Term
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Definition
| injury to the ligamentous structures surrounding a joint, usually caused by a wrenching or twisting motion. Most sprains occur in the ankle and knee joints. A sprain is classified according to the degree of ligament damage. |
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Term
| first-degree (mild) sprain |
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Definition
| involves tears in only a few fibers resulting in mild tenderness and minimal swelling. |
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Term
| second-degree (moderate) sprain |
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Definition
| sprain is partial disruption of the involved tissue with more swelling and tenderness. |
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Term
| third-degree (severe) sprain |
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Definition
| a complete tearing of the ligament in association with moderate to severe swelling. A gap in the muscle may be apparent or palpated through the skin if the muscle is torn. Because areas around joints are rich in nerve endings, the injury can be extremely painful. |
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Term
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Definition
| an excessive stretching of a muscle, its fascial sheath, or a tendon. Most strains occur in the large muscle groups including the lower back, calf, and hamstrings. Strains may also be classified as first degree (mild or slightly pulled muscle), second degree (moderate or moderately torn muscle), and third degree (severely torn or ruptured or muscle). |
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Term
| Clinical Manifestations of sprains and strains |
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Definition
| pain, edema, decrease in function, and contusion. Pain aggravated by continued use is common. Edema develops in the injured area because of tiny hemorrhages within the disrupted tissues and the ensuing local inflammatory response. Usually the patient will recount a history of traumatic injury, possibly of an inversion or twisting nature, or recent exercise activity. |
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Term
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Definition
| usually self-limiting, with full function returning within 3 to 6 weeks. X-rays of the affected part may be taken to rule out a fracture or widening of the joint structure. |
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Term
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Definition
| can result in a concomitant avulsion fracture, in which the ligament pulls loose a fragment of bone. Alternatively, the joint structure may become unstable and result in subluxation or dislocation. At the time of injury, hemarthrosis (bleeding into a joint space or cavity) or disruption of the synovial lining may occur. Severe strains may require surgical repair of the muscle, tendon, or surrounding fascia. |
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Term
| If sprain/strain injury occurs: immediate care |
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Definition
| care focuses on (1) stopping the activity and limiting movement, (2) applying ice compresses to the injured area, (3) compressing the involved extremity, (4) elevating the extremity, and (5) providing analgesia as necessary |
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Term
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Definition
| (rest, ice, compression, elevation) has been found to decrease local inflammation and pain for most musculoskeletal injuries. Movement should be restricted and the extremity rested as soon as pain is felt. . Unless the injury is severe, prolonged rest is usually not indicated. |
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Term
| Cold (cryotherapy) physiological changes |
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Definition
| occur in soft tissue as a result of the use of cold include vasoconstriction and a reduction in the transmission and perception of nerve pain impulses. These changes result in analgesia and anesthesia, reduction of muscle spasm without changes in muscular strength or endurance, reduction of local edema and inflammation, and reduction of local metabolic requirements. Cold is most useful when applied immediately after the injury has occurred. Ice applications should not exceed 20 to 30 minutes per application, and ice should not be applied directly to the skin. |
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Term
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Definition
| helps limit swelling, which, if left uncontrolled, could lengthen healing time. An elastic compression bandage can be wrapped around the injured part. The bandage should be wrapped starting distally (at the point farthest from the midline of the body), and progressing proximally (toward the midline of the body), to encourage fluid return. The bandage is too tight if numbness is felt below the area of compression or there is additional pain or swelling beyond the edge of the bandage. The bandage can be left in place for 30 minutes and then removed for 15 minutes. However, some elastic wraps are left on during training, athletic, and occupational activities. |
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Term
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Definition
| The injured part should be elevated above the heart level to help mobilize excess fluid from the area and prevent further edema. The injured part should be elevated even during sleep. Mild analgesics and nonsteroidal antiinflammatory drugs (NSAIDs) may be necessary to manage patient discomfort. |
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Term
| After the acute phase (24-48 hours) |
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Definition
| warm, moist heat may be applied to the affected part to reduce swelling and provide comfort. Heat applications should not exceed 20 to 30 minutes allowing a “cool-down” time between applications. NSAIDs may be recommended to decrease edema and pain. Encourage the patient to use the limb, provided that the joint is protected by means of casting, bracing, taping, or splinting. Movement of the joint maintains nutrition to the cartilage, and muscle contraction improves circulation and resolution of the contusion and swelling. |
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Term
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Definition
| a severe injury of the ligamentous structures that surround a joint. Dislocation results in the complete displacement or separation of the articular surfaces of the joint. |
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Term
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Definition
| a partial or incomplete displacement of the joint surface. The clinical manifestations of a subluxation are similar to those of a dislocation but are less severe. Treatment of subluxation is similar to that of a dislocation, but subluxation may require less healing time. |
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Term
| most obvious sign/symptom of a dislocated extremity |
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Definition
| deformity. For example, if a hip is dislocated in a posterior or backward direction, the limb can be shorter and is often internally rotated on the affected side. Additional manifestations include local pain, tenderness, loss of function of the injured part, and swelling of the soft tissues in the region of the joint. The major complications of a dislocated joint are open joint injuries, intraarticular fractures, avascular necrosis (bone cell death as a result of inadequate blood supply), and damage to adjacent neurovascular tissue. |
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Term
| Nurse's role with dislocation emergency |
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Definition
| requires prompt attention and is considered an orthopedic emergency. The longer the joint remains unreduced, the greater the possibility of avascular necrosis. Compartment syndrome may also occur after a dislocation, and dislocation is often associated with significant vascular injury. The hip joint is particularly susceptible to avascular necrosis. Neurovascular assessment is critical. |
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Term
| First goal of dislocation management |
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Definition
| realign the dislocated portion of the joint in its original anatomic position. This can be accomplished by a closed reduction, which may be performed under local or general anesthesia or intravenous (IV) conscious sedation. Anesthesia is often necessary to produce muscle relaxation so that the bones can be manipulated. In some situations, surgical open reduction may be necessary. After reduction, the extremity is usually immobilized by bracing, splinting, taping, or using a sling to allow the torn ligaments and capsular tissue time to heal. |
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Term
| Nursing management of subluxation or dislocation |
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Definition
directed toward relief of pain and support and protection of the injured joint. Resist the impulse to immediately reduce a dislocation without evaluation by a clinician. After the joint has been reduced and immobilized, motion is usually restricted. A carefully regulated rehabilitation program can prevent fracture instability and joint dysfunction. Gentle range of motion (ROM) may be started if the joint is stable and well supported. An exercise program slowly restores the joint to its original ROM without causing another dislocation. The patient should gradually return to normal activities.
