unit c musculoskeletal_chpt_46 part iii voice and no underline
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Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Rheumatoid Arthritis Chronic, Progressive, Systemic
Inflammatory Disease Destroys Synovial Joints and Other
Connective Tissues includes Major Organs Juvenile rheumatoid arthritis is also known
as Stills disease
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Rheumatoid Arthritis
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Pathophysiology Synovitis Synovium Thickens, Fluid Accumulates Destructive Pannus (new growth) Erodes
Joint Cartilage, Destroys Joint Bone Pannus Converted to Bony Tissue Joint Deformity Other Connective Tissue Affected
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Etiology Unknown Genetic Predisposition Environmental Autoimmune Response - Antibodies
(Rheumatoid Factor)◆Local and Systemic Inflammation
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Signs and Symptoms Remissions and Exacerbations Varies by Individual
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
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Signs and Symptoms Early Symptoms
◆Bilateral, Symmetrical Joint Inflammation◆Reddened, Warm, Swollen, Stiff, Painful◆Stiffness After Resting◆Activity Decreases Pain and Stiffness◆Low Grade Fever, Weakness, Fatigue,
Anorexia
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Signs and Symptoms Late Symptoms
◆Joint Deformity◆Secondary Osteoporosis
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
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Joint Abnormalities in Rheumatoid Arthritis
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
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Therapeutic Interventions Medication
◆Disease-modifying antirheumatic drugs • Leflunomide (Arava) • Etanercept (Enbrel)
◆Gold salts have been used but may not produce results for 2-4 months.
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Therapeutic Interventions Medication con’t
◆Methotrexate◆Gold ◆Prednisone◆NSAIDS◆Aspirin has anti inflammatory properties which makes it
a good drug for rheumatoid arthritis patients.◆ Large does of aspirin may cause tinnitus (ringing of the
ears)
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Therapeutic Interventions Heat/cold Balanced Rest and Activity Surgery – Total Joint Replacement
Rehabilitative procedures are used to primarily help keep the patient as independent as possible.
Range of motion exercise will help patients from developing contractures
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Nursing Diagnoses Acute Pain Disturbed Body Image Fatigue Self-care Deficit Impaired Physical Mobility Deficient Knowledge
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
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Patient Education Disease Process Medication Management Rest and Exercise
◆Exercise helps to prevent the joints from becoming immobile
◆When resting joints should be support in a position of extention
Vocational Counselor Community Resources
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
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Total Hip Replacement Acetabular Cup Inserted Into Pelvic
Acetabulum Femoral Component Inserted Into Femur
http://medicalimages.allrefer.com/large/7019.jpg
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
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Total Hip Replacement Preoperative Care
◆Total Joint Education Programs ◆Autologous Blood Donation
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
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Total Hip Replacement Postoperative Care to Prevent
Complications◆Hip Dislocation
• Prevent Adduction or Hyperflexion• Usually a maximum of 60 degree flexion is allowed• Internal rotation is also restricted
◆Skin Breakdown• Prevent Pressure Ulcers
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
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Abductor Pillow
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Hip Flexion after Total Hip Replacement
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Total Hip Replacement◆Pain
• Provide Pain Relief
◆Infection• Prophylactic Antibiotics • Coughing and Deep Breathing• Incisional Care
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
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Total Hip Replacement◆Bleeding
• Monitor Incision/drainage From Drain
◆Neurovascular Compromise• Neurovascular Checks
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
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Total Hip Replacement◆Ambulation
• Physical Therapy• Use Walker/crutches
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Total Hip Replacement Thromboembolitic Complications
◆Compression Devices◆Leg Exercises
• Enoxaparin (Lovenox)
◆The chief cause of mortality for total hip patients is pulmonary embolism.
