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N353: Practice of Nursing II > Module 9: Fractures and Joint Replacement > Flashcards

Module 9: Fractures and Joint Replacement Flashcards

1
Q

Risk Factors for Fractures

A

Age (older)

Athleticism/Athletic Injury

Diet

Gender - women more so than men

Genetics

Traumas

Co-morbidities

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2
Q

What sort of diets cause increased risk for fractures

A

poor vitamin D and calcium intake

Excessive alcohol intake

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3
Q

How do the genders compare for fracture risk

A

1 out of 2 women while 1 out of 4 men

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4
Q

What sort of co morbidities leave you at higher risk for fracture

A

HIV

Bone cancer

osteoporosis

Hyper and hypothyroidism (hyper revs up bone activity and hypo may relate more so to meds they take)

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5
Q

Almost any ___ is at risk for fracture

A

age

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6
Q

Why, despite falling often and getting hurt do infants and preschoolers get less fractures

A

they have softer bones that do no break as easily

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7
Q

How does alcohol use cause more fracture risk

A
  1. calories taken in this way do now have many vitamins for strong bones
  2. it impairs judgment and causes clumsiness
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8
Q

Why are women at higher risk for fracture than men

A

they are smaller on average and have a lower bone density than men

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9
Q

4 Types of Fracture Etiologies

A

Segmental

Displaced

Non-displaced

Pathological

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10
Q

Segmental Fracture

A

large fragments separate from the main bone

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11
Q

Displaced Fracture

A

Separated, not aligned

so the broken bone is broken and moved out of normal alignment

can also be segmental or not

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12
Q

Non-displaced fracture

A

separated but aligned fracture

bone is broken but outline is still the same, the line of fracture is there but the bone did not move out of place after

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13
Q

Pathological Fracture

A

a fracture as a result of non traumatic forces (frequently underlying illness)

could be something like a cough with a condition like cancer causing a fracture

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14
Q

Fractures are defined by what two things?

A

Bone (Incomplete or Complete)

Skin (Closed or Open)

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15
Q

What does it mean if the fracture is incomplete?

A

the fracture line only goes through part of the bone

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16
Q

What does it mean if the fracture is complete

A

the fracture line goes through the entire bone

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17
Q

What does it mean if the fracture is Simple or Closed

A

the skin remained closed and intact

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18
Q

What does it mean if the fracture is Compound or Open

A

skin is open with a greater infection risk

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19
Q

Different types of fracture lines/”Styles”

A

Transverse

Oblique

Spiral

Comminuted

Segmental

Avulsed

Impacted

Torus

Greenstick

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20
Q

Transverse Fracture

A

a fracture perpendicular across the bone

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21
Q

Oblique Fracture

A

an angled line of fracture across the bone

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22
Q

Spiral Fracture

A

A fracture that has a non straight non neat angle that is more jagged and twisted across the bone

occurs from twisting force

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23
Q

Comminuted Fracture

A

fracture where there are multiple pieces (looks like shattered glass)

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24
Q

Segmental (Line) Fracture

A

when a tendon or ligament pulls a piece of the fracture away so you end up with 2 areas of fracture leaving a piece that you could hypothetically pull away

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25
Q

Avulsed Fracture

A

A fracture where you could hypothetically pull a piece away but there is only one line of fracture

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26
Q

Impacted Fracture

A

when two piece of fracture (the shard and the bone) are driven together

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27
Q

Torus Fracture

A

Torus is greek for “Bulging”

it is like if you pushed on each end of the bone until it buckles and now bulged somewhere along the bone

has no distinct fracture line

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28
Q

Greenstick Fracture

A

a bone that gets bent and has an incomplete/partial fracture line that only goes partway through the bone

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29
Q

What are the 2 most common childhood fractures

A

Torus

Greenstick

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30
Q

Usually torus and greenstick fractures are not seen after what ages?