A patient who has dislocated a joint may be at greater risk for repeated dislocations because of loose ligaments. Activity restrictions may be imposed on the use of the affected joint to decrease the risk of repeatedly dislocating the joint. |
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Term
| pathology of Carpal tunnel syndrome (CTS)? |
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Definition
| caused by compression of the median nerve, which enters the hand through the narrow confines of the carpal tunnel (Fig. 63-2). The carpal tunnel is formed by ligaments and bones. CTS is the most common compression neuropathy in the upper extremity. This syndrome is associated with hobbies or occupations that require continuous wrist movement (e.g., musicians, painters, carpenters, computer operators). This condition often is caused by pressure from trauma or edema caused by inflammation of a tendon (tenosynovitis), neoplasm, rheumatoid arthritis, or soft tissue masses such as ganglia. Hormones may be involved as initial manifestations often occur during the premenstrual period, pregnancy, and menopause. Persons with diabetes mellitus and hypothyroidism have a higher incidence of CTS. Women are more likely than men to develop CTS, possibly due to a smaller carpal tunnel. |
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Term
| clinical manifestations of CTS? |
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Definition
| weakness (especially of the thumb), burning pain, and numbness, or impaired sensation in the distribution of the median nerve and clumsiness in performing fine hand movements. Numbness and tingling may awaken the patient at night. Shaking the hands will often relieve these symptoms. |
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Term
| -What are the names of the 2 signs (not how to do, but awareness of them) |
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Definition
| Physical signs of CTS include Tinel's sign and Phalen's sign. Tinel's sign can be elicited by tapping over the median nerve as it passes through the carpal tunnel in the wrist. A positive response is a sensation of tingling in the distribution of the median nerve over the hand. Phalen's sign can be elicited by allowing the wrists to fall freely into maximum flexion and maintain the position for longer than 60 seconds. A positive response is a sensation of tingling in the distribution of the median nerve over the hand. In late stages there is atrophy of the thenar muscles around the base of the thumb, resulting in recurrent pain and eventual dysfunction of the hand. |
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Term
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Definition
| rotator cuff is a complex of four muscles in the shoulder: the supraspinatus, infraspinatus, teres minor, and subscapularis muscles. These muscles act to stabilize the humeral head in the glenoid fossa while assisting with the ROM of the shoulder joint and rotation of the humerus. Degenerative changes of the rotator cuff may be associated with normal aging. |
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Term
| What precipitates an injury; can occur with normal aging process, from RSI, or an injury, such as a fall. |
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Definition
| A tear in the rotator cuff may occur as a gradual, degenerative process resulting from aging, repetitive stress (especially overhead arm motions), or injury to the shoulder while falling. The rotator cuff can tear as a result of sudden adduction forces applied to the cuff while the arm is held in abduction. In sports, repetitive overhead motions, such as in swimming, racquet sports (tennis, racquetball), and baseball (especially pitching), are activities that often cause injury. Other causative factors include (1) falling onto an outstretched arm and hand, (2) a blow to the upper arm, (3) heavy lifting, or (4) repetitive work motions. |
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Term
| What are the signs/symptoms of an injury? |
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Definition
| Manifestations of a rotator cuff injury include shoulder weakness and pain and decreased ROM. The patient usually experiences severe pain when the arm is abducted between 60 and 120 degrees (the painful arc). The drop arm test, in which the arm falls suddenly after the patient is asked to slowly lower the arm to the side after it has been abducted 90 degrees, is another sign of rotator cuff injury. An x-ray alone is usually not beneficial in the diagnosis of a rotator cuff injury. A tear can be confirmed by magnetic resonance imaging (MRI). |
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Term
| What is the treatment or repair of a torn rotator cuff? |
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Definition
| The goal of treatment emphasizes maintaining passive ROM and the return of abduction strength. The patient with a partial tear or cuff inflammation may be treated conservatively with rest, ice and heat, NSAIDs, corticosteroid injections into the joint, and physical therapy. If the patient does not respond to conservative treatment or if a complete tear is present, a surgical repair may be necessary. Most surgical repairs are performed through an arthroscope.7 If an extensive tear is present, acromioplasty (surgical removal of part of the acromion to relieve compression of rotator cuff during movement) may be necessary. A sling, or more commonly, a shoulder immobilizer may be used immediately after surgery to limit shoulder movement. |
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Term
| What is a concern for the patient who has had a rotator cuff repair? |
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Definition
| shoulder should not be immobilized for too long a period because “frozen” shoulder or arthrofibrosis may occur. Pendulum exercises and physical therapy begin the first postoperative day. |
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Term
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Definition
| disruption or break in the continuity of the structure of bone. |
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Term
| 2 types ways in which bone fractures occur |
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Definition
Pathological occur when?? --Although some fractures are secondary to a disease process (pathologic fractures from cancer or osteoporosis).
