Joint Replacement/Assessment Flashcards
Exam 1
ROM
Pain
Joint deformity
assessment for joint replacement
When pt has pain in the jont what should you look?
effusion, redness, and warmth (active inflammation
During the _______ __________ the patient may have __________ on palpation or when putting the joint through ________ __ ________
joint examination
tenderness
range of motion
t/f should you force a joint during ROM
false
The buildup of excessive ____ ______ that restricts joint motion and _________ ability.
Arthrofibrosis
scar tissue
functional
Severe pain and __________ often interfere with ___________ and self-care
deformity
ambulation
The presence of excess joint fluid especially common in the _____.
joint effusion
knee
A grating sound caused by loosened bone and _______ in a synovial joint
crepitus
cartilage
joints should move ___________ no grating should be heard
smoothly
__________ typically a result of a known event or condition that directly __________ cartilage or causes joint __________
osteoarthritis
directly damages
instability
which is the most commmon form of arthritis?
osteoarthritis
why would you get a joint arthroplasty?
impaired mobility, persistent pain, and disability
occurs less often than primary disease and can result from joint injury and obesity
Secondary OA
Injury to the ______ from excessive use, trauma, or other joint disease (e.g., ___________ __________) predisposes a person to OA
joints
rheumatoid arthritis
Joint arthroplasties are often ________, knee, and some shoulders
hips
Replaced mostly with ______ __________ ________ and polyethylene, ________
high density metal
ceramic
t/f should pt be optimal health prior to surgery
TRUE
what may be prescribed prior to surgery to increase hemoglobin
Epoetin alfa
what would you do if a surgery is not emergent?
make efforts to get pt to optimal health
Hypertension and _________ and chf and will need to stabilizes before surgery
diabetes
t/f Epoetin alfa may be given instead of giving blood products
TRUE
________ ____ _____________ is a replacement of a severely ___________ hip with an artificial joint
total hip arthroplasty
damaged
what are some diseases that might cause you to get a total hip arthroplasty
osteoarthritis, rheumatoid arthritis, femoral neck fractures
Pt and family will need to ___________ for life at home
accommodate
t/f to have a toal hip arthroplasty the pt must have irreversibly damged hip joints and the potential benefits much outweight risks
TRUE
during a hip fracture a leg will…
shorten
exrernal rotation
adduction
older in age
female
history of osteroporsis
decrease estrogen related to metaphase
increase falls
history of chronic conditions
TIA’s anemia
medication
cardiovascular disease
risk factors that increase the likihood that a pt may have hip fracture
Interventions for hip fractures
bucks traction, immobility ( trochanter roll or sand bags)
surgery - internal fixation
surgically implanted devices applied directly to fractured bone segments to keep them temporarily or permanently in place.
surgery - internal fixation
t/f pt are at a high risk for venous thrmoembolism
true should take measures to prevent DVT
Stop meds that increase risk at least 1 wk before (unless emergent surgery) – will stop _________ _______ and ______ and OTC meds
blood thinners
herbals
what pulse should you assess before and after surgery?
Assess distal pulses for arterial flow and compare to prior
t/f Intermittent compression device (SCUDS)intraop/postop
don’t help to prevent dvt
false
what should you take to for the prophylaxis of deep vein thrombosis (DVT) after surgery
LMWH (Lovenox)
what increases the risk for venous thromboembolism?
- Advanced age
- obesity
- preoperative leg edema
- previous history of any VTE
- varicose veins
may be applied before surgery to help decrease pain
skin (Buck) traction
t/f Most commonly done in hip replacements before surgery is when buck’s is used
TRUE
involves the use of a Velcro boot belt, or halter, which is usually secured around the affected leg
Buck traction
post op hip fracture what should you look for?
- sever pain
- inability to move leg
- shortening & external rotation of the leg
- dvt
- bleeding, swelling
- pulmonary complication (atelectasis_
- pressure ulcer
- urinary retention
post op complications of hip fracyure surgery
Some fractures _____ achieve union; that is, they never completely _______ (________)
never
heal
nonunion
- coughing and deep breathing
- stocking and compression devices
- turn q2h
- maintain leg abduction
- neuro status check
- pain contril
- mobilize ASAP
- check under client for drainage
Nursing care intervention for post op hip fractures
you will hear what when a joint comes out?
you will hear a pop
Infection_________ before surgery will delay surgery
2-4 weeks
what will you ask a patient to do before surgery to prevent infection?
Shower with antiseptic soap
what may a patient take to prevent infection after surgery and before a dental procedure?
Prophylactic antibiotics prior
what may a pt be given before surgery to decrease risk of infection?
prophylactic broad-spectrum antibiotics
if a pt has to have a foley what may you be worried about
CAUTI and this is why you want the foley out ASAP
a pt acuquires an infection in the no affected joint what my this cause the patient to do?
