Mobility Flashcards
Adverse effects of Immobility
Atelectasis ◦Turn/cough/deep breathe ◦Avoid VTE ◦Anticoagulant therapy ◦SCDs
Wasting of bones
◦ROM exercises
◦Proper alignment
Functional loss of muscle
Urinary stasis
◦Increase fluids & decrease calcium intake
Constipation
◦Encourage diet with adequate protein, bulk & liquids
Arthroplasty
Surgical removal of a diseased joint and replacing it with prosthetics or artificial components made of metal and/or plastic
Arthroplasty types
Total joint arthroplasty
◦Involves replacement of all components of an articulating joint.
Total knee arthroplasty
◦Replacement of the distal femoral component, the tibia plate, and the patellar button.
◦Surgical option when conservative measures fail.
Unicondylar knee replacement
◦Joint is diseased in one compartment of the joint.
Total hip arthroplasty
◦Replacement of the acetabular cup, femoral head, and femoral stem.
Hemiarthroplasty
◦Half of a joint replacement.
◦Fractures of the femoral neck can be treated only with the replacement of the femoral component.
Contraindications
◦Recent or active infection (UTI), which can cause micro-organisms to migrate to the surgical area and cause the prosthesis to fail
◦Arterial impairment to the affected extremity
◦Client inability to follow the postsurgical regimen
◦A comorbid condition
PreOp: Nursing Responsibilities
Review…
◦CBC, urinalysis, electrolytes, BUN, creatinine:
- Assess surgical readiness, and rule out anemia, infection, or organ failure.
- Epoetin alfa may be prescribed several weeks preoperatively to increase Hgb for a client who has mild anemia.
◦Chest x-ray:
- Rule out pulmonary surgical contraindications (infection, tumor)
◦ECG:
- Gather baseline rhythm to identify cardiovascular surgical contraindications (dysrhythmia).
PreOp: Client Education for fracture
Outpatient
◦Incentive spirometry, transfusion, surgical drains, dressing, pain control, transfer, exercises, and activity limits.
◦The client donates blood prior to procedure to be used during or after the procedure.
◦Scrub the surgical site with a prescribed antiseptic soap the night before and the morning of surgery to decrease bacterial count on skin, which helps lower the chance of infection.
◦Wear clean clothes and sleep on clean linens the night before surgery.
◦Take antihypertensive and other medications the surgeon allows with a sip of water the morning of surgery.
IntraOp fracture
◦General or spinal anesthesia.
◦Joint components are removed and replaced with artificial components.
◦Components can be cemented in place.
◦Components that do not use cement allow the bone to grow into the prosthesis to stabilize it. Weight bearing is delayed several weeks until the femoral shaft has grown into the prosthesis.
PostOp: Client Education for fracture
◦Physical therapy to regain mobility
◦Can be discharged home or to an acute rehabilitation facility. If discharged home, outpatient or in-home therapy must be provided. Home care should be available for 4 to 6 weeks.
◦Monitor for evidence of incisional infection (fever, increased redness, swelling, purulent drainage).
◦Care for the incision (clean daily with soap and water).
◦Monitor for deep vein thrombosis (swelling, redness, pain in calf).
◦Pulmonary embolism (shortness of breath, chest pain).
◦Bleeding if the client is taking an anticoagulant.
Needs of Patients With Hip or Knee Replacement Surgery
◦Mobility and ambulation
◦Drain use postoperatively
◦Assess for bleeding and fluid accumulation
◦Prevention of infection
◦Infection may occur in the immediate postoperative period (within 3 months), as a delayed infection (4–24 months), or because of spread from another site (more than 2 years)
◦Prevention of DVT
◦Patient education and rehabilitation
Knee Prostheses
Encourage active flexion exercises
◦Use of continuous passive motion (CPM) device
- to promote motion in the knee, promote circulation, and prevent scar tissue formation.
- Placed and initiated immediately after surgery.
- Provides passive range of motion from full extension to the prescribed amount of flexion.
- Follow the prescribed duration of use, but turn it off during meals.
Why do elderly folks break their hips?
Trip and falls are the most common reasons for hip fractures. (up to 90%)
◦Decreased bone density and muscle mass.
