5 P's
Pain
Pulse
Pallor
Paresthesia
Paralysis
Osteoarthritis
Degenerative joint disease
-noninflammatory, localized
-most common disability
-progressive
-affects cartalidge
Osteoarthritis Symptoms
Pain (dull, ache, throb)
Crepitus
Stiffness
Rheumatoid Arthritis
Autoimmune
-inflammatory, systemic
-chronic and progressive
-affects synovial joints
Rheumatoid Treatment
Methotrexate (DMARDs)
Entracept
Humira
Steroids (BRMs)
Rheumatoid Early Symptoms
Joint Stiffness
Swelling
Pain
Fatigue
Generalized weakness
Low grade fever
Rheumatoid Late Symptoms
Inflammation
Deformity
Morning Stiffness
ROM and ADL limitations
Arthritis Self Management
exercise, weight loss, cane usage
Gout
urate crystal buildup
Gout Treatment
NSAIDs
Allopurinol (prevents uric acid production)
Colchicine
Low protein and purine diet, eat plenty of fish
Osteoporosis
common in thin, white women post menopause
first sign usually fracture
low calcium
Osteomalacia
soft bones due to vitamin D deficiancy
Pagets Disease
bones broken down and reformed over and over
Osteomyelitis
infection of the bone
--*
PAIN is the priority
--Swelling leads to decresed blood flow, necrosis, and abscess
Osteomyelitis Treatment
Pain medications
Antibiotics via PICC
Wound Care
Hyperbaric oxygen chamber
Acute Osteomyelitis
Fever greater than 101
Swelling
Erythema
Tenderness
Constant Bone Pain
Chronic Osteomyelitis
Ulceration of Skin
Sinus tract formation
localized pain
Drainage
Hip Replacement
position correctly, keep leg abducted
--no hip flexion more than 90 degrees
--no bending over in chair
--no crossing legs
--no twisting body
--Incision care
--no extreme weight bearing
--Q2 turns
Knee Care
CPM machine
No rotations internal or external
Frequent rest
Cane
helps maintain balance by widening base of support
---least supportive is standard crook cane
Crutches
Removes weight off one or both legs
-proper use
Walker
most stability and wide base of support
VTE
Do NOT massage legs
Use compression techniques (stockings, wraps, machines)
Stages of Bone Healing
Hematoma (mass of clotted blood)
Callus Formation (soft callus, cartilaginous splint)
Bony callus formation (hard callus, new spongy bone)
Remodeling (remove spongy bone and replace w/ compact bone)
Wound healing diet
Calories = energy to heal
Carbs = cell growth
Protein = tissue repair
Fats = concentrated source of calories
Vitamin A = increase wound strength
Vitamin C = collagen synthesis
Zinc = collagen, protein synthesis
Water = maintain hydration
Acute Compartment Syndrome
Increased pressure causes reduced circulation
--most common in lower extremities and forearms
Acute Compartment Syndrome Treatment
Relief of pressure by Bivalving the cast. Fasciotomy or incision into fascia.
---If not taken care of tissue necrosis, infection, extremity contracture, and renal failure may result.