A

10 for torus

12 for greenstick

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31
Q

FOOSH

A

Falling on outstretched hand

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32
Q

What is the most common cause of the Torus fracture

A

FOOSH

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33
Q

Diagnostic Tests for Fractures

A

X Ray

CT Scan/MRI if occult

Bone scan

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34
Q

How can an X Ray help ID a fracture

A

it is good for outlining the bone (not perfect), and is quick

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35
Q

How can a CT Scan or MRI help ID a fracture

A

X rays can miss angles and tissues so this will make sure the fractures as seen from angles or tissues are seen

not the first choice though

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36
Q

How can a bone scan help with fractures

A

the body is injected with a tracer to mark inflammation and problem areas

it can then determine fracture complications like delayed healing and infection

only done if there is one of the complications suspected

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37
Q

What are some things we look for on general assessment of a suspected fracture

A

deformity (depends if displaced)

edema (can take time)

pain

crepitus

spasms

ecchymosis

loss of function

abnormal ROM

circulatory compromise

not all of these are seen all the time, different people have different results

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38
Q

What can hurt worse than the fracture at times

A

spasms

it is when the muscles around and near the fractures change and pull in from inflammation

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39
Q

What is our biggest concern on a fracture general assessment

A

circulatory compromise

if this is impinged than it could make a problem below the area - ex: in the forearm if there is compromise it could cause problems in the hand

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40
Q

We always worry about what is ____/____ the fracture

A

beyond/distal-to

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41
Q

What are the three early neurovascular assessment concerns for a fracture

A

Pain
Paresthesia
Pallor

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42
Q

What are the three late neurovascular assessment concerns for a fracture

A

Polar
Paralysis
Pulses

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43
Q

Early Pain in fractures is …

A

unrelieved with medication or repositioning/elevation

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44
Q

What does Polar mean

A

cool or cold fingers and toes

compare bilaterally like everything else

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45
Q

How does Paresthesia compare to Paralysis

A

paresthesia is early numbness, tingling, pins and needles sensations

paralysis is an inability to move those toes and finger

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46
Q

What are Pulses like in late fractures

A

doppler only pulse or no pulse felt distal to the injury

need to compare to a baseline tho

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47
Q

How might you check pallor with a fracture

A

check cap refill (>3 sec) and for bluish fingers and toes distal to the fracture

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48
Q

How are treatments for fractures determined

A

by type and location

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49
Q

2 Types of fracture treatment

A

External immobilization

internal immobilization

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50
Q

External Immobilization

A

for more stable fractures

casts, splints, traction

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51
Q

Internal Immobilization

A

For less stable fractures or if more conservative treatment fails or immobilization risk is greater than surgical risk

skeletal traction, external fixator, internal fixation (ORIF), bone grafting

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52
Q

Medullary Nail

A

a large nail that goes through the center of a bone a (the core) and can connect something like a segmental fracture back together

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53
Q

What happens to the hardware used in internal immobilization after healing?

A

no one goes in and removes it, it stays there

may get a card for metal detectors

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54
Q

Cast

A

external immobilization

a rigid external immobilizing device

use determined by underlying condition

immobilizes the proximal and distal joints too around the fracture to prevent damage and movement

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55
Q

Uses for Casts

A

Immobilize a reduced fracture

correct a deformity (like congenital hip dysplasia)

apply uniform pressure to soft tissues (to prevent skin breakdwon)

support to stabilize a joint

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56
Q

Reduced Fracture

A

one where the pieces have been put back into place and now need immobilization to hold them there and heal

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57
Q

Materials for Casts

A
  1. Fiberglass - lightweight, durable, waterproof
  2. Plaster - heavier, break apart when wet, require 24+ hours to dry
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58
Q

What to assess about a patient when using a cast

A

how is the skin

check neurovascular status below area of injury (temp, cap refill, movement)

is there edema and swelling present or no (if pressing on the area may need to loosen or redo cast)

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59
Q

What to assess about the cast itself

A

is it dry

is it intact

are there no rough edges, if so then pad them

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60
Q

What to educate a patient on before applying the cast

A

purpose and goals of the cast

expectations for the casting process (like the heat the plaster gives off while hardening)

not to scratch or stick anything under the cast

cushion rough edges

discuss what they can and cannot do with it (activity and mobility options)

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61
Q

What to educate a patient on after applying a cast

A

control of edema and pain

exercises to do

safe use of assistive devices

S/S to report

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62
Q

What S/S should be reported with a cast

A

persistent pain or swelling

changes in sensation, movement, skin color, or temperature

signs of infection like burning or itching at pressure areas

burning or itching at pressure areas from it digging in

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63
Q

Common pressure areas that a cast can harm if not padded or careful?

