athroscopy
Apply ice
PT for exercise
Looks at internal strucutres and knee joints. Must be able to bend 40 degrees
1. Apply _____
2. PT for __________
Bone scan
Give 4 to 6 hours before
30 to 6 mins still laying
Increase fluid
Radioactive medium injected to view skeleton. To see tumors, fractures, arthritis, vertebral compression, bone pain
1. Give radioactive medium ____ to ____ hours BEFORe
2. Lay flat and still for ______ to _____ mins
4. Increase _______
DEXA scan
Measures bone density in osteroporosis and osteopenia
1. Baseline women in 40/s
2. Loose clothing - no zippers
3. No jewelry
4. Stop Vit D and calcium 48 hours before procedure
Electromyography and nerve conduction
Activity
Needle insertion for hematoma
Support anxiety
Used to test muscle weakness
Ex: Carpal tunnel, MG, ALS, gillin bairre)
1. Patient does _______
2. Observe needle insertion for _________
3. Support ________
MRI
NO metals
Pacemaker, surgical stent and clips
Supine for 45 to 60 mins
Titanium joint can have MRI
Imaging produced by magnetic fields, radio waves, and atomic nuclei to diagnose muscle and bone tissue
1. NOO ___________
2. Contradicted =
3. CLaustophobia??
4. Is patient able to lay supine for _____
5. Patient with _____________ ________ may get MRI
JOint swelling
Finger tips = Herbeden nodes
Bouchard = Middle
Crepitus - Grating of bones
Activity
Joint fluid
Osteoarthritis manifestations
Joint ________________ and pain
Herbeden nodes (________)
Bouchard nodes (________)
Crepitus??
Pain worsens with _____________
joint _________
Ice and heat therapy
ROM exercises
Good rest and diet
Osteoarthritis interventions
Pain mangaement
______/_______ therapy
ROM exercises
Good ________ and diet
Assistive devices
PT
Corticosteriods
NSAIDs
Topical analgesics
Osteoarthritis meds =
Rhuematoid arthritis (RA)
Chronic progresive autoimmune connective tissue disorder affecting synovial joints (shoulder, elbow, hips)
NO
SHould u elevate legs for RA?
AM stiffness; pain at rest
Bilateral
red, edema
dry mouth and eyes
tingly, and numb in hands and feet
Manifestations of RA
What time of the day stiffness? and pain at ______
___________ joint inflamation
Warm, ______, ________ affecting area
______ eyes and mouth
__________ in hands and feet
ICE heat therapy
PT
Monitor for fatigue
Interventions for RA
___________ therapy
PT
MOnitor for ________
Corticosteriods
NSAIDS
DMARDS
BIologic response modifiers
What meds for RA?
Methotrexate
Leflominade
Hydryxchloroquine
DMARD examples
Etancercept (Enbrel) and Adairmuab
Biologic response modifiers ?
Gouty arthritis
Systemic inflammation disease caused by purine metabolism or hyperuricemia
Excess alcohol
Increase intake of purine (organ meats, yeast, spinach, sardines)
Factors for gouty arthritis
Genetic
Excess _________
Increase intake of _________ (..)
Obesity
DM and Kidney _______
BIg toe
Tophi
Renal crystals
joint damage and deformity
S/S of gouty arthritis
Excruciating pain/inflammation of small joints like _________ ___
_______ (deposts of sodium crystals
Increase uric acid _________ _________
Progressive joint ______________ and DEFORMITY
No alcohol
Decrease weight (slowly)
Fluid intake 3 L daily
Limit purine diet
Bed cradle
INterventions for gouty arthritis
NO _________
DECREASE ____________
Fluid intake =
Limit ________ diet
Bed _________ to keep linen elevated above affected joint
Acute = Colchicine
Chronic = Allopurinol
MEdications for gouty arthritis
Acute =
Chronic =
NSAIDS
Coticosteriods (-sone)
greenstick fracture
Compound fracture
Spiral fracture
a fracture in which the bone has been twisted apart
Comminuted fracture
Pain
Pressure
Paralysis
Pallor
Pulselessness
Paresthesia
What are the 6 P's for neruvascular status?
Monitor skin temperature
fat embolsim
Compartment syndrome
Body alignment
How to care for fractures
MOnitor skin _________
Monitor complications for fat ________________ (...)
