, non-obese (< 127 lbs) Caucasian or Asian womenAge MenopauseFamily historyDiets low in Ca and Vit DSedentary lifestyleExcessive ETOH, caffeine, & tobacco use
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Nursing Assessment for Osteoporosis
Asymptomatic for years Decreased radio-density on X-ray- Norm: bone mineral density (BMD) value w/in 1 stand dev- Osteopenia: - BMD value btw 1 & 2.5 SD below the mean BMD- Osteoporosis:- BMD value > 2.5 SD below the mean BMD
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Nursing Assessment for OsteoporosisCurvature of the spine Kyphosis: dowagers hump urine Ca levelsFractures wrist, hip, pelvis, vertebral collapseLoss of height
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Nursing Interventions for OsteoporosisPrevention!!!Diet Weight bearing exercisesResistance trainingMedications1. Stabilizes bone loss- Ca carbonate/ Ca citrate - Estrogen replacement therapy2. Build bone mass- Fosamax, Actonel - Evista: Selective Estrogen Receptor Modulators (SERMs)- Effective in preventing 40% of spinal fx only- Calcitonin- Forteo: parathyroid hormone