A

Ulna and Radial Styloid (the wrist bones)

Olecranon and Lateral Epicondyle (Elbow bones)

Lateral malleolus (ankle bone)

tibial tuberosity (knee bone)

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64
Q

What should be monitored for in a leg cast?

A

peroneal nerve damage that can cause foot drop

this leads to problems walking so we must monitor for different feelings in the calf or foot

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65
Q

Body and Spica Cast

A

cast that encases the trunk and portions of 1 or 2 extremities

tricky to put on

perineal opening must be large enough for hygiene and voiding

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66
Q

What kind of person may get a spica cast

A

children born with malformed hips

casting the legs apart can help the hip joint heal in a healthy way

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67
Q

Cast Syndrome

A

something that can happen in any cast that encases any of the trunk or abdomen

it causes claustrophobia and anxiety from compressing the mesenteric nerve

can talk someone through it and it is sort of like a panic attack

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68
Q

What kinda of cast has the greatest likelihood to cause cast syndrome

A

an abdominal or trunk cast and the higher up it is the more risk there is

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69
Q

What nerve can lead to foot drop if not monitored for

A

Peroneal nerve

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70
Q

What nerve can lead to cast syndrome if not monitored for

A

mesenteric nerve

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71
Q

Traction

A

external immobilization

means “Pull” - it pulls on the area and you want to maintain this pull to keep things in alignment so they can heal properly

this is mostly to align and immobilize and keep pieces where they need to be in complicated fractures that cannot be fixed normally

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72
Q

Purpose of Traction

A

Reduce muscle spasms (reduces strain from fracture pieces wiggling)

Reduce, align, and immobilize fractures

Reduce deformity

Increase space between opposing forced

short term intervention (skin) or treatment (skeletal)

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73
Q

Skin traction is a ___ ___ intervention

A

short term (can be used while waiting surgery)

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74
Q

skeletal traction can be used as ___

A

treatment (can be weeks or days)

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75
Q

Types of Traction

A

Manual (AKA: Skin)

Skeletal

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76
Q

Manual (Skin) Traction

A

used before surgery

can be intermittent

weight limit maximums

ex: a leg in a foam boot with nothing going in, there is a free weight pulling on it and the only thing touching skin is the boot

can even be done intermittently or on going

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77
Q

Skeletal Traction

A

continuous traction

pins are screwed through bones

a treatment

more internal and external immobilization (pins in bone but come outside the body

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78
Q

It is important to never let what happen with traction

A

never let the weight hit the floor (that would mean there is no pull)

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79
Q

External Fixators

A

external traction that does have things going into bones or skin

it can look like a steel cage with pins going into a leg or a device going into the foot or arm that hangs out like a large metal bar

pins go in proximal and distal to the fracture site

nurses never adjust or place there and people can go home with these

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80
Q

What is a big concern with external fixators and skeletal traction

A

the pins leave open areas for infection

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81
Q

If there is already a lot of open areas and injury, a person may get an external fixator, and what is the benefit then for the nurse

A

they can assess healing better in that case as they can see it

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82
Q

Nursing Responsibilities regarding traction

A
  1. Hydration/nutrition, back rubs, float heels, reposition, avoid shearing damage (skin)
  2. minimize calf pressure (peroneal nerve)
  3. monitor pulses and sensation (circulation)
  4. position feet to avoid plantar flexion, inversion, or eversion (proper body alignment) - we want them pointed up not rotated or down
  5. pin care (infection)
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83
Q

What is the goal of pin care

A

prevent infection of skin/soft tissue/bone

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84
Q

Pin care is specific to…

A

skeletal traction and external fixators

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85
Q

What should be done for pin care initially (first 48 hours)

A

insertion sites may be covered by a sterile non stick dressing - do not give access too much and check too much

inspect pins every shift for infection

teach patient to perform this care at home

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86
Q

What should occur later in pin care?

