NRSR 22 Unit 3: Arthroplasties, Orthopedics, Trauma Flashcards
Reasons for arthroplasty?
- Fractures - Either as the cause of the fall or result of the fall.
- Degenerative joint disease or osteoarthritis - more common among older people.
Possible complications from arthoplastic surgery?
- Altered skin
- DVT - 50% increased risk
- Infection - Very difficult to rid if infected in the bone. Long term, patients have to take added safeguards against infection.
- Constipation - due to pain meds
- Blood loss -
Prophylactic Treatment prior to surgery
- Antibiotics - prior and afterward
2. DVT prophylactics - Lovenox and SCD/TEDs
Why should patient do rehab?
To help with their flexibility. Patients have a small window to improve their range of motion usually before 6 months. If they don’t, they will have restrictive movement permanently. However, rehab can be very painful.
Risk factors for respiratory depression in PCA patients
- Use of basal infusion
- Advanced age
- Obesity
- Upper abdominal surgery
- Obstructive sleep apnea
- Concurrent use of CNS depressants
- Pumping programming errors-requires two nurses to program.
- PCA by proxy (family pushing)
- Lack of opioid tolerance (opioid-naive)
What materials are used for prosthetics? How do they last?
-Metal (eq. titanium)
-High-density polyethylene (eq. plastic)
-Ceramic - wears longer
Replacements can last between 10-20 years. Young patients are advised to postpone surgery as long as possible.
Why does temperature and WBC increase after athroplastic surgery?
Can be due to infection. However, inflammation can also cause the same manifestations.
How to prevent dislocation?
- Avoid extremes of flexion - eq. sitting more than 90 degrees
- Avoid rotation - no pivoting
- No crossing legs
- Not lying on the affected side.
- Avoid abduction.
Why does cemented prosthetics cause more complications?
- The cemented adhesive can fail.
- Heat is used to apply the cemented adhesive increasing risk of infection.
How long before the bone grows around the prosthesis?
6-10 days. Prior to this period, the prosthesis is susceptible to dislocation.
What is the purpose of taking oral iron replacement? What is the side effect?
To treat anemia from patients who suffered blood loss. Oral iron replaces the iron lost in blood loss. Iron is best absorbed on an empty stomach, but in hospital settings, they are provided with food given that some patients may have very sensitive stomachs. Side effect is constipation.
What are benefits of Heparin?
- Reduces the risk of DVT. Prevents clots from growing.
- Heparin (IV) has a short half life. The effects can be very quick and the reversal of the drug can be very quick as well with antidote protamine sulfate for heparin (subq).
- Can be given IV or subq.
What are the disadvantageous of Heparin?
- Bleeding
- Can lead to thrombocytopenia (low platelets)
- Does not dissolve existing clots.
What is Warfarin? What complication can it cause for orthopedic patients?
It’s an anticoagulant agent that reduces development of thrombosis of patients vulnerable to DVTs. Patients on warfarin have difficulty in stopping bleeds. Patients need to wait 5 days before having surgery.
Why is Warfarin given in the evening?
Lab work is performed in the morning. Based on morning lab results, health care providers can adjust dosage in the afternoon.