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Total Hip Replacement Postop care includes:
◆Proper positioning to maintain abduction◆Monitoring amount of wound drainage◆Planned administration of an analgesic prior to
exercise
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
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Total Hip Replacement Self-care
◆Assistive Dressing Devices ◆Raised Toilet Seat ◆Rehabilitation
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
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Total Knee Replacement Femoral Component, Tibial Component, Patellar Button
Dislocation Not a Concern
Care like Total Hip Replacement
Frequent monitoring of vital signs is essential Continuous Passive Motion Machine (CPM)
Knee Arthroplasty is surgery to reshape, reconstruct, or replace a diseased or damaged knee joint. (A new knee joint made with a prosthesis)
http://www.kneereplacement.co.in/images/2%20Knee%20replacement%20implant.JPG
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Total Knee Replacement The nerve that could be compromised in the total
knee patient is the peroneal or fibular nerve
The peroneal nerves wraps around the head of the fibula and innervates the knee joint, skin of the lateral calf and dorsum of the foot. Also the muscles that dorsiflex the foot are innervated.
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Total Knee Replacement Nursing care after total knee surgery
◆Obtain a walker to minimize weight-bearing on the affected leg
◆Apply knee immobilizer brace before getting the patient up (primary method of protecting knee joint)
◆ elevate the leg while sitting in a chair
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Continuous Passive Motion Machine
Flexion and extension are important in the overall rehabilitation process for total knee replacement patients.
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
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Amputation Surgical Amputations
◆Ischemia From Peripheral Vascular Disease ◆Bone Tumor or cancer of the bone◆ Frostbite◆ Congenital Problems◆ Infections◆Burn injury
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Amputation Traumatic Amputations
◆Accidents
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Amputation Replantation
◆Wrap Severed Body Part in Cool, Slightly Moist Cloth
◆Place in Sealed Plastic Bag Submerged in Cold Water
◆Transported to Hospital
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
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Amputation Levels Of Amputation
◆Below-the-knee (BKA) ◆Above-the-knee (AKA) ◆Below-the-elbow (BEA) ◆Above-the-elbow (AEA)
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
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Amputation Nursing Care
Preoperative ◆ Deficient Knowledge
• Teach Preoperative Procedures◆ Disturbed Body Image ◆ Begin Support Services
Factors that can influence a persons reaction to an amputation include:◆ Previous dealings with loss◆ Economic status◆ Emotional stability
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
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Amputation Nursing Care
Postoperative◆Hemorrhage Prevention ◆Infection◆Pain Control
• Phantom Pain
◆Mobility and Ambulation
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Bandaging for Above-the-Knee Amputation
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
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Amputation Nursing Care
Postoperative◆Prosthesis
• Fitting a patient for a prosthesis at the time of surgery– Helps to get the patient out of bed as soon as possible– Improve the patients mental outlook and reduce anxiety
• Patient can not be hurried through the stages of grieving and acceptance
◆ Lifestyle Adaptation• New amputees are very likely to be concerned about their
dependence on family and friends.
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Amputation Nursing Care
Postoperative◆The patient will be scheduled to spend some time in
the prone position each day to prevent contractures of the hip
◆Exercise of operative as well as unoperative side prevents muscle weakness and atrophy
◆Patients usually begin walking in 2 – 4 days after an amputated leg.
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Congenital Hip Dysplasia Abnormal development
of tissue in hip
Affected side knee may be higher than the unaffected side
Skin folds of the thigh of the affected are deeper than the unaffected side
http://www.pediatric-orthopedics.com/Topics/Bones/Hip/Gal.jpg
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Congenital hip dysplasia Treatment may include:
◆Surgery◆Splints or braces◆Traction
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
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Scoliosis A lateral curvature of the spine
80% are attributed to idiopathic causes
A Milwaukee Brace and exercise is frequently the treatment of choice
Treatment is aimed a correcting the curvature
http://img.youtube.com/vi/BR5XHARFmoA/0.jpg
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
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Temporomandibular Joint Dysfunction
Painful condition involving the joint that opens and closes the mouth, the temporomandibular joints
Patient may experience clicking and popping when moving jaw during chewing
Medical management includes moist heat or cold therapy
http://www.aurorahealthcare.org/yourhealth/healthgate/getcontent.asp?URLhealthgate=%2211502.html%22