-Traumatic is the most common |
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Term
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Definition
| the break is completely through the bone |
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Term
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Definition
| the fracture occurs partly across a bone shaft but the bone is still in one piece. An incomplete fracture is often the result of bending or crushing forces applied to a bone. |
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Term
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Definition
| the skin is broken, exposing the bone and causing soft tissue injury. |
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Term
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Definition
| the skin has not been ruptured and remains intact. |
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Term
Clinical Manifestions of fractures
Front (Manifestation) |
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Definition
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Term
(Manifestation)
Edema and Swelling
Disruption and penetration of bone through skin or soft tissues, or bleeding into surrounding tissues |
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Definition
| (significance) Unchecked bleeding, swelling, and edema in closed space can occlude circulation and damage nerves (e.g., risk of compartment syndrome). |
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Term
Pain and Tenderness
Muscle spasm as a result of involuntary reflex action of muscle, direct tissue trauma, increased pressure on nerves, movement of fracture parts
MANIFESTATION |
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Definition
Pain and tenderness encourage splinting of muscle around fracture with reduction in motion of injured area.
SIGNIFICANCE |
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Term
Muscle Spasm
Irritation of tissues and protective response to injury and fracture
MANIFESTATION |
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Definition
Muscle spasms may displace nondisplaced fracture or prevent it from reducing spontaneously.
SIGNIFICANCE |
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Term
Deformity
Abnormal position of extremity/part as result of original forces of injury and action of muscles pulling fragment into abnormal position; seen as a loss of normal bony contours
MANIFESTATION |
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Definition
Deformity is cardinal sign of fracture; if uncorrected, it may result in problems with bony union and restoration of function of injured part.
SIGNIFICANCE |
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Term
Ecchymosis/Contusion
Discoloration of skin as a result of extravasation of blood in subcutaneous tissues
MANIFESTATION |
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Definition
Ecchymosis may appear immediately after injury and may appear distal to injury. Reassure patient that process is normal and discoloration will eventually resolve.
SIGNIFICANCE |
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Term
Loss of Function
Disruption of bone or joint, preventing functional use of limb or part
MANIFESTATION |
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Definition
Fracture must be managed properly to ensure restoration of function to limb/part.
SIGNIFICANCE |
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Term
Crepitation
Grating or crunching together of bony fragments, producing palpable or audible crunching or popping sensation
MANIFESTATION |
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Definition
Crepitation may increase chance for nonunion if bone ends are allowed to move excessively. Micromovement of bone-end fragments (postfracture) assists in osteogenesis (new bone growth).
SIGNIFICANCE |
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Term
| Stage of fracture healing • 1.Fracture hematoma. |
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Definition
| When a fracture occurs, bleeding creates a hematoma, which surrounds the ends of the fragments. The hematoma is extravasated blood that changes from a liquid to a semisolid clot. This occurs in the initial 72 hours after injury. |
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Term
| Stage of fracture healing • 2.Granulation tissue. |
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Definition
| During this stage, active phagocytosis absorbs the products of local necrosis. The hematoma converts to granulation tissue. Granulation tissue (consisting of new blood vessels, fibroblasts, and osteoblasts) produces the basis for new bone substance called osteoid during days 3 to 14 postinjury. |
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Term
| Stage of fracture healing • 3.Callus formation. |
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Definition
| As minerals (calcium, phosphorus, and magnesium) and new bone matrix are deposited in the osteoid, an unorganized network of bone is formed that is woven about the fracture parts. Callus is primarily composed of cartilage, osteoblasts, calcium, and phosphorus. It usually appears by the end of the second week after injury. Evidence of callus formation can be verified by x-ray. |
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Term
| Stage of fracture healing • 4.Ossification |
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Definition
| Ossification of the callus occurs from 3 weeks to 6 months after the fracture and continues until the fracture has healed. Callus ossification is sufficient to prevent movement at the fracture site when the bones are gently stressed. However, the fracture is still evident on x-ray. During this stage of clinical union the patient may be allowed limited mobility or the cast may be removed. |
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Term
| Stage of fracture healing • 5.Consolidation. |
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Definition
| As callus continues to develop, the distance between bone fragments diminishes and eventually closes. During this stage ossification continues. It can be equated with radiologic union. Radiologic union occurs when there is x-ray evidence of complete bony union. This phase can occur up to a year following injury. |
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Term
| Stage of fracture healing • 6.Remodeling |
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Definition
| Excess bone tissue is reabsorbed in the final stage of bone healing, and union is completed. Gradual return of the injured bone to its preinjury structural strength and shape occurs. Bone remodels in response to physical loading stress or Wolf's law.12 Initially, stress is provided through exercise. Weight bearing is gradually introduced. New bone is deposited in sites subjected to stress and resorbed at areas where there is little stress. Radiologic union is present. |
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Term
| Explain a Closed Reduction of a fracture? |
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Definition
| nonsurgical, manual realignment of bone fragments to their previous anatomic position. Traction and countertraction are manually applied to the bone fragments to restore position, length, and alignment. Closed reduction is usually performed while the patient is under local or general anesthesia. After reduction, traction, casting, external fixation, splints, or orthoses (braces) immobilize the injured part to maintain alignment until healing occurs. |
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Term
| Explain an Open Reduction of a fracture? |
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Definition
| the correction of bone alignment through a surgical incision. It usually includes internal fixation of the fracture with the use of wires, screws, pins, plates, intramedullary rods, or nails. The type and location of the fracture, age of patient, and presence of concurrent disease, as well as the result of attempted closed reduction by means of traction, may influence the decision to use open reduction. The chief disadvantages of this form of fracture management are the possibility of infection, the complications associated with anesthesia, and the effect of preexisting medical conditions (e.g., diabetes) in the patient. |
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Term
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Definition
| application of a pulling force to an injured or diseased part of the body or an extremity while countertraction pulls in the opposite direction. |
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Term
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Definition