A

use betadine (water/saline solution) to clean once a shift or 2 times daily AS ORDERED/PER POLICY

inspect pin sites every shift for infection

teach patient to perform this care at home

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87
Q

___ may occur and is normal during pin care

A

crusting (do not scrub it off just gently clean the area)

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88
Q

Always clean pin sites or any open area __ to __

A

inner to outer

89
Q

Open Reduction and Internal Fixation

A

surgical procedure to repair bones using internal hardware

open reduction involves opening the area to internally fix it via pins and stuff

90
Q

Open Reduction and Internal Fixation is sometimes seen in charts as what

A

ORIF

91
Q

ORIF Nursing Responsibilities include what things

A

Routine post op care

administer IV antibiotics as ordered (not usually on them longer than 3 days unless there is infection)

wound care as ordered (minimal, nothing crazy)

elevate extremity (if possible and PER ORDERS) - may help edema but a surgeon may not want you doing that

monitor for signs of infection

assess for safety

assess neurovascular status frequently

92
Q

Why is wound care more minimal with ORIF

A

because the more you touch the surgical area the higher the infection chance is

93
Q

6 Complications that can occur from a Fracture

A

Compartment Syndrome

Fat Emboli

DVT

Osteomyelitis

Avascular Necrosis/Non-union

Localized infection at the pin site

94
Q

Compartment Syndrome

A

A fracture is relieved, but reperfusion occurs which leads to rapid swelling –> this leads to increased pressure in the muscle compartments –> this leads to compression of nerves and blood vessels

the muscle will swell and push out on compartments causing nerves and blood vessels to squeeze and shrink - it will look red and angry

95
Q

Fascia

A

fibrous tissue that keeps things separate in the body compartments

96
Q

How is Compartment Syndrome diagnosed

A

you must measure the pressure that is inside (a nurse does not do that)

97
Q

What may be a huge red flag for compartment syndrome

A

the human response of pain in the area that does not change regardless of what you do to alleviate it and may even get worse

98
Q

Compartment syndrome is a ___ situation if acute

A

emergency

99
Q

What things can occur in 4-6 hours if compartment syndrome is left unaddressed?

A
  1. Necrosis
  2. Neuromuscular Damage
  3. Death in severe cases
100
Q

What is the device that measures pressure for compartment syndrome, and why is it not used much?

A

The intra compartmental pressure monitor

it can measure pressure through insertion but if someone is suspected to have compartment syndrome they are almost always brought immediately to the OR

101
Q

What is the first step to being able to do nursing interventions for compartment syndrome?

A

First - be aware of the risk profile and clinical picture

102
Q

What nursing interventions can be done for the following 3 human responses as it relates to compartment syndrome:

  1. Pain
  2. Edema
  3. Anxiety
A
  1. analgesic administered as ordered
  2. elevate extremity (helps swelling a little
  3. educate/answer questions
103
Q

Despite it not doing much necessarily, what is still done in nursing interventions for compartment syndrome?

A

We still address and attempt to treat pain

104
Q

Medical Treatments for Compartment Syndrome

A
  1. Control and reduce swelling through elevation of the extremity
  2. Release any restrictive dressings/casts to relieve pressure
  3. Fasciotomy
105
Q

Fasciotomy

A

Cutting open of the fascia - the tissue dividing compartments

a very dramatic response to compartment syndrome but sometimes needed - high risk for infection

the cut is kept open and only loosely sutured (retention suture) to allow pressure to not be that much

it is covered with moist sterile dressings for 3-5 days

106
Q

What nursing responsibilities for Pain should be done following a fasciotomy

A
  1. analgesics ordered
  2. elevate extremity
107
Q

What nursing responsibilities for Risk for Infection should be done following a fasciotomy

A
  1. maintain moist, sterile dressing (3-5 days)
  2. monitor incision
  3. monitor labs (WBCs)
  4. monitor VS (pulse and temp)
  5. give antibiotics as ordered
108
Q

What nursing responsibilities for Post op Status should be done following a fasiotomy

A
  1. diet for healing (protein and vitamin C diet)
  2. routine post op care
109
Q

Fat Emboli Syndrome (FES)

A

A fat embolism (not a blood clot) - anything can move as an embolism

these fat globules cannot just be grabbed and pulled out

110
Q

What is the only treatment for FES?

