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