| (1) prevent or reduce pain and muscle spasm associated with low back pain or cervical sprain (e.g., whiplash), (2) immobilize a joint or part of the body, (3) reduce a fracture or dislocation, and (4) treat a pathologic joint condition (e.g., tumor, infection). Traction is also indicated to (1) provide immobilization to prevent soft tissue damage, (2) promote active and passive exercise, (3) expand a joint space during arthroscopic procedures, and (4) expand a joint space before major joint reconstruction |
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Term
| traction used to treat fractures |
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Definition
| forces are usually exerted on the distal fragment to obtain alignment with the proximal fragment. Several types of traction can be used for this purpose. One of the more common types is Buck's traction. Fracture alignment depends on the correct positioning and alignment of the patient while the traction forces remain constant. For extremity traction to be effective, forces must be pulling in the opposite direction (countertraction). Countertraction is commonly supplied by the patient's body weight or by weights pulling in the opposite direction, and may be augmented by elevating the end of the bed. It is imperative to maintain traction continuously and keep the weights off the floor and moving freely through the pulleys. |
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Term
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Definition
| is generally used for short-term treatment (48 to 72 hours) until skeletal traction or surgery is possible. Tape, boots, or splints are applied directly to the skin to maintain alignment, assist in reduction, and help diminish muscle spasms in the injured extremity. The traction weights are usually limited to 5 to 10 lb (2.3 to 4.5 kg). Pelvic or cervical skin traction may require heavier weights applied intermittently. |
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Term
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Definition
| generally in place for longer periods than skin traction, is used to align injured bones and joints or to treat joint contractures and congenital hip dysplasia. It provides a long-term pull that keeps the injured bones and joints aligned. To apply skeletal traction, the physician inserts a pin or wire into the bone, either partially or completely, to align and immobilize the injured body part. Weight for skeletal traction ranges from 5 to 45 lb (2.3 to 20.4 kg). The use of too much weight can result in delayed union or nonunion. The major disadvantages of skeletal traction are infection in the area of the bone where the skeletal pin is inserted and the consequences of prolonged immobility. |
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Term
| Have a basic, principle understanding of fracture immobilization with a cast |
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Definition
A cast is a temporary circumferential immobilization device.12 Casting is a common treatment following closed reduction. It allows the patient to perform many normal activities of daily living while providing sufficient immobilization to ensure stability. Cast materials are natural (plaster of paris), synthetic acrylic, fiberglass free, latex-free polymer, or a hybrid of materials. A cast generally incorporates the joints above and below a fracture. Immobilization above and below a joint restricts tendinoligamentous movement, therefore assisting with joint stabilization while the fracture heals.
After bony prominences have been padded, plaster of paris casting material is immersed in water. Then it is wrapped and molded around the affected part. The number of layers of plaster bandage and the technique of application determine the strength of the cast. The plaster sets within 15 minutes, so the patient may move around without difficulty. However, it is not strong enough for weight bearing until about 24 to 72 hours after application.
A fresh plaster cast should never be covered because air cannot circulate, heat builds up in the cast, and drying can be delayed. During the drying period direct pressure on the cast should be avoided. Handle the cast gently with an open palm to avoid denting the cast. Once the cast is thoroughly dry the edges may need to be petaled to avoid skin irritation from rough edges and to prevent plaster of paris debris from falling into the cast and causing irritation or pressure necrosis. Several strips (petals) of tape are placed by the health care provider over the rough areas to ensure a smooth cast edge.
Casts made of synthetic materials are being used more than plaster because they are lightweight, stronger, relatively waterproof, and provide for early weight bearing. The synthetic casting materials (thermolabile plastic, thermoplastic resins, polyurethane, and fiberglass) are activated by submersion in cool or tepid water. Then they are molded to fit the torso or extremity. |
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Term
| body jacket cast or brace |
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Definition
| often used for immobilization and support for stable spine injuries of the thoracic or lumbar spine. This cast is applied around the chest and abdomen and extends from above the nipple line to the pubis. After application of the cast, assess the patient for the development of cast syndrome. This condition occurs if the body cast is applied too tightly and the cast compresses the superior mesenteric artery against the duodenum. The patient generally complains of abdominal pain, abdominal pressure, nausea, and vomiting. Assess the abdomen for decreased bowel sounds (a window may be left over the umbilicus). Treatment includes gastric decompression with a nasogastric (NG) tube and suction. The cast may need to be removed or split. Assessment also includes observation of respiratory status, bowel and bladder function, and areas of pressure over the bony prominences, especially the iliac crest. |
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Term
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Definition
| used for treatment of femoral fractures. The purpose of the hip spica cast is to immobilize the affected extremity and the trunk securely. It includes two casts joined together: (1) the body jacket cast and (2) the long leg cast. The location of the femoral fracture will determine whether the thigh of the unaffected extremity will have to be immobilized to restrict rotation of the pelvis and possible hip motion on the side of the femur fracture. The hip spica cast extends from above the nipple line to the base of the foot (single spica) and may include the opposite extremity up to an area above the knee (spica and a half) or both extremities (double spica). |
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Term
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Definition
a metallic device composed of metal pins that are inserted into the bone and attached to external rods to stabilize the fracture while it heals. It can be used to apply traction or to compress fracture fragments and to immobilize reduced fragments when the use of a cast or other traction is not appropriate. The external device holds fracture fragments in place similar to a surgically implanted internal device. The external fixator is attached directly to the bones by percutaneous transfixing pins or wires (Fig. 63-13). External fixation is indicated in simple fractures, complex fractures with extensive soft tissue damage, correction of bony defects (congenital), pseudoarthrosis, nonunion or malunion, and limb lengthening.
External fixation has many advantages over other fracture management strategies and is often employed in an attempt to salvage extremities that otherwise might require amputation. Because the use of an external device is a long-term process, ongoing assessment for pin loosening and infection is critical. Infection signaled by exudate, erythema, tenderness, and pain may require removal of the device. Instruct the patient and caregiver about meticulous pin care. Although each physician has a protocol for pin care cleaning, half-strength hydrogen peroxide with normal saline is often used. |
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Term
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Definition
| Internal fixation devices (pins, plates, intramedullary rods, and metal and bioabsorbable screws) are surgically inserted at the time of realignment (Fig. 63-14). Biologically inert metal devices such as stainless steel, Vitallium, or titanium are used to realign and maintain bony fragments. Proper alignment is evaluated by x-ray studies at regular intervals |
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Term
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Definition
should consist of a peripheral vascular assessment (color, temperature, capillary refill, peripheral pulses, and edema) and a peripheral neurologic assessment (sensation, motor function, and pain). Throughout the neurovascular assessment, compare both extremities to obtain an accurate assessment.