A

there is no treatment - it is all supportive - the only way to treat this is through PREVENTION

111
Q

What is the profile of someone who may get FES?

A

Young someone with juicy bone marrow out of a long bone)

Casted (instead of ORIF)

Closed Fracture

Long bone/hip fracture

Necrosis of bone marrow

Trauma

112
Q

Preventative Care for FES

A

recognize profile and increased risk

Maintenance of adequate oxygenation and ventilation

stable hemodynamics

hydration and nutrition

early ambulation

prophylaxis of stress related GI bleeding

monitor labs, VS, and ABGs

113
Q

When is FES usually seen/when does it clinically present

A

24-72 hours post fracture/trauma

114
Q

What is the clinical presentation like for FES

A

Respiratory Compromise

Cerebral Dysfunction

Petechiae!

115
Q

75% of FES leads to respiratory compromise, and 10% progress to…

A

respiratory failure

116
Q

How does respiratory compromise present in FES

A

Tachypnea, Dyspnea, Cyanosis (late sign)

Elevated Temperature

Decreased Hct

Hypoxemia hours before onset of reps. complaints

117
Q

How does cerebral dysfunction present in FES

A

acute confusion

rigidity

drowsiness

convulsions

coma

118
Q

Petechiae

A

blockages in small vessels leading to small pin point hemorrhages that appear usually in the upper torso and maybe the eye(s)

119
Q

When do Petechiae appear in FES

A

within 24-36 hours and disappears within a week

120
Q

How does petechiae present in FES

A

nonpalpable petechial rash in the chest, axilla, neck

reddened conjunctiva

121
Q

How to diagnose FES

A
  1. Take the clinical picture and risk factors
  2. Rule out alternative pathologies like increased ICP, PE, Pneumonia, etc
  3. Blood gases
  4. Chest x ray
122
Q

What will blood gases show in FES

A

hypoxia with a paO2 <60 mmHg

AND

Hypocapnia with respiratory alkalosis (if hyperventilating)

123
Q

What will a CXR show in FES

A

fluffy white shadows

124
Q

Neurological + Respiratory + Petechiae = ____

A

FES

125
Q

Schonfeld’s Criteria

A

Not used by nurses

A chart used by medical students and doctors to check for estimation risk of whether someone has FES

It looks at Petechiae, CXR changes, hypoxia, fever, tachycardia and tachypnea

A score greater than 5 has a high probability of it being a fat emboli and petechiae instantly scores 5

126
Q

What should a nurse do as part of their responsibilities and interventions for FES

A

Telemetry (monitor heart rhythm as this is an early warning sign of emboli in coronary circulation)

Ventilation via face mask or mechanical ventilator (maintain resp system)

Nutrition (TPN or feeding tube if needed)

Adequate hydration (IV fluids)

Foley Catheter (Accurate I&O)

SCDSs(prevent venous stasis in lower extremities)

Air mattress for good skin care

good eye care (keep moist)

ongoing diagnostics (track progress)

127
Q

DVT

A

Deep vein thrombosis

a common complication of trauma, surgery, or disability that can progress to a PE SO we focus on prevention rather than treatment of this

swelling is normally in one calf and it is unilateral

128
Q

What is the most common complication following trauma, surgery, or disability?

A

DVT

129
Q

Another name for DVT

A

VTE - Venous Thromboembolism

130
Q

What are some prevention measures for DVT

A

OOB

leg and ankle exercises

adequate hydration

131
Q

How to treat (1) pain, (2) swelling, and (3) decreased pedal pulse in DVT?