◦Balance problems and inactivity.
◦Problems with vision and balance.
*Can be life-threatening!
Hip Prosthesis
◦Positioning of the leg in abduction to prevent dislocation of the prostheses ◦Do not flex hip more than 90 degrees ◦Avoid internal rotation ◦Protective positioning ◦Hip precautions
Plan of care for amputation
◦Assess neurovascular signs; 6 Ps ◦Monitor for infection ◦Position stump on pillow ◦U need to implement shrinkage interventions ◦Treat pain ◦Avoid prolonged sitting ◦Try to prevent contractures ◦Encourage and support grieving processes
Osteoarthritis
Develop due to deterioration of cartilage
Hyaline cartilage (provide surface for bones to slide/ glide w/ movement or absorb shock)
Happens and worsens over time
“Weight baring joints” hands, knee, hip, spine
Not symmetrical! Or systemic
Hard to move, work or enjoy activities
No cure - damage can’t be reversed
Osteoarthritis signs
Bones “grating” on each other bc of decrease joint space
Bone spur “ostephytes”
Sclerosis (abnormal hardening of bone)
Part of bone/cartilage break off - float in joint space
Hard bony joints
Pain
Stiffness (<30 mins to recover)
What is Osteoporosis
Thinning of bone to a point it can’t withstand normal stress
Can lead to fracture
The inside of the bone (spongy bone) become so porous = ⬇️ bone density
Rate of bone reabsorption exceeds rate of bone formation
Osteoporosis signs
Fractures
Rounding of upper back
Inches of height lost
Lower back hip or neck pain
Amputation
Traumatic or used to treat injuries:
Cancers
Limb gangrene
Limb threatening arterial disease
Planned surgical amputation
Done as distally as possible
Closed amputation: allows skin flap to close site
Open amputation: used with active infection; may need reconstructive surgery later
Complete fracture
The break goes completely through the bone, separating it in two.
Incomplete fracture
crack that does not completely break the bone into two or more pieces
Closed or simple fracture
The bone is broken, but the skin is intact
Open or compound/ complex fracture
The bone pokes through the skin and can be seen
Type of fractures
Green stick: when a bone bends and cracks, instead of breaking completely into separate pieces
Spiral: long bone is broken by a twisting force
Comminuted: The bone is broken into more than two pieces.
Transverse: broken straight across
Vertebral compression: vertebral body in the spine collapses
Manifestations of fracture
Pain Loss of function Deformity Shortening of extremity Crepitus (grating sound or sensation produced by friction between bone and cartilage) Local swelling and discoloration
Goal of treating fracture
Control hemorrhage
Provide pain relief
Prevent ischemia (inadequate blood supply)
Remove potential source of contamination
Care of patient with fracture
System- specific assessment
- pain
- analysis & observation of injury (6 P)
- immobility of affected limb
- Need to confirm w/ X-ray
Diet
- increase cal, vit D, protein
Equipment
- assistive device, traction, cast
Plan/ intervention
- pain control
- cleanse site of injury
- immobilized
- elevate extremity
- may prepare for surgery
- PT/OT
Stages of bone fractures
1) bone breaks
2) hematoma occur form ruptured blood vessels
- swelling and pain
- clotting factor form fibrin mesh around fractures site
3) granulation process
- 48-72 he
- proliferation of osteoblasts
4) granulation tissue become callus
- new cartilage
- calcium, phosphorus
- osteoblasts
5) Ossification
- callus is replaced with new bone
Complication of fracture
Shock Fat embolism Compartment syndrome Delayed union and nonunion Reaction to internal fixation device
Shock
Treat: bleeding and pain, stabilize fracture
Signs: decrease BP, increase HR
Fat embolism syndrome
Occur with large bone fracture
occurs when fat globules are released into the bloodstream
Signs: R distress ⬆️ HR ⬇️ consciousness Petal rash on chest
- if subtle personality changes, restlessness, irritability; obtain blood gas immediately
Fat embolism syndrome interventions
