NRSR 22 Unit 3: Arthroplasties, Orthopedics, Trauma Flashcards
Reasons for arthroplasty?
- Fractures - Either as the cause of the fall or result of the fall.
- Degenerative joint disease or osteoarthritis - more common among older people.
Possible complications from arthoplastic surgery?
- Altered skin
- DVT - 50% increased risk
- Infection - Very difficult to rid if infected in the bone. Long term, patients have to take added safeguards against infection.
- Constipation - due to pain meds
- Blood loss -
Prophylactic Treatment prior to surgery
- Antibiotics - prior and afterward
2. DVT prophylactics - Lovenox and SCD/TEDs
Why should patient do rehab?
To help with their flexibility. Patients have a small window to improve their range of motion usually before 6 months. If they don’t, they will have restrictive movement permanently. However, rehab can be very painful.
Risk factors for respiratory depression in PCA patients
- Use of basal infusion
- Advanced age
- Obesity
- Upper abdominal surgery
- Obstructive sleep apnea
- Concurrent use of CNS depressants
- Pumping programming errors-requires two nurses to program.
- PCA by proxy (family pushing)
- Lack of opioid tolerance (opioid-naive)
What materials are used for prosthetics? How do they last?
-Metal (eq. titanium)
-High-density polyethylene (eq. plastic)
-Ceramic - wears longer
Replacements can last between 10-20 years. Young patients are advised to postpone surgery as long as possible.
Why does temperature and WBC increase after athroplastic surgery?
Can be due to infection. However, inflammation can also cause the same manifestations.
How to prevent dislocation?
- Avoid extremes of flexion - eq. sitting more than 90 degrees
- Avoid rotation - no pivoting
- No crossing legs
- Not lying on the affected side.
- Avoid abduction.
Why does cemented prosthetics cause more complications?
- The cemented adhesive can fail.
- Heat is used to apply the cemented adhesive increasing risk of infection.
How long before the bone grows around the prosthesis?
6-10 days. Prior to this period, the prosthesis is susceptible to dislocation.
What is the purpose of taking oral iron replacement? What is the side effect?
To treat anemia from patients who suffered blood loss. Oral iron replaces the iron lost in blood loss. Iron is best absorbed on an empty stomach, but in hospital settings, they are provided with food given that some patients may have very sensitive stomachs. Side effect is constipation.
What are benefits of Heparin?
- Reduces the risk of DVT. Prevents clots from growing.
- Heparin (IV) has a short half life. The effects can be very quick and the reversal of the drug can be very quick as well with antidote protamine sulfate for heparin (subq).
- Can be given IV or subq.
What are the disadvantageous of Heparin?
- Bleeding
- Can lead to thrombocytopenia (low platelets)
- Does not dissolve existing clots.
What is Warfarin? What complication can it cause for orthopedic patients?
It’s an anticoagulant agent that reduces development of thrombosis of patients vulnerable to DVTs. Patients on warfarin have difficulty in stopping bleeds. Patients need to wait 5 days before having surgery.
Why is Warfarin given in the evening?
Lab work is performed in the morning. Based on morning lab results, health care providers can adjust dosage in the afternoon.
What oral intake should patients with anticoagulant should avoid?
- Excessive intake of Vitamin K foods (mayo, greens)
- Alcohol
- ASA (Aspirin), Acetaminophen (Tylenol), NSAIDS (Ibuprophen)
What is nursing care for patients on anticoagulants?
- Assess for bleeding: (eq. gums, hematoma, GI bleeding)
- Avoid IM injections
- Minimize blood draws
- Monitor labs
- Educate patient to use soft toothbrush, electric razors, remain consistent on vitamin K food intake.
- Avoid oral intakes as mentioned previously.
What lab work should look for with patients preoperatively related to bleeding?
- INR (International Normal Ratio): Standardized PT
- PT (Prothrombin time): The time it takes for plasma to clot.
- PTT (Partial Thromboplastin Time): How long it takes for blood to clot.
Which patients do not receive total hip replacement (THR), total knee replacement (TKR) and hip pinning? And why?
- Ultra geriatric patients: May not survive surgery.
- Patients with many comorbidities: May result in many complications.
- Patients with dementia: May not be able to follow rehab plan.
- Very obese patients: May not be able to follow rehab plan.
What are common preventions of traumatic injuries?
- Seat belts
- Responsible driving
- Regular exercise
- Stretching before physical activities
- Protective athletic equipment
- Safety equipment on the job
- Living environment
- Nutrition: Vitamin D, Calcium
What are the 8 neurovascular assessment checks?
- Sensation: Numbness, tingling,
- Motor function: Motion, strength, joint mobility
- Pain: Intensity, character, related to injury/origin
- Color: Pink, white, dusty, pale
- Temperature: Cold or hot on the extremities
- Capillary refill: How fast the nail bed refill. < 3 sec.
- Peripheral pulse: Checking for equal pulse.
- Edema: Swelling
What are the six P’s?
- Parasthesia: Sensation
- Pain: Pain
- Pallor: Color, temperature
- Paralysis: Motor function
- Pulselessness: Capillary refill, peripheral pulse
- Pressure: Edema
PreOp Nursing Actions: Contraindications
- Recent or active infection
- Arterial impairment of the affected extremity
- Patient’s inability to follow the post surgery regimen.
- Comorbid condition (eq. DM, HTN, osteoporosis, unstable cardiac and respiratory conditions).
PreOp Nursing Actions: Diagnostic Tests Results
- CBC, urinalysis, electrolytes, BUN, creatinine - surgical readiness and rule out anemia, infection or organ failure.
- Chest x-ray - Rule out pulmonary surgical contraindications (infection, tumor).
- ECG - Gather baseline to identify cardiovascular surgical contraindications.