A
  1. Analgesia
  2. Assess pulses pain and swelling
  3. Report to PCP
132
Q

Why would Pedal Pulse decrease in DVT

A

Pulses are minor in DVT since its a venous issue not arterial

however there could be so much swelling that pulses are blocked off

133
Q

If you suspect a DVT clot…

A

check bilaterally

134
Q

Osteomyelitis

A

Inflammation of the bone because of penetrating organisms

135
Q

What is the most common penetrating organism for Osteomyelitis

A

Staphylococcus aureus (which is normally on our skin)

136
Q

Who is at risk for Osteomyelitis

A

DM Patients

Patients undergoing orthopedic surgery - placement of prosthesis and other clean orthopedic surgery, management of open fractures, Hx of previous osteomyelitis

137
Q

How to reduce the risk of osteomyelitis?

A

Open fractures who receive antibiotics within 6 hours of injury AND prompt surgical treatment

Avoid health care associated osteomyelitis, with careful attention to intravascular and urinary catheters, surgical incisions, and other wounds

138
Q

S/S of Osteomyelitis

A

bone pain worse with movement

elevated WBC

elevated temperature

139
Q

How to diagnose Osteomyelitis

A

biopsy and culture

140
Q

Treatments for Osteomyelitis

A

long term antibiotic therapy (3 MONTHS)

surgery

debridement

amputation

141
Q

Complications from Osteomyelitis

A

abscess formation

sepsis

bone deformity

limited ROM

motor and or sensory deficits

142
Q

Approximately 20-30% of osteomyelitis patients will…

A

experience recurrence within 2 years, even with appropriate medical and surgical treatment

143
Q

Nursing Responsibilities and Interventions for Osteomyelitis

A

Recognize profile and risk factors

Inspection of surgical site and pin sites and note and report any change in COCA or REEDA

Administer antibiotics as ordered

monitor VS and labs

note complaints of worsening pain with movement

maintain “Separation” from potential infectious agents (not in a room with another infectious patient)

144
Q

What is a major indication for osteomyelitis

A

pain WHEN MOVING

145
Q

What are 2 other major complications?

A

Non Union (Poor Healing)

Avascular Necrosis

146
Q

Non-union

A

poor healing of a fracture where bone is not reuniting or healing back together

147
Q

Diagnosis of Non Union

A

clinical picture

X Ray

CT or MRI

148
Q

Treatment for Non Union

A

internal fixation (surgery)

Bone grafting

Electrical bone stimulation

149
Q

Avascular Necrosis

A

Disruption of blood flow to a fracture site leading to bone necrosis

150
Q

Diagnosis for Avascular Necrosis

A

clinical picture

X ray

151
Q

Treatment for Avascular necrosis

A

repair vascular compromise

surgical joint replacement

152
Q

What is most often the damaged site for avascular necrosis

A

A joint like the hip or knee - and this may require a replacement

153
Q

Joint Replacement

A

a reconstructive procedure using artificial parts or aftermarket parts

154
Q

Arthro-

A

a prefix meaning joint

155
Q

Arthroscopy

A

the repair of joint problems through the operating arthroscope or through open joint surgery

156
Q

Arthroplasty

A

forming a “new joint”

157
Q

Hemiarthroplasty

A

the replacement of ONE of the articular surfaces

hemi = half

158
Q

Osteotomy

A

surgical cutting of the bone

159
Q

-plasty

A

to form or to make

160
Q

Prosthesis

A

artificial substitute for a missing part of the body

can be any missing part

161
Q

Total Hip Arthroplasty (THA)

A

total hip replacement (THR)

162
Q

Total Knee Arthroplasty (TKA)

A

total knee replacement (TKR)

163
Q

What parts of the body are frequently replaced?

A

Hip

Knee

Finger Joints

164
Q

What parts of the body are replaceable but done so less frequently

A

shoulder

elbow

wrist

ankle

165
Q

Who typically gets Replacement Parts

A

Arthritis (osteo or RA)

Trauma leading to functional joint damage (like certain hip fractures)

congenital deformity leading to functional joint damage

tumors

avascular necrosis

166
Q

Why replace a joint

A
  1. To increase mobility
  2. To increase us
  3. To increase joint stability
  4. To relieve pain
167
Q

What are the 4 main reasons to replace a joint

A

Mobility-Functionality-Stability-Comfort

168
Q

What usually brings people to an orthopedic surgeon

A

pain

169
Q

When is a joint replacement done

A

usually after all other, more conservative therapies for healing and health have failed