Assess an extremity's color (pink, pale, cyanotic) and temperature (hot, warm, cool, cold) in the area of the affected extremity. Pallor or a cool/cold extremity below the injury could indicate arterial insufficiency. A warm, cyanotic extremity could indicate poor venous return. Next assess capillary refill (blanching of the nail bed). The standard for a compressed nail bed to return to its original color is within 3 seconds. Accurate documentation and ongoing neurovascular assessments are the cornerstones of nursing care for the individual with a musculoskeletal injury.
Compare pulses on both the unaffected and injured extremity to identify differences in rate or quality. Pulses are described as strong, diminished, audible by Doppler, or absent. A diminished or absent pulse distal to the injury can indicate vascular dysfunction and insufficiency. However, up to 12% of healthy adults do not have a palpable dorsalis pedis or posterior tibial pulse.15 Also assess peripheral edema; pitting edema may be present with severe injury.
Evaluate the ulnar, median, and radial nerves by assessing sensation and motor innervation in the upper extremity. Assess neurovascular status by abduction and adduction of the fingers, opposition of the fingers, and supination and pronation of the hand. In the lower extremity, dorsiflexion and plantar flexion assess motor function of the peroneal and tibial nerves. Sensory innervation is evaluated for the peroneal nerve on the dorsal part of the foot between the web space of the great and second toes. Tibial nerve assessment is performed by stroking the plantar surface (sole) of the foot. Contralateral evaluation is critical. Paresthesia (abnormal sensation [e.g., numbness, tingling]) and hypersensation/hyperesthesia may be reported by the patient. Partial or full loss of sensation (paresis/paralysis) may be a late sign of neurovascular damage. Reduced motion or strength in an injured extremity can alert you to potential limb-threatening complications or disability. |
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Term
| Drug Therapy for the fracture patient. Includes Central & Peripheral muscle relaxants such as; Flexeril, Soma, Robaxin to assist in pain management that is 2nd to muscle spasms. |
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Definition
| Patients with fractures experience varying degrees of pain associated with muscle spasms. Central and peripheral muscle relaxants, such as carisoprodol (Soma), cyclobenzaprine (Flexeril), or methocarbamol (Robaxin), may be prescribed for relief of pain associated with muscle spasms. |
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Term
| Common side effects associated with muscle relaxants |
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Definition
| drowsiness, headache, weakness, fatigue, blurred vision, ataxia, and gastrointestinal upset.14 Hypersensitivity reactions may include skin rash or pruritus. Ingestion of large doses of muscle relaxants may cause hypotension, tachycardia, or respiratory depression. The possible habituating effects associated with long-term use and the potential for abuse must be carefully considered. |
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Term
| In an open fracture the threat of tetanus can be reduced with tetanus and diphtheria toxoid or tetanus immunoglobulin for the patient who has not been previously immunized. |
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Definition
| Bone-penetrating antibiotics, such as a cephalosporin (e.g., cefazolin [Kefzol, Ancef]), are used prophylactically. |
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Term
| What is the nutritional and fluid requirement of the patient who has a fracture? |
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Definition
| include ample protein (e.g., 1 g/kg of body weight), vitamins (especially B, C, and D), and calcium, phosphorus, and magnesium to ensure optimal soft tissue and bone healing. Low serum protein levels and vitamin C deficiencies interfere with tissue healing. Immobility and callus formation increase calcium needs. Three well-balanced meals a day will usually provide the necessary nutrients. The well-balanced meal should be supplemented by a fluid intake of 2000 to 3000 mL/day to promote optimal bladder and bowel function. Adequate fluid and a high-fiber diet with fruits and vegetables will prevent constipation. If immobilized in bed with skeletal traction or in a body jacket or hip spica cast, instruct the patient to eat six small meals so as not to overeat and thus avoid abdominal pressure and cramping. |
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Term
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Definition
Teach the people in the community to take appropriate safety precautions to prevent injuries while at home, at work, when driving, or when participating in sports. Be a staunch advocate for personal actions known to reduce injuries, such as the regular use of seat belts, driving within posted speed limits, warming up muscles before exercise, use of protective athletic equipment (helmets and knee, wrist, and elbow pads), use of safety equipment at work, and not combining drinking and driving.
Encourage individuals (especially older adults) to participate in moderate exercise to aid in the maintenance of muscle strength and balance. To reduce falls, examine living environments so that scatter rugs are removed, adequate footwear and lighting should be maintained, and paths to the bathroom cleared for nighttime use. Also stress the importance of adequate calcium and vitamin D intake. |
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Term
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Definition
| Patients with fractures may be treated in an emergency department or a physician's office and released to home care, or they may require hospitalization for varying amounts of time. Specific nursing measures depend on the type of treatment used and the settings in which patients are placed. |
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Term
| Preoperative Management fx |
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Definition
If surgical intervention is required to treat a fracture, patients will need preoperative preparation. In addition to the usual preoperative nursing measures (see Chapter 18), inform patients of the type of immobilization and assistive devices that will be used and the expected activity limitations after surgery. Assure patients that their needs will be met by the nursing staff until they can again meet their own needs. Knowing that pain medication will be available if needed is often beneficial.
Proper skin preparation is an important part of preoperative preparation. The protocol for skin preparation varies among institutions and may be your responsibility. The aim of skin preparation is to assist in the cleansing of the skin and to remove debris and hair, thus reducing the possibility of infection. Careful attention to this preoperative treatment can influence the postoperative course. |
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Term
| Postoperative Management fx |
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Definition
Postoperative Management
In general, postoperative nursing care and management are directed toward monitoring vital signs and applying the general principles of postoperative nursing care (see Chapter 20). Frequent neurovascular assessments of the affected extremity are necessary to detect early and subtle neurovascular changes. Closely monitor any limitations of movement or activity related to turning, positioning, and extremity support. Pain and discomfort can be minimized through proper alignment and positioning. Carefully observe dressings or casts for any overt signs of bleeding or drainage. Report a significant increase in size of the drainage area. If a wound drainage system is in place, regularly measure and assess the patency of the system and the volume of drainage. Whenever the contents of a drainage system are measured or emptied, use aseptic technique to avoid contamination.
