Joint Surgery/Test 4 Flashcards
Joints:
Where ends of 2 bones are in proximity and move in relation to each other
- synarthrotic
- amphiarthrotic
- diarthrodial
Synarthrotic:
immovable
Amphiarthrotic
slightly movable
Diarthrodial
freely movable
Joint replacement is the most
common orthopedic operation performed on older adults
Indication for joint surgery:
- Relief of pain
- Improving joint motion
- Correcting deformity and malalignment
- Removing intraarticular causes of erosion
Types of surgeries:
- Arthroplasty
* Arthrodesis
Arthroplasty:
reconstruction or replacement of a joint to relieve pain, improve or maintain ROM and correct deformity.
Arthrodesis:
Surgical fusion of a joint
Spondyloarthropathy:
refers to a family of inflammatory arthritic conditions which include-
- Ankylosing spondylitis
- reactive arthritis
- psoriatic arthritis
- enteropathic spondyloarthropathy (arthritis of inflammatory bowel)
- Undifferentiated spondyloarthropathy
Undifferentiated Spondyloarthropathy:
with peripheral joint involvement, not assoicated with any skin, bowel or genitourinary disease
Enteropathic Spondyloarthropathy (arthritis of inflammatory bowel disease)
*Ulcerative colitis and Crohn’s disease are inflammatory conditions of the bowel which result in diarrhoea, often bloody. They are associated with an arthritis which may affect the spine and sacroiliac joints, and peripheral joints as well.
Psoriatic Arthritis:
Which can involve the joints in a variety of ways. sometimes mainly the hands and feet, sometimes the large joints like the knees and feet and sometimes the spine and sacroiliac joints (which join the pelvis to the sacrum)
Reactive arthritis:
which typically causes hot swollen joints, usually in the legs, but may cause stiffening in the spine as well. Infection in the bowel or genitourinary tract sets up a reaction in the joints. This is not the same as septic arthritis which is infection inside the joint itself.
Ankylosing spondylitis:
Which mainly involves the spine and can result in stiffening and loss of movement in the neck, rib cage and lower back
Hip Arthroplasty (Prosthesis)
- Total hip
- cemented
- noncemented
- Hemiarthroplasty
Total Hip
head and neck of the femur are removed and replaced with metal ball and intramedullary stem. The acetabulum is replaced by a plastic cup.
Total Hip Cemented:
- Can crack or loosen over time
- Early ambulation
- Used for older folks
Total Hip Noncemented
Fibrin growth over prosthesis
Hemiarthroplasty
usually replace head, leave acetabulum
Nursing management: Prevent dislocation of prosthesis: Specific position restrictions (example)
- Avoid extremes: flexion, adduction, or rotation
- When supine or lying on side; legs should have abduction pillow for a reminder not to cross legs
- Avoid positioning on operative side
S/S of dislocation:
- Onset of pain unrelieved by medication
- Popping sensation associated with movement
- Loss of movement
- Leg discrepancy
- Deformity
Total Knee Arthroplasty:
- Past op management may include continuous passive motion machine
- reduces swelling
- prevents adhesions
- decreases pain
- increases circulation and movement
If no CPM (Continuous passive motion machine) is used
- elevate the operative leg on pillows no flexion of the knee
- prevent flexion contractures: keep the knee extended-knee immobilizer may be used
CPM
Continuous Passive Motion Machine- passive movement to prevent joint contracture, hematoma formation
*Drains: post op-hemovac, J-P (Jackson-pratt)
Purpose of CMP Machine:
- Passive flexion exercise
- early joint mobility
- improve circulation
Physical Therapy:
Isometric exercises of the quadriceps (muscle contraction without shortening no movement, contracting muscle quadriceps-hamstrings. Muscles used in ambulation)- progress to straight leg raises and gentle ROM to increase muscle strength
How to obtain 90 degree flexion
*This is accomplished by active flexion exercises or by the CMP
Complications fracture healing: Direct
- Problems with union
- table 63-5
- infection
- avascular necrosis
Complications fracture healing: Indirect
- Blood vessel/nerve damage
- Compartment syndrome
- Fat embolism
- Shock
Infection secondary to fracture healing:
- High incidence in open and soft tissue injuries
* Ideal medium for pathogens
Osteomyelitis is a
severe infection of bone, bone marrow and surrounding soft tissue
- requires multiple IV antibiotics and means to deliver (PICC)
- Dx with Bone Scan
- osteomyelitis may be chronic
Fat Embolism Syndrome (FES)
- the presence of fat globules in tissues and organs after a traumatic skeletal injury
- Seen in fractures, total joint replacement
- particularly long, bone fx, ribs, tibia and pelvis
- Can lead to ARDS which has 50% mortality
- Usually occurs 24-48 hours
S/S of FES
- Mental status change- restlessness, confusion, lethargy, coma
- Respiratory- hypoxemia, cyanosis, dyspnea, tachypnea
- Cardiac- tachycardia, hypotension, chest pain
- Impending doom
- Petechiae- conjunctivae, axilla, neck and chest fever
- Present of fat in the sputum/urine (Lipuria)
- Multisystem failure
Nursing Management:
- *Prevention-early ambulation especially pt with long bone injury
- early stabilization and early recognition of symptoms of FES
- *Most important intervention is to monitor those who are high risk
- careful handling of fracture site
- tx like ARDS
- adequate hydration
- supportive care to family
Compartment syndrome:
increased pressure within a limited anatomical space compromising circulation-**peripheral neuropathy can develop within 24 hrs.
Decreased compartment size
- restrictive compartment content- bleeding, edema, snake bite, IV infiltration
- threatens the viability and function of the tissue within that space
- if not treated can lead to loss of function, deformity, and even amputation
- failure to recongnize is the most common cause of medical litigation
Compartment Syndrome S/S
Six P’s-Critical to know
- Pain w/edema- earliest sign
- unrelieved by pain medication
- increased when leg is elevated
- epidurals may mask onset
- abnormally higher than expected
- Paresthesia (numbing and tingling)
- Pressure
- Pallor (coolness and loss of normal color)
- Paralysis/muscle weakness, loss of function
- Pulselessness (late sign)
- *Pt may present with one or all of the six P’s
- *Remember this is why we do neural checks!
Surgical Interventions:
*Decompressive fasciotomy-opens the compartment to decrease pressure and restore normal perfusion