Monitor for _____________syndrome
Maintain body ________________
Cyanosis
Pallor
Paresthesia
Tinly
Paralysis
Pain unrelieved by meds and positioning
Compartment syndrome s/s
Anxiety confusion
tachycardia
chest pain
hemotypsis
PEtechiae (neck, chest, ab)
Fat embolism symtoms
Assess neurovasular status
Allow cast to air dry
ELEVATE extremity
TEll patient to not place anything on the cast bc it will increase inflammation
Care for a cast
1. Assess ____________________ status
2. Allow cast to _____ ______. Handle with palms when drying
3. _____________ extremity
4. Tell patient to...
Skin traction
Mechanical pull to overcome muscle spasm and to immobilize or decrease pain
Bucks
Bryants
Pelvic
Cervical halter
Types of skin traction?
Skeletal traction
Applied to bone to decrease fracture/maintain surgically manipulated bone alignment
Pins and wires
Balances suspension
Skeletal traction
1. ______/_________ are in skin and soft tissue in bone
2. Balanced _____________ using splints, weights, slings
External fixation devices
Rigid metal frames with pins and wires to align and immobilize
Assess pulse
Maintain proper body alignement
Check SKIN
Strengthening exercises
PIn site protocol
MEDS = opioids, NSAIDs, muscle relaxtant
External fixation devices
Care
Assess _______ and vascular status
Maintain proper ....
Check ________
Do __________- exercises
PT
_______ site protocol
MEDS =
Total joint arthroplasty
Surgical procedure performed to replace a joint with presthetic. For ankle. finger, elbow, toe, wrist, hip, and knee
Trauma
Impaired mobility related to OA
COngenital
Osteonecrosis
Factors for Total joint arthroplasty
Hip = abductor pillow in place, dont flex hip greater than 90 degreees, dont place on operative side
Knee = CPM (continuous passive motion machine)
Total joint arthroplasty
Care
Positioning
- Hip = Keep abductor __________ in place in bed
DONT flex hip _______
DONT position on __________ side
- Knee = Maintain ______ to promote joint immobility
Circles feet
Push down on bed and tighten quads
Leg raises
Total joint arthroplasty
What exercises to perform?
Assess pain, rotation, extremity shorening
Check neurovascular status
Aseptic technique
Toliet seat extender
Ambular day of surgery, after stabilization and, discharge of PACU
Total joint arthroplasty
Care
Assess pain, _________, and extremity shortening
Check ________________ status
What technique for wound cleaning and drainage
MONitor infections
Toliet _________ _____________
AMBULATE day of ___________, after ______________
Ambulatory and exercise
Client educaiton for Total joint arthroplasty
A
E
Physical therapy and occupational therapy
Total joint arthroplasty Referal =
Osteoporosis
Chronic disease in which bone loss causes decrease density and fractures
Women > 65
Men > 75
Asian and white
Decrease estrogen
Osteoporosis factors
Primary
Women > ____
Men > _____
What ethnicities?
Genetic
Decrease ___________ and androgen
Decrease PROTEIN
NO exercise
Smoking and alcohol
Bone cancer
Cushing syndrome
Prolonged immobilization
RA
Pagets disease
MEds like loop diuretic, phenytoin, corticosteriods
Osteoporosis factors
Secondary
Bone __________
_______ syndrome
DM
Prolonged ...
RA
_________ disease
Medications like
Short height
History of fractures
Thoracic kyphosis
Decrease bone mass
Manifestations of osteoporosis
1.
2.
3.
4.
Walking
Vitamin D and calcium
Fall precautions
MEds like Vit D and calcium supplements, calcitonnin, PTH hormone (Feotoe SC daily) Biphosphates, and estrogen aganosit
Interventions for osteoposis
1. Strengthening exercises and __________-
2. Increase in foods like
3. NO SMOKING
4. What precautions?
5. MEds?
Osteomyelitis
Acute and chronic bone infection
DM
Hemodialysis
Injection drug use
Poor blood supply
Trauma
What are factors of Osteomyelitis
Bone pain
Fever
Discomfort and ill feeling
Chills and sweating
sweeling of ankles, feet and legs
Osteomyelitis Manifestations
1. Bone pain
2. _______
3. Discomfort, _____ feeling
4. Local....
5. Chills, _______, back pain
6. Swelling of?
IV antiobitiocs ASAP
WOund drainge = contact precautions
Finish full course of antibiotics
Wound irrigation
MEds = Analgesics and antiobics
Osteomyelitis interventions
1. _____ ASAP
2. Wound drainge =
3. Finish full course of ?
4. Wound irrigation
5. Meds =
Confusion and restless
Dyspnea
Chest petechiae
Hypoxia
Fever
Symptoms of Fat embolsim