Acute Compartment Syndrome Causes
External: tight, bulking dressing or cast, burn, snake bites, IV fluid infiltration, extreme edema
Internal: blood or fluid accumulation
Trauma/contamination >> Pressure causes histamine release >> edema >> decreased ischemia and perfusion >> necrosis
Crush Syndrome
Crush injury that compresses compartments
Life threatening
Cause kidney failure from myoglobin blocks
Crush Syndrome Causes
Twisting injury
Natural Disasters
Work related injury
drug/alcohol overdose
Fall
Acute Compartment Syndrome Complications
Infection
Motor Weakness
Contractures
Myoglobinuric Renal Failure
Amputation
Fat Embolism
Earliest manifestation
altered oxygenation
characterized by
change in mental status/confusion
--commonly seen in lungs
--impair organ perfusion
Fat Embolism S/S
Dyspnea
Chest pain
Crackles
Petechiae
Thrombocytopenia
Decrease SpO2
Fat Embolism Treatment
OXYGEN
Hydration
Steroids
Best Rest
Gentle handling
Fracture immobilization
Transverse Fracture
occurs straight across the bone
Linear Fracture
non-displaced, runs parallel to shaft
Oblique Fracture
non-displaced, runs diagonal
Displaced/Compound Fracture
bone is separated w/ full fracture
--exits skin
Spiral Fracture
ragged break occurs when excessive twisting forces are applied to a bone
Greenstick fracture
bending and incomplete break of a bone; most often seen in children
Comminuted Fracture
bone breaks into many fragments (direct trauma)
Casts
Keep limb elevated and not resting on hard surface
-check distally for circulation
External Fixation
a fracture treatment procedure in which pins are placed through the soft tissues and bone so that an external applicance can be used to hold the pieces of bone firmly in place during healing
Internal Fixation
a fracture treatment in which a plate or pins are placed directly into the bone to hold the broken pieces in place
Skin Traction
Pulling force directly to skin and soft tissue
Immobilize fracture and relieve muscle spasms and pain
--temporary
--more weight = higher risk for skin breakdown
Skin Traction Contraindications
Pressure Ulcers
Dermatitis
Burns
Abrasions
Skin Traction - High Risk Patients
Older Adults
Tissue Perfusion issues
Monitor skin Q4
Skeletal Traction
Used for multiple traumas that cannot be repaired all at one time
--
meticulous skin site care required
--risk for infection
--neuro assessment every shift
--weights must hang freely off floor
Risk Factors for Surgical Complications
Older than 65
History of Malignant Hyperthermia
Drugs, Alcohol, Smoking
Medications (herbs, anticoagulants, antihypertensives)
Diabetes, Autoimmune, etc.
Immobilizers
Splints, Slings, braces
Outpatient Surgery
do not let patient drive home
Elective Surgery
planned, but not acute
--knee replacement
Urgent Surgery
immediate but not emergent
--knee infection
Emergent Surgery
requires immediate intervention
--knee bone protruding from skin
Number 1 Priority for Surgery
Patient Safety
Malnutrition
occurs w/ obesity and anorexia
What medications should be stopped before surgery?
Aspirin, anticoagulants
When is an EKG required for a surgical patient
Starting at age 40 or w/ heart condition
Pre Op
scheduling of surgery to transfer to surgical suite
Nursing Roles Pre-Op
verify informed consent is signed
clarify information for the patient
education
NPO maintained
Advanced Directives/DNR followed
Risk for Venous Thromboembolism
Obese
other than 40
Cancer patient
Immobility/decreased mobility
Spinal Cord injury
History of DVT
Oral contraceptives
When should the patient ambulate after surgery?
As soon as possible
Time Out Surgery
Verify patient, procedure, site, etc
Surgical Assistant
suctions wounds, cuts, sutures, etch
Anesthesiologist
gives anesthesia
Holding Area Nurse
manages care in the holding area
Circulating Nurse
coordinate, oversee, involved in nursing care in OR
Coordinates all activities w/in OR
Count Instruments
Administer medications
Scrub Nurse
Set up Sterile fields
Hands over =surgical instruments
Counts instruments
Specialty nurse
Specialty surgeries
What must all people who enter the OR wear?
Mask
Malignant Hyperthermia
Fever
Low CO2
Tachycardia
Dysrhythmias
Muscle Rigidity
Hypotension
Tachypnea
Cola Colored urine
Skin mottling
Cyanosis
Malignant Hyperthermia Treatment
DANTROLENE SODIUM
Types of Anesthesia
general, regional, local, conscious sedation
Anesthesia stages
stage 1 = analgesia, conscious
stage 2 = excitement, delirium, violent behavior, incr BP/resp/HR, retching, vomiting, etc
stage3 = no eye movement, fixed pupils, regular resps, relax skel muscle
stage 4 = resp depression, decr vasomotor
Post Op Monitoring
RESPIRATORY
Decreased or no peristalsis for 24 hrs