Additional nursing responsibilities depend on the type of immobilization used. A blood salvage and reinfusion system that allows for recovery and reinfusion of the patient's own blood may be used. The blood is retrieved from a joint space or cavity, and the patient receives this blood in the form of an autotransfusion. (Autotransfusion is discussed in Chapter 31.) Additional nursing measures for the patient who has had orthopedic surgery are discussed in NCP 63-2 on p. 1600. |
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Term
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Definition
| Patients often have reduced mobility as a result of the fracture. Plan care to prevent the many complications associated with immobility. Prevent constipation by increased patient activity and maintenance of a high fluid intake (more than 2500 mL/day unless contraindicated by the patient's health status) and a diet high in bulk and roughage (fresh fruits and vegetables). If these measures are not effective in maintaining the patient's normal bowel pattern, warm fluids, stool softeners, laxatives, or suppositories may be necessary. Maintain a regular time for elimination to promote bowel regularity. |
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Term
| What is the teaching that the nurse would do in regard to cast care? DO NOT: |
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Definition
• •Get cast wet.
• •Remove any padding.
• •Insert any objects inside cast.
• •Bear weight on new cast for 48 hr (not all casts are made for weight bearing; check with health care provider when unsure).
• •Cover cast with plastic for prolonged periods. |
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Term
| What is the teaching that the nurse would do in regard to cast care? DO: |
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Definition
• •Apply ice directly over fracture site for first 24 hr (avoid getting cast wet by keeping ice in plastic bag and protecting cast with cloth).
• •Check with health care provider before getting fiberglass cast wet.
• •Dry cast thoroughly after exposure to water.
o •Blot dry with towel.
o •Use hair dryer on low setting until cast is thoroughly dry.
• •Elevate extremity above level of heart for first 48 hr.
• •Move joints above and below cast regularly.
• •Use hair dryer on cool setting for itching.
• •Report signs of possible problems to health care provider.
o •Increasing pain.
o •Swelling associated with pain and discoloration of toes or fingers.
o •Pain during movement.
o •Burning or tingling under cast.
o •Sores or foul odor under the cast.
• •Keep appointment to have fracture and cast checked. |
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Term
| When is a fracture at risk for an infection and what is the collaborative care that may be provided? |
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Definition
| Open fractures and soft tissue injuries have a high incidence of infection. An open fracture usually results from the impact of severe external forces. Massive or blunt soft tissue injury often has more serious consequences than the fracture. Devitalized and contaminated tissue is an ideal medium for many common pathogens, including gas-forming (anaerobic) bacilli. Treatment of infection is costly in terms of extended nursing and medical care, time for treatment, and loss of patient income. Osteomyelitis can become chronic. |
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Term
| When is a fracture at risk for an infection and what is the collaborative care that may be provided? MORE COLLABORATIVE CARE |
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Definition
| Open fractures require aggressive surgical debridement.17 The wound is initially cleansed by pulsating saline lavage in the operating room. Gross contaminants are irrigated and mechanically removed. Contused, contaminated, and devitalized tissue such as muscle, subcutaneous fat, skin, and fragments of bone are surgically excised (debridement). The extent of the soft tissue damage determines whether the wound will be closed at the time of surgery, whether closed suction drainage may be necessary, and whether skin grafting will be needed. Depending on the location and extent of the fracture, reduction may be maintained by external fixation or traction. During surgery the open wound may be irrigated with antibiotic solution. Antibiotic-impregnated beads may also be placed in the surgical site. During the postoperative phase the patient will have antibiotics administered intravenously for 3 to 7 days. Antibiotics, in conjunction with aggressive surgical management, have greatly reduced the occurrence of infection. |
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Term
| What is Compartment Syndrome? |
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Definition
| Compartment syndrome is a condition in which elevated intracompartmental pressure within a confined myofascial compartment compromises the neurovascular function of tissues within that space. Compartment syndrome causes capillary perfusion to be reduced below a level necessary for tissue viability. It is classified as acute, chronic/exertional, or crush syndrome. Thirty-eight compartments are located in the upper and lower extremities |
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Term
| Understand the difference between the 2 types of compartment syndrome. |
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Definition
| . Two basic causes of compartment syndrome are (1) decreased compartment size resulting from restrictive dressings, splints, casts, excessive traction, or premature closure of fascia and (2) increased compartment contents related to bleeding, edema, chemical response to snakebite, or IV infiltration. Depending on the patient's age and body mass index, the expected range of intracompartmental pressure readings is 0 to 10 mm Hg. Readings of 30 mm Hg or higher indicate compartment syndrome. |
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Term
| -What does compartment syndrome “look” like – how will the patient present? |
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Definition
| Ischemia can occur within 4 to 8 hours after onset. Compartment syndrome may occur initially from the physiologic response of the body or may be delayed for several days from the original insult/injury. pallor, coolness, and loss of normal color of the extremity; (5) paralysis or loss of function; and (6) pulselessness or diminished/absent peripheral pulses.18 |
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Term
| What is the collaborative and independent care that the nurse may be involved in with the care of this problem? |
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Definition
Carefully assess the location, quality, and intensity of the pain (see Chapter 10). Evaluate the patient's level of pain on a scale of 0 to 10. Pain unrelieved by drugs and out of proportion to the level of injury is one of the first indications of impending compartment syndrome. Pulselessness and paralysis (in particular) are later signs of compartment syndrome. Notify the health care provider immediately of a patient's changing condition.
Because of the possibility of muscle damage, assess urine output. Myoglobin released from damaged muscle cells precipitates as a gel-like substance and causes obstruction in renal tubules. This condition results in acute tubular necrosis and acute kidney injury. Common signs are dark reddish brown urine and clinical manifestations associated with acute kidney injury (see Chapter 47).