Persistent infection of a joint may require another replacement
how long should a pt be on an anticoagulant post op?
6 weeks post op to prevent dvt
- Dislocations
- Excess _______ drainage
- Heel pressure ulcers
- Avascular necrosis (_____ ______ _ ___)
- _________ of prosthesis
other issues that arise from post op
wound
cell death of bone
Loosening
On all post op- want early _______ to prevent ___________!
mobilization
complications
what will an older pt absolutely need to get post op?
Older patient will definitely need pressure reducing mattress
what may occur post op?
pt may be constipated
__________ position with his or her head slightly elevated
supine
Preventing Dislocation of the Hip Prosthesis
_______ splint, a wedge pillow placed between the legs __________ ________ beyond the midline of the body.
abduction
prevent adduction
Preventing Dislocation of the Hip Prosthesis
hip is never flexed ____ _____ ___ degrees.
more than 90
Preventing Dislocation of the Hip Prosthesis
When turning patient keep the ________ hip in abduction
operative
Preventing Dislocation of the Hip Prosthesis
When using fracture bedpan nurse reminds patient to flex the __________ __and to use the ______ __ _____the pelvis onto the pan.
unaffected hip
trapeze to lift
Preventing Dislocation of the Hip Prosthesis
On ______ times out of bed abduction pillow is _____ ___.
initial
left in
Preventing Dislocation of the Hip Prosthesis
full flexion (_________) , adducted (legs together), and _______rotated.
risj for dislocation when
bending
internally
t/f post op THA you want legs to be together when ambulating or moving
false you want something inbetween
away from midline
abduction
towards midline
adduction
t/f you should bend affected him more than 90 degrees
FALSE
t/f when lying on your back do NOT roll or turn your affect leg towards the other leg or turn your toes in ward?
TRUE
t/f you should let the toes of your affect leg turn downward?
FALSE
you should not
t/f when lying on your side, keep the affect leg outside the midline of the body?
TRUE
t/f you can bend over to pick up objects post THA
FALSE
t/d do not rotate your leg when standing. Keep leg straight.
TRUE
t/f you can cross your legs when sitting?
FALSE
t/f keep leg in extention when getting up?
TRUE
t/f you should pivot on affected leg
FALSE
pivot on unaffected leg
High-seat (orthopedic) chairs, __________ wheelchairs, and ________ toilet seats to prevent ________
semi-reclining
raised
flexion
Nurse protects leg from _________, flexion, ________ or _________ rotation, or excessive weight ________
adduction
interal or external
bearing
t/f a pt post op THA can put on shoes and socks
FALSE
t/f a pt will be able to go back to normal ADL without assistance or modifications
FALSE
Will need someone to go to home to assess for need for modification- bath seat- elevated. Elevated toilet seat.
what will a pt need post op to gain some indepence?
rehab/PT/OT
__ __ __ _____is when the highest risks for the hip to come out
8 to 12 weeks
- Increased pain at the surgical site, ______, and immobilization
- ________ ______ pain in the affected hip or increased discomfort
- ___________ of the affected extremity
- Abnormal external or internal rotation of the _____ extremity
- Restricted ability or _________ to move the leg
- Reported “________” sensation in the hip
S/S of dislocation
swelling
Acute groin
Shortening
affected
inability
popping
t/f if pain is bad and leg is rotated odds are you should not be concerned?
FALSE
you SHOULD be concerned
you get a pt up post op and they complain of lightheadness, they are experincing…
Orthostatic hypotension
t/f a pt will have a weight bearing limit post op?
TRUE
t/f a pt may begin to ambulate within 24 hours after surgery
TRUE
t/f you should notify the surgeon of excessive or foul-smelling drainage?
TRUE
driange of 200 to 500 in the first 48 hours is expected?
FALSE
it is normal the first 24 hours not 48
t/f a drain is usully removed within the first 24 hours post op
TRUE
t/f a there is no risk DVT after a TKA?
FALSE
there is a risk
what can help decrease the risk for DVT?
Lovenoz (LMWH)
t/f Prophylactic antibiotics are only given for THA
FALSE
Prophylactic antibiotics are also given for TKA
t/f pt shoul flex foot frequently
TRUE
t/f ice packs are used to control bleeding and swelling?
TRUE
t/f Assess neurovascular status (pulse, color )frequently
TRUE
when would a continuous passive motion machine be place post TKA
placed right after surgery
The ______ is usually protected with a knee __________ and is elevated when the patient sits in a chair
knee
immobilizer
t/f pain post op of TKA is worse than a THA
FALSE
hip pain is worse