170
Q

What are some of the more conservative therapies done before a joint replacement

A

PT

medications

joint injections

weight loss

activity modifications

171
Q

What are the parts of a Hip Prothesis

A

A metal hip ball that fits into the hip socket and lining

A joint stem that goes into the femur through the middle of it

172
Q

What can prosthesis components be made of

A

plastic (polyethylene)

metal (cobalt chrome, titanium)

ceramic (actually a metal oxide)

cement

173
Q

How is cement used in joint replacement

A

It is being moved away from and it was used more as a filling compound

it holds the “after market parts” in place

174
Q

Cement less Hip prothesis

A

Prosthesis is hammered into more precisely bored holes in the femur and there is a porous coating on it that allows the bone to grow into the nooks and crannies to stabilize

175
Q

Advantages of Cementless Hip Prosthesis

A

avoid cement related problems

minimal risk of prosthesis bone bond loss

176
Q

Disadvantages of Cementless Hip Prosthesis

A

Risk of bone marrow chunks forced into circulation during shaft placement

Potential need for weight-bearing restriction

Thigh pain (larger prosthesis)

Loosening of fibers from porous coated surface

Requires good circulation to injury site so it may not be appropriate

while this appears more, the advantages outweigh the disadvantages

177
Q

Cemented Hip Prothesis

A

the prosthesis is placed into a bored opening in the femur and surrounded by the bone cement

bored opening does not have to be precise here

178
Q

Advantages of Cemented Hip Prosthesis

A

Surgical skill deviations

Early weight-bearing

Is smaller, lighter prosthesis

Is cost effective

179
Q

Disadvantages of Cemented Hip Prosthesis

A

Cement may cause circulatory interruptions

With age, cement can crack –> bonding loss between prosthesis and bone –> joint instability

180
Q

How may a knee prosthesis differ from a regular knee?

A

If the bone is injured the meniscus is gone and the bone on bone contact is painful

so the prosthesis will have a metallic coat over the top leg bone and a prosthetic meniscus in the bottom one

these pieces are smooth and allow for smooth bending and function

may have a pieces to mimic the patella too

181
Q

Complications of a Joint Replacement

A

Dislocation/Loosening (Osteolysis) of the artificial joint

Infection at the surgical site

Thromboembolism

Complications from immobility

Long term issues

182
Q

What are some long term issues/complications of joint replacement

A

Heterotopic Ossification

Avascular Necrosis

Loosening of the Joint

183
Q

Heterotopic Ossification

A

bone growth in odd places

184
Q

Nursing Goals for Joint Replacement Patients

A

! - Minimize discomfort/pain

prevent infection at surgical site

prevent and minimize negative consequences of immobility

Prevent dislocation and loosening of the prosthesis

185
Q

Post Op Nursing Responsibilities for Joint replacements

A
  1. VS and Neurovascular checks as ordered
  2. control Pain
  3. Monitor the incision
  4. prevent DVT
  5. maintain body and limb alignment
  6. respiratory toilet
  7. assess skin integrity
  8. maintain nutrition and hydration
  9. home health and social service for rehab referrals
186
Q

How often are VS and Neurovascular checks usually ordered for joint replacements?

A

every 1-2 hours

187
Q

Ways to control joint replacement pain

A

Medications: IV, PO, PCA, nerve block - as needed and before planned activities

Individualized strategies - like repositioning

188
Q

What to monitor for at the incision site of a joint replacement

A

Infection

Bleeding

record drainage/drain output

Maintain clean, dry dressings

usually begins occurring around day 5

189
Q

PCA

A

patient controlled analgesia

190
Q

What kind of pain treatment is used a lot and why in joint replacements

A

nerve blocks

they are local anesthetics with less pain post op, a higher likelihood to progress and participate in therapy, and encourages activity sooner than analgesics

191
Q

Always give ___ before PT

A

medications like analgesics

192
Q

How to prevent DVT

A
  1. thrombus preventive therapy (lovenox, coumadin, ASA)
  2. AE Hose and SCDs
  3. Activity and weight bearing as allowed by surgeon (OOB ASAP WITH ORDER)
  4. PROM
193
Q

Respiratory Toilet

A

this means cleansing the airways

this is done via C-DB and IS

194
Q

How to assess joint replacement skin integrity

A

investigate complaints of itching, burning, redness of boney prominences (especially in the heels)

195
Q

What are the 3 Early Ps of Neurovascular assessment and concerns for Joint Replacement

A

Pain

Paresthesia

Pallor

196
Q

What are the 3 late Ps of neurovascular assessment and concerns for Joint replacement

A

Polar

Paralysis

Pulses

197
Q

What is familiar about the 3 early and late Ps of joint replacement?

