Musculoskeletal Problems Mona Garrett NURS 210. Fractures of the Hip Incidence S/S: External...
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Transcript of Musculoskeletal Problems Mona Garrett NURS 210. Fractures of the Hip Incidence S/S: External...
Treatment of Hip Fractures
Preoperative managementBuck’s traction with 5-7 lbs of weightTurn to unaffected sideTrapezeNeurovascular checksSurgeryOpen Reduction Internal Fixation (ORIF)Total Hip Arthroplasty (THR)
ORIF of the HipMost common surgical procedure for repairing hip fracturesUsed for inter and subtrochanter fracturesFracture realigned and secured with hardwarePostoperative careMaintain good limb alignmentEarly mobility; PT; adequate pain controlRehabilitation
Total Hip Arthroplasty (THR)
Used for femoral head fracturesIf only femoral head or acetabulum replaced, called partial / hemi-arthroplastyPostoperative careAbduction pillowHemovac or other drain for 2 daysUrinary catheter for 2 daysHip precautionsPain management
Complications of Hip Fractures
DVT - SCD’s, TED’s, anticoagulants, early mobilityAtelectasis/pneumoniaSkin breakdownUTI or unable to voidConstipationConfusion
Interventions for Clients with Connective Tissue Disease
OsteoarthritisRheumatoid Arthritis
LupusGout
Other
Osteoarthritis
Most common form of arthritisProgressive deterioration of joint cartilageAlso called Degenerative Joint Disease (DJD)Affects weight bearing joints (hips, knees, spine, hands)Risk factors: Aging, obesity, repetitive joint overuse
Osteoarthritis
S/S: Joint pain usually aggravated by use, loss of function, decreased ROM, crepitus (grating), enlarged joints are hard and cool to touch Diagnostic TestsLab values usually normalXrays; CT or MRI for vertebralSynovial fluid analysis to R/O rheumatoid
Treatment of Osteoarthritis
AcetaminophenNSAIDSCOX 2 Inhibitors (Celebrex and Bextra)Intra-articular corticosteroidsWeight lossExercise after heat applicationSurgery: Arthroscopy, osteotomy, arthrodesis, joint replacement (total joint arthroplasty)
Total Joint ReplacementGoal: Restores mobility and relieves painHip, knee, shoulder, elbow, fingers, toesCemented versus non-cementedComplicationsInfectionLooseningDislocationContraindications: Infection or advanced osteoporosisNursing Implications
Total Knee ReplacementReplacement with 3 parts: femoral component, tibial plate, patellar buttonBilateral TKRs possiblePostoperative care:Drain and pressure dressingHot/ice machine or ice packsPain managementBlood transfusionsContinuous Passive Motion (CPM) machineRehabilitation
Rheumatoid Arthritis
Chronic, systemic inflammatory disease that affects synovial jointsSpontaneous remissions & exacerbationsS/S: Systemic signs of inflammationJoint swelling with stiffness, warmth, tendernessAffects wrists, elbows, knees, ankles, PIP and MCP joints usually bilaterally
Diagnosis of Rheumatoid Arthritis
Positive rheumatoid factorElevated ESRSynovial fluid analysis(arthrocentesis)Xrays
Medications for RA
ASA and NSAIDS (Celebrex, Bextra)DMARDS (Disease modifying drugs) Plaquenil, Azulfidine, MinocyclineCytotoxic drugs (Methotrexate)Biological Response ModifiersEnbrel, Remicade, Humira, KineretLong term steroidsGold salts
Rheumatoid ArthritisTreatment: Moist heat or iceJoint rest with progressive exerciseCortisone injectionsDiet with omega 3 fatty acids & antioxidantsAssistive devices Management of fatigue and stressAlternative therapiesPlasmapheresisSurgery: Arthroplasty, arthrodesis
Systemic Lupus Erythematosus
Chronic inflammatory autoimmune disorder affecting the connective tissuesAntibody-antigen reactionCharacterized by recurrent seasonal remissions and exacerbationsS/S: Similar to RA in beginningRed butterfly rash; wolf bite “lupus”Photosensitivity; alopecia
Systemic Lupus Erythematosus
Diagnosis: Positive rheumatoid factorAntinuclear antibody; elevated ESR
Treatment: Goal is to control symptomsASA and NSAIDS for arthritis symptomsTopical medications and sunscreenCorticosteroids for systemic symptomsDialysis or kidney transplant for ESRDPlasmapheresis
Client Teaching for SLE
Protect the skinMonitor body temperaturePsychological support for unpredictability of lifeBalance life and stressPregnancy issuesRefer to Lupus Foundation of America
Gout (Gouty Arthritis)
Results from decreased renal excretion of uric acid or genetic defect in purine metabolism that causes overproduction of uric acidRed, swollen, and acutely painful jointsIntermittent attacks earlyChronic gout results in tophi (urate deposits) on outer ear, arms and fingers near joints; and kidney stones
GoutDiagnosis: Synovial fluid analysisElevated serum uric acid, WBC’s and ESRTreatment: Bedrest; immobilization of painful jointsApplication of cold; analgesicsNSAIDS especially Indocin; corticosteroidsColchicine for acuteAllopurinol or Benemid for chronicLots of fluid to prevent renal calculiAvoid diuretics and ASA; excess alcohol and fad “starvation” diets
Other Connective Tissue Diseases
Progressive Systemic Sclerosis (Scleroderma) - hardening of the skinLyme Disease - has an identified causeIf not diagnosed and treated early, chronic complications and arthritis occurFibromyalgiaTrunk, extremity, and facial painAssociated with Chronic Fatigue Syndrome