Amps/Joint surg/Herniated Disks - 405 Flashcards
who is a candidate for an amputation
-PVD (esp w/ DM)
-trauma
-thermal injuries
-osteomyelitis
-tumors
-congenital limb disorders
types of amputations
1) open vs closed
2) elective vs traumatic
open (guillotine) amputation
leaves the wound bed open
-used for someone with an infected area where they don’t want to close it yet
needs to be aseptic before closure
closed amputation
edges of wound bed are approximated right after surgery
complications of amputations
-hemorrhage
-infection
-phantom limb pain
-flexion contractures (esp at hip)
phantom limb pain mgt
-usually self limiting within a year
-mirror therapy
-neuropathic analgesics
post op care & pt teaching for an amputation
-assess tissue perfusion
-pain mgt (ATC dosing)
-prevent infection
-promote proper position/ambulation/PA
-initially compression bandage to foster shaping & molding (take off for PT & baths) then figure 8 wrapping to prevent restricted blood flow)
-psychosocial issues
-prosthesis (consult prosthetist-orthotist)
proper positioning for a post op amputee pt
-prone position 30 min 4x/d (extends the hip)
-elevate stump based on provider preference (does cause concern for flexion @ hip)
bone on bone in the spinal column (ex: degenerative disc disease in lumbar area) get what
sciatic pain
what is the spinous process
C7
how to dx problems with the spinal discs
-MRI: no metal, non invasive, sedation prn d/t claustro
-CT scan
-myelogram: x ray after injection of contrast into subarachnoid space, sedate prn, done on tilt table, encourage fluids after
collaborative care fro pt w/ suspected disk herniation
-brace/corset/belt
-local heat/ice
-massage
-traction
-TENS
-NSAIDs/short term narcotics/muscle relaxants
-back strengthening exercise
trying to avoid surgery
laminectomy
excision of lamina (posterior arch of vertebra) to gain access to protruding disk to remove it
diskectomy
decompresses the nerve root
minimally invasive
spinal fusion
add bone graft/synthetic product for stabilization & so the bone isn’t sitting on another bone
nursing implications post spinal procedure
-lie flat / avoid twisting
-log rolling
-pain mgt
-monitor for HA and clear yellow drainage d/t risk for CSF leak
-peripheral neurovascular checks
-spinal fusion recovery longer + monitor donor site
-avoid sitting/standing for long periods of time
why do people have to have joint surgeries
-relieve pain
-improve joint motion
-correct deformity & mal-alignment
-remove intra-articular causes of erosion
arthroplasty
reconstruction of replacement of joint
who gets a joint surgery
-osteoarthritis
-rheumatoid arthritis
-congenital deformities
what joints can an arthroplasty be done on
-elbow&shoulder
-wrist&phalangeal joints of finger
-hip
-knee
-ankle
-foot
total joint arthroplasty related nursing problems
-acute pain
-impaired physical mobility
-risk for peripheral NV dysfunction
-risk for injury
-risk for impaired skin integrity
-possible VTE
post op total knee replacement goals
restore strength, muscle tone & ROM (will be given exercises to do and if can’t will have a machine to move leg for them)
total hip (& knee) arthroplasty post op care
-neurovascular assessment of affected extremity
-original surgical dressing to be removed by surgeon
-maintain specific ROM limitations
post op hip replacement limitations: posterior approach
avoid the following for at least 6 weeks
-extreme internal rotation
-adduction
->90 flexion
-elevate toilet seat
post op hip replacement limitations: anterior approach
hyperextension is the only restriction
post op limitations for pts who fractured their hips and had an open reduction internal fixation
limit weight bearing for 6-12 wks
non weight bearing (NWB)
affected extremity should not touch floor
toe touch weight bearing (TTWB)
affected foot may rest on floor for balance but no bearing of weight
partial weight bearing (PWB)
can bear 30-50% of weight on affected extremity
weight bearing as tolerated (WBAT)
as much as can tolerate without undue strain or pain
what helps prevent muscle atrophy
isotonic movements -> contract & release muscle but joint doesn’t move
post op ORIF s/p hip fracture to restore strength, muscle tone & ROM
-quadriceps setting
-gluteal muscle setting
-leg raises in supine & prone position
-lef abduction exercises