A

they are the same as the neurovascular assessment concerns for fractures

198
Q

What prosthesis dislocates most readily

A

the hip

199
Q

What is the human response to dislocation of a hipprosthesis

A

increased pain, swelling, immobilization

shortening of affected leg

abnormal internal/external rotation

restricted movement

“popping sensation” of affected hip

200
Q

What is the main way to prevent prosthesis dislocation

A

PROPER Positioning (but this depends on surgical approach)

ex: maintain abduction for some replacements and sue an abductor pillow

201
Q

Position depends on…

A

surgical approach (anterior approach has different instructions that posterior approach)

202
Q

What are some suggestions other that positioning to prevent dislocation

A

do not flex hip more than 90 degrees (bending over while sitting in chair)

no internal or external rotation of the affected area

203
Q

Risk for hip dislocation is greatest…

A

3 months post op

204
Q

What are some other risk factors for hip prosthesis dislocation

A

age

bone loss

RA

cognitive impairment

implant issues

205
Q

It is important to know what depending on surgical approach?

A

SPECIFIC precautions straight from the surgeon for hip dislocation

206
Q

Always give the patient what before discharge?

A

printed literature with pictures to review

207
Q

Human response to dislocation of a knee prosthesis

A

pain or swelling after movement

obvious deformity of the knee

numbness in the foot

no pulse in the foot

less common than hip

208
Q

Why can a dislocation of a knee or hip be very concerning

A

it can put pressure on blood vessels

209
Q

What is the most important nursing intervention to prevent knee dislocation

A

PROPER POSITIONING:

Maintain the leg in full extension (towel roll under ankle of operative leg)

Reposition towel roll frequently to prevent peroneal nerve damage

210
Q

What are some devices used in nursing intervention in order to maintain joint function after a knee replacement

A
  1. Polar Pack
  2. Knee Immobilizer
  3. CPM
211
Q

Polar Pack

A

A bio chill cooler

it helps reduce post op swelling

it wraps around the knee and circulates cool ice water to the area to improve inflammation pain and comfort

can be used at home

212
Q

Knee Immobilizer

A

foam wrap with a hole in the middle for the patella

rigid back keeps the knee straight and maintains stability

sometimes called POKI (post operative knee immobilizer)

213
Q

CPM

A

Continuous Passive motion

Device you put leg in with adjustments that will slowly extend and flex the knee for the patient

they wear them at night in the hospital to improve venous return, prevent joint stiffening and help the knee

214
Q

What is important to document regarding someone who had a joint replacement?

A

NOTE AND DOCUMENT DIFFERENCES:

  1. In time (time of perfusion like cap refill and baselines) on operative limb
  2. Differences between operative limb and non operative limb
215
Q

What are some general discharge instructions regarding joint replacements?

A

There are some restrictions of movement

continue PT as ordered

Medication education and compliance

Education on when to contact PCP/Surgeon

216
Q

What is a restriction for Hip replacements

A

you have to follow specific positioning guidelines (surgical approach dependent)

217
Q

What are the restrictions for knee replacements

A
  1. Avoid prolonged kneeling positions
  2. no running or involvement in sporting activities requiring high speed running and/or jumping until OK with MD/PT
218
Q

When should a joint replacement patient call the surgeon/PCP?

A

Elevated temperature or fever

Drainage from the surgical site

sudden increase in pain

significant changes in range of mobility

gait instability

219
Q

What sort of medication may the joint replacement patient be on past discharge?

A

anticoagulants to prevent blood clots

N353: Practice of Nursing II (14 decks)

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