Notify MD immediately
Start on o2
Iv fluids
Albumin bind fatty acids
Steroids
Compartment syndrome
Hemorrhage and edema following a fracture lead to inability of fascia to accommodate edema impairing circulation
Sign:
Pain that is uncontrolled/ unrelieved that is sharpe and sudden
Compartment syndrome interventions
Monitor 6 p’s
Call MD
Losses dressing or clothing
Keep extremity at heart level
Prepare for faciotomy
Prevention of osteoporosis
Vit D and calcium
Regular weight bearing exercises: walking
Weight training stimulates bone mineral density
Calcium rich foods
Milk Cheese Almond Leafy vegetables Oranges Yogurt
Osteoporosis risk factors
Postmenopause
Advanced age: low testosterone in men
Low calcium intake
High phosphate intake (carbonated beverage)
Sedentary, lack of exercise
Corticosteroids, anti seizure, heparin, kidney failure
Test osteoporosis
DXA scan ** bone mineral density
Serum calcium
X-ray
Plan of care for osteoporosis
Bone density scan
Supplement calcium and vit D
Prevent further deterioration
Estrogen
Exercise program (weight bearing)
Fall precautions
Assess for stress fracture
Osteoarthritis patho
Non inflammatory
Progressive deterioration
- loss of cartilage in one or more joints
Joint space narrows
- as cartilage erodes
Bone cyst / secondary synovitis are common in advance disease
Osteoarthritis risk factors
Age > 60
Women
Obesity
Smoking
Genetics
History of repetitive stress on joints
Osteoarthritis treatment
Surgery
- Arthoscopy with tidal irrigation
- wash debris from joint spaces
- Arthroplasty
- replacement t of all or part of joint
- last resort for pain
Osteomyelitis
Infection of the bone
Occur bc:
- extension of soft tissue infection
- direct bone contamination
- spread form other site of infection
Osteomyelitis assessment
Signs: Infection localized pain Edema Erythema Fever Drainage
- when chronic, fever may be low grade and occur in the afternoon or evening
- watch for adverse reaction to antibiotics
- assess ability to adhere to prescribed therapy
Planning goal for osteomyelitis
Control pain
Improve physical mobility within therapeutic limitation
Control and eradication of infection
Knowledge of therapeutic regimen
Osteomyelitis interventions
Reliving pain:
- immobilized
- elevation
- handle with great care and gentle
- administer Pain meds
Improve physical mobility:
- activity is restricted
- gentle ROM above and affected part
- participation in ADL with limitations
Encourage hydration, vitamins, protein
Treatment of osteomyelitis
Surgical debridement: sequestrectomy- debride infected bone
Bone graft:
1) remove necrotic tissue
2) graft bone
3) cover skin
- sterile dressing change daily For 2 wk
Gout
Arthritis
Accumulation of Uric acid in the blood
- cause needle like crystals within joints
Painful
Food to avoid with gout
High purine foods
- internal organ meat
- red meat
- seafood
- alcohol (beer)
- high fructose corn syrup can increase uric acid
Gout diet
Fruits Vegetable Whole grain Low fat dairy Legumes Nuts
Gout risk factors
high intake of purines
Kidney problems
- CRF
Overweight BMI >25
Physical stress
Medications
Acute gout symptoms
Random - may be once
Last 1-2wk
No long term joint damage
Usually start in big toe
Swelling
Severe pain
Redness
Sensitive- don’t touch
Chronic gout symptoms
Chronic elevated uric acid levels
Repeated acute attacks
Damaged joints
Masses (Tophil)
- nodules under skin
- yellowish color
- ears, fingers, elbows, toes
Itching/ peeling skin
At risk for uric acid kidney stones
Gout diagnosis
W/ symptoms
Increased uric acid
- > 6 mg/dl
- not diagnostic
24 he urine
- determine cause
- decrease renal excretion
- overproduction of uric acid
Synovial joint aspiration - gold standard
- fluid contains needle like crystal
Education for gout
Avoid …
Height purine food
ASA
High fructose corn syrup drinks
Dehydration
Gout interventions
Cold/warm compresses if tolerated
Stay hydrated
Bed rest
Weight loss
Places of osteoporosis fractures
Wrist
Hip
Spine
