unit c musculoskeletal_chpt_46 part iii voice and no underline

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



Rheumatoid Arthritis



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



Etiology Unknown Genetic Predisposition Environmental Autoimmune Response - Antibodies

(Rheumatoid Factor)◆Local and Systemic Inflammation



Signs and Symptoms Remissions and Exacerbations Varies by Individual



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



Signs and Symptoms Late Symptoms

◆Joint Deformity◆Secondary Osteoporosis



Joint Abnormalities in Rheumatoid Arthritis



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.



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)



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



Nursing Diagnoses Acute Pain Disturbed Body Image Fatigue Self-care Deficit Impaired Physical Mobility Deficient Knowledge



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



Total Hip Replacement Acetabular Cup Inserted Into Pelvic

Acetabulum Femoral Component Inserted Into Femur

http://medicalimages.allrefer.com/large/7019.jpg



Total Hip Replacement Preoperative Care

◆Total Joint Education Programs ◆Autologous Blood Donation



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



Abductor Pillow



Hip Flexion after Total Hip Replacement



Total Hip Replacement◆Pain

• Provide Pain Relief

◆Infection• Prophylactic Antibiotics • Coughing and Deep Breathing• Incisional Care



Total Hip Replacement◆Bleeding

• Monitor Incision/drainage From Drain

◆Neurovascular Compromise• Neurovascular Checks



Total Hip Replacement◆Ambulation

• Physical Therapy• Use Walker/crutches



Total Hip Replacement Thromboembolitic Complications

◆Compression Devices◆Leg Exercises

• Enoxaparin (Lovenox)

◆The chief cause of mortality for total hip patients is pulmonary embolism.



Total Hip Replacement Postop care includes:

◆Proper positioning to maintain abduction◆Monitoring amount of wound drainage◆Planned administration of an analgesic prior to

exercise



Total Hip Replacement Self-care

◆Assistive Dressing Devices ◆Raised Toilet Seat ◆Rehabilitation



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



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.



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



Continuous Passive Motion Machine

Flexion and extension are important in the overall rehabilitation process for total knee replacement patients.



Amputation Surgical Amputations

◆Ischemia From Peripheral Vascular Disease ◆Bone Tumor or cancer of the bone◆ Frostbite◆ Congenital Problems◆ Infections◆Burn injury



Amputation Traumatic Amputations

◆Accidents



Amputation Replantation

◆Wrap Severed Body Part in Cool, Slightly Moist Cloth

◆Place in Sealed Plastic Bag Submerged in Cold Water

◆Transported to Hospital



Amputation Levels Of Amputation

◆Below-the-knee (BKA) ◆Above-the-knee (AKA) ◆Below-the-elbow (BEA) ◆Above-the-elbow (AEA)



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




Postoperative◆Hemorrhage Prevention ◆Infection◆Pain Control

• Phantom Pain

◆Mobility and Ambulation



Bandaging for Above-the-Knee Amputation




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.




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.



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



Congenital hip dysplasia Treatment may include:

◆Surgery◆Splints or braces◆Traction



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



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

unit c musculoskeletal_chpt_46 part iii voice and no underline

Health & Medicine

williams paula

medical surgical nursing

edition linda

hopper signs

hopper abductor pillow

total hippatients

rheumatoid arthritis

joint bone pannus