Elevation of the extremity may lower venous pressure and slow arterial perfusion, thus the extremity should not be elevated above heart level. Similarly, the application of cold compresses may result in vasoconstriction and exacerbate compartment syndrome. It may also be necessary to remove or loosen the bandage and bivalve or split the cast in half. A reduction in traction weight may also decrease external circumferential pressures.
Surgical decompression (e.g., fasciotomy) of the involved compartment may be necessary. The fasciotomy site is left open for several days to ensure adequate soft tissue decompression. Infection resulting from delayed wound closure is a potential problem following a fasciotomy. Severe compartment syndrome may require amputation to decrease myoglobinemia or to replace a functionally useless extremity with a prosthesis. |
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Term
| What is Venous Thromboembolism (VTE)? |
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Definition
| The veins of the lower extremities and pelvis are highly susceptible to thrombus formation after a fracture, especially a hip fracture. Venous thromboembolism (VTE) may also occur after total hip or total knee replacement surgery.19 In patients with limited mobility, venous stasis is aggravated by inactivity of the muscles that normally assist in the pumping action of venous blood returning to the extremities. |
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Term
| -Who is at risk for developing a VTE? |
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Definition
| orthopedic surgical patient |
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Term
| -What are some preventative measures that can be put in place either collaboratively or independently by the nurse to prevent VTE? |
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Definition
| Because of the high risk of venous thromboembolism in the orthopedic surgical patient, prophylactic anticoagulant drugs such as warfarin, low-molecular-weight heparin, or fondaparinux (Arixtra) may be ordered. In addition to wearing compression gradient stockings (antiembolism hose) and using sequential compression devices, instruct the patient to move (dorsiflex/plantar flex) the fingers or toes of the affected extremity against resistance and to perform ROM exercises on the unaffected lower extremities. (Assessment and management of VTE are discussed in Chapter 38.) |
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Term
| What is Fat Embolism Syndrome (FES)? |
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Definition
| Fat embolism syndrome (FES) is characterized by the presence of systemic fat globules from fractures that are distributed into tissues and organs after a traumatic skeletal injury. FES is a contributory factor in many deaths associated with fractures. |
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Definition
| The fractures that most often cause FES are those of the long bones, ribs, tibia, and pelvis. FES has also been known to occur following total joint replacement, spinal fusion, liposuction, crush injuries, and bone marrow transplantation. One theory related to the origin of fat emboli suggests that fat is released from the marrow of injured bone and enters the systemic circulation where the fat embolizes to other organs such as the brain.20 A second theory postulates that a biochemical change initiated by injury sets up an inflammatory response causing a biochemical injury to the lung parenchyma. The tissues of the lungs, brain, heart, kidneys, and skin are most often affected. |
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Term
| What are the signs & symptoms of FES? |
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Definition
Early recognition of FES is crucial in preventing a potentially lethal course. Most patients manifest symptoms usually within 24 to 48 hours after the injury. Severe forms have occurred within hours of injury. The fat globules transported to the lungs cause a hemorrhagic interstitial pneumonitis that produces signs and symptoms of acute respiratory distress syndrome (ARDS), such as chest pain, tachypnea, cyanosis, dyspnea, apprehension, tachycardia, and decreased partial pressure of arterial oxygen (PaO2). All of these symptoms are caused by poor oxygen exchange. Because they are frequently the presenting symptoms, changes in mental status as a result of hypoxemia are important to recognize. Memory loss, restlessness, confusion, elevated temperature, and headache should prompt further investigation so that central nervous system involvement is not mistaken for alcohol withdrawal or acute head injury. The continued change in level of consciousness and petechiae located around the neck, anterior chest wall, axilla, buccal membrane, and conjunctiva of the eye helps distinguish fat emboli from other problems. Petechiae may appear due to intravascular thromboses caused by decreased oxygenation.
The clinical course of a fat embolus may be rapid and acute. Frequently the patient expresses a feeling of impending disaster. In a short time, skin color changes from pallor to cyanosis, and the patient may become comatose. No specific laboratory examinations are available to aid in the diagnosis. However, certain diagnostic abnormalities may be present. These include fat cells in the blood, urine, or sputum; a decrease of the PaO2 to less than 60 mm Hg; ST segment changes on electrocardiogram; a decrease in the platelet count and hematocrit levels; and a prolonged prothrombin time. A chest x-ray may reveal areas of pulmonary infiltrate or multiple areas of consolidation. This is sometimes referred to as the “white-out effect”. |
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Term
| What is the collaborative care for a patient experiencing FES? |
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Definition
| Treatment for fat embolism is directed at prevention. Careful immobilization of a long bone fracture is probably the most important factor in the prevention of fat embolism. Management of FES is essentially symptom related and supportive.20 Treatment includes fluid resuscitation to prevent hypovolemic shock, correction of acidosis, and replacement of blood loss. Encourage coughing and deep breathing. Reposition the patient as little as possible before fracture immobilization or stabilization because of the danger of dislodging more fat droplets into the general circulation. Use of corticosteroids to prevent or treat fat embolism is controversial. Oxygen is administered to treat hypoxia. Intubation or intermittent positive pressure ventilation may be considered if a satisfactory PaO2 cannot be obtained with supplemental oxygen alone. Some patients may develop pulmonary edema, ARDS, or both, leading to an increased mortality rate. Most persons survive FES with few sequelae. |
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Term
| FES is an acute emergency for the patient when reading the text think of what your initial actions should be for the patient? |
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Definition
| Treatment for fat embolism is directed at prevention. Careful immobilization of a long bone fracture is probably the most important factor in the prevention of fat embolism. Management of FES is essentially symptom related and supportive.20 Treatment includes fluid resuscitation to prevent hypovolemic shock, correction of acidosis, and replacement of blood loss. Encourage coughing and deep breathing. Reposition the patient as little as possible before fracture immobilization or stabilization because of the danger of dislodging more fat droplets into the general circulation. Use of corticosteroids to prevent or treat fat embolism is controversial. Oxygen is administered to treat hypoxia. Intubation or intermittent positive pressure ventilation may be considered if a satisfactory PaO2 cannot be obtained with supplemental oxygen alone. Some patients may develop pulmonary edema, ARDS, or both, leading to an increased mortality rate. Most persons survive FES with few sequelae. |
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Term
| Basic understanding of a Fracture of Pelvis and the problems that can occur from it. |
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Definition
Pelvic fractures range from benign to life threatening, depending on the mechanism of injury and associated vascular insult.21 Although only a small percentage of all fractures are pelvic fractures, this type of injury is associated with the highest mortality rate. Preoccupation with more obvious injuries at the time of a traumatic event may result in an oversight of pelvic injuries. Pelvic fractures may cause serious intraabdominal injury such as paralytic ileus, hemorrhage, and laceration of the urethra, bladder, or colon. Patients may survive the initial pelvic injury, only to die from sepsis, FES, or thromboembolism.
Physical examination demonstrates local swelling, tenderness, deformity, unusual pelvic movement, and ecchymosis on the abdomen. Assess the neurovascular status of the lower extremities and manifestations of associated injuries. Pelvic fractures are diagnosed by x-ray and computed tomography (CT) scan.
Treatment of a pelvic fracture depends on the severity of the injury. Stable, nondisplaced fractures require limited intervention and early mobilization is encouraged. Bed rest for stable pelvic fractures is maintained from a few days to 6 weeks. More complex fractures may be treated with pelvic sling traction, skeletal traction, hip spica casts, external fixation, open reduction, or a combination of these methods. Open reduction and internal fixation of a pelvic fracture may be necessary if the fracture is displaced. Extreme care in handling or moving the patient is important to prevent serious injury from a displaced fracture fragment. Only turn the patient when ordered by the health care provider. Because a pelvic fracture can damage other organs, assess bowel and urinary elimination and distal neurovascular status. Provide back care while the patient is raised from the bed either by independent use of the trapeze or with adequate assistance. |
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Term
| Basic understanding of a hip fracture. |
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Definition
Hip fractures are common in older adults with 90% of these fractures due to a fall.22 More than 320,000 patients are admitted to hospitals annually due to a hip fracture. By age 90, approximately 33% of all women and 17% of all men will have sustained a hip fracture. In adults more than 65 years old, hip fracture occurs more frequently in women than in men because of osteoporosis. An estimated 30% of patients who experience a hip fracture will die within 1 year of injury because of medical complications caused by the fracture or resulting immobility.23 Many older adults with a hip fracture develop disabilities necessitating long-term care.
A fracture of the hip (Fig. 63-17) refers to a fracture of the proximal third of the femur, which extends up to 5 cm below the lesser trochanter. Fractures that occur within the hip joint capsule are called intracapsular fractures. Intracapsular fractures (femoral neck) are further identified by their specific locations: (1) capital (fracture of the head of the femur), (2) subcapital (fracture just below the head of the femur), and (3) transcervical (fracture of the neck of the femur). These fractures are often associated with osteoporosis and minor trauma. Extracapsular fractures occur outside the joint capsule. They are termed (1) intertrochanteric if they occur in a region between the greater and lesser trochanter or (2) subtrochanteric if they occur in the region below the lesser trochanter. Extracapsular fractures are usually caused by severe direct trauma or a fall. |
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Term
| What is the primary presentation with a hip fracture? |
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Definition
| The clinical manifestations of hip fractures are external rotation, muscle spasm, shortening of the affected extremity, and severe pain and tenderness in the region of the fracture site. Displaced femoral neck fractures cause serious disruption of the blood supply to the femoral head, which can result in avascular necrosis of the femoral head. |
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Term
| What is the most common cause of the pain with the fractured hip? |
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Definition
| The pain resulting from poor alignment of the affected extremity can be reduced by keeping pillows (or an abductor splint) between the knees when the patient is turning to either side. |
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Term
| Understand the difference for the patient between a repair that is by posterior approach or anterior approach? |
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Definition
If the hip fracture has been treated by insertion of femoral head prosthesis with a posterior approach (accessing the hip joint from the back), measures to prevent dislocation must always be used (Table 63-11). Avoid extremes in flexion initially after prosthetic replacement from a posterior approach. The patient and caregiver must be fully aware of positions and activities that predispose the patient to dislocation (more than 90 degrees of flexion, abduction, or internal rotation). Many daily activities may reproduce these positions, including putting on shoes and socks, crossing the legs or feet while seated, assuming the side-lying position incorrectly, standing up or sitting down while the body is flexed more than 90 degrees relative to the chair, and sitting on low seats, especially low toilet seats. Until the soft tissue capsule surrounding the hip has healed sufficiently to stabilize the prosthesis, teach the patient to avoid these activities, usually for at least 6 weeks.
When the hip fracture is accessed during surgery with an anterior approach (joint reached from front of body), the hip muscles are left intact. This approach generally results in a more stable hip in the postoperative period with a lower rate of complications. Patient precautions related to motion and weight bearing are few and may include instructions to avoid hyperextension. |
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Term
The posterior approach is still the more common repair method what is the teaching for this patient and family? (hint refer to table 63-11) *note this is not a replacement
DO NOT |
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Definition
Do Not
• •Force hip into greater than 90 degrees of flexion (e.g., sitting in low chairs or toilet seats).
• •Force hip into adduction.
• •Force hip into internal rotation.
• •Cross legs at knees.
• •Put on own shoes or stockings until 6 weeks after surgery without adaptive device (e.g., long-handled shoehorn or stocking-helper).
• •Sit on chairs without arms. They are needed to aid rising to a standing position. |
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Term
The posterior approach is still the more common repair method what is the teaching for this patient and family? (hint refer to table 63-11) *note this is not a replacement
DO |
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Definition
• •Use an elevated toilet seat.
• •Place chair inside shower or tub and remain seated while washing.
• •Use pillow between