Joint Surgery/Test 4

Question 1

Joints:

Answer 1

Where ends of 2 bones are in proximity and move in relation to each other

• synarthrotic
• amphiarthrotic
• diarthrodial

Question 2

Synarthrotic:

Answer 2

immovable

Question 3

Amphiarthrotic

Answer 3

slightly movable

Question 4

Diarthrodial

Answer 4

freely movable

Question 5

Joint replacement is the most

Answer 5

common orthopedic operation performed on older adults

Question 6

Indication for joint surgery:

Answer 6

• Relief of pain
• Improving joint motion
• Correcting deformity and malalignment
• Removing intraarticular causes of erosion

Question 7

Types of surgeries:

Answer 7

• Arthroplasty

* Arthrodesis

Question 8

Arthroplasty:

Answer 8

reconstruction or replacement of a joint to relieve pain, improve or maintain ROM and correct deformity.

Question 9

Arthrodesis:

Answer 9

Surgical fusion of a joint

Question 10

Spondyloarthropathy:

Answer 10

refers to a family of inflammatory arthritic conditions which include-

• Ankylosing spondylitis
• reactive arthritis
• psoriatic arthritis
• enteropathic spondyloarthropathy (arthritis of inflammatory bowel)
• Undifferentiated spondyloarthropathy

Question 11

Undifferentiated Spondyloarthropathy:

Answer 11

with peripheral joint involvement, not assoicated with any skin, bowel or genitourinary disease

Question 12

Enteropathic Spondyloarthropathy (arthritis of inflammatory bowel disease)

Answer 12

*Ulcerative colitis and Crohn’s disease are inflammatory conditions of the bowel which result in diarrhoea, often bloody. They are associated with an arthritis which may affect the spine and sacroiliac joints, and peripheral joints as well.

Question 13

Psoriatic Arthritis:

Answer 13

Which can involve the joints in a variety of ways. sometimes mainly the hands and feet, sometimes the large joints like the knees and feet and sometimes the spine and sacroiliac joints (which join the pelvis to the sacrum)

Question 14

Reactive arthritis:

Answer 14

which typically causes hot swollen joints, usually in the legs, but may cause stiffening in the spine as well. Infection in the bowel or genitourinary tract sets up a reaction in the joints. This is not the same as septic arthritis which is infection inside the joint itself.

Question 15

Ankylosing spondylitis:

Answer 15

Which mainly involves the spine and can result in stiffening and loss of movement in the neck, rib cage and lower back

Question 16

Hip Arthroplasty (Prosthesis)

Answer 16

• Total hip
• cemented
• noncemented
• Hemiarthroplasty

Question 17

Total Hip

Answer 17

head and neck of the femur are removed and replaced with metal ball and intramedullary stem. The acetabulum is replaced by a plastic cup.

Question 18

Total Hip Cemented:

Answer 18

• Can crack or loosen over time
• Early ambulation
• Used for older folks

Question 19

Total Hip Noncemented

Answer 19

Fibrin growth over prosthesis

Question 20

Hemiarthroplasty

Answer 20

usually replace head, leave acetabulum

Question 21

Nursing management: Prevent dislocation of prosthesis: Specific position restrictions (example)

Answer 21

• Avoid extremes: flexion, adduction, or rotation
• When supine or lying on side; legs should have abduction pillow for a reminder not to cross legs
• Avoid positioning on operative side

Question 22

S/S of dislocation:

Answer 22

• Onset of pain unrelieved by medication
• Popping sensation associated with movement
• Loss of movement
• Leg discrepancy
• Deformity

Question 23

Total Knee Arthroplasty:

Answer 23

• Past op management may include continuous passive motion machine
• reduces swelling
• prevents adhesions
• decreases pain
• increases circulation and movement

Question 24

If no CPM (Continuous passive motion machine) is used

Answer 24

• elevate the operative leg on pillows no flexion of the knee
• prevent flexion contractures: keep the knee extended-knee immobilizer may be used

Question 25

CPM

Answer 25

Continuous Passive Motion Machine- passive movement to prevent joint contracture, hematoma formation *Drains: post op-hemovac, J-P (Jackson-pratt)

Question 26

Purpose of CMP Machine:

Answer 26

* Passive flexion exercise * early joint mobility * improve circulation

Question 27

Physical Therapy:

Answer 27

Isometric exercises of the quadriceps (muscle contraction without shortening no movement, contracting muscle quadriceps-hamstrings. Muscles used in ambulation)- progress to straight leg raises and gentle ROM to increase muscle strength

Question 28

How to obtain 90 degree flexion

Answer 28

*This is accomplished by active flexion exercises or by the CMP

Question 29

Complications fracture healing: Direct

Answer 29

* Problems with union - table 63-5 - infection - avascular necrosis

Question 30

Complications fracture healing: Indirect

Answer 30

* Blood vessel/nerve damage * Compartment syndrome * Fat embolism * Shock

Question 31

Infection secondary to fracture healing:

Answer 31

* High incidence in open and soft tissue injuries | * Ideal medium for pathogens

Question 32

Osteomyelitis is a

Answer 32

severe infection of bone, bone marrow and surrounding soft tissue - requires multiple IV antibiotics and means to deliver (PICC) - Dx with Bone Scan - osteomyelitis may be chronic

Question 33

Fat Embolism Syndrome (FES)

Answer 33

* the presence of fat globules in tissues and organs after a traumatic skeletal injury * Seen in fractures, total joint replacement - particularly long, bone fx, ribs, tibia and pelvis * Can lead to ARDS which has 50% mortality * Usually occurs 24-48 hours

Question 34

S/S of FES

Answer 34

* Mental status change- restlessness, confusion, lethargy, coma * Respiratory- hypoxemia, cyanosis, dyspnea, tachypnea * Cardiac- tachycardia, hypotension, chest pain * Impending doom * Petechiae- conjunctivae, axilla, neck and chest fever * Present of fat in the sputum/urine (Lipuria) * Multisystem failure

Question 35

Nursing Management:

Answer 35

* *Prevention-early ambulation especially pt with long bone injury - early stabilization and early recognition of symptoms of FES * *Most important intervention is to monitor those who are high risk - careful handling of fracture site - tx like ARDS - adequate hydration - supportive care to family

Question 36

Compartment syndrome:

Answer 36

increased pressure within a limited anatomical space compromising circulation-**peripheral neuropathy can develop within 24 hrs.

Question 37

Decreased compartment size

Answer 37

- restrictive compartment content- bleeding, edema, snake bite, IV infiltration - threatens the viability and function of the tissue within that space - if not treated can lead to loss of function, deformity, and even amputation - failure to recongnize is the most common cause of medical litigation

Question 38

Compartment Syndrome S/S

Answer 38

Six P's-Critical to know * Pain w/edema- earliest sign - unrelieved by pain medication - increased when leg is elevated - epidurals may mask onset - abnormally higher than expected * Paresthesia (numbing and tingling) * Pressure * Pallor (coolness and loss of normal color) * Paralysis/muscle weakness, loss of function * Pulselessness (late sign) * *Pt may present with one or all of the six P's * *Remember this is why we do neural checks!

Question 39

Surgical Interventions:

Answer 39

*Decompressive fasciotomy-opens the compartment to decrease pressure and restore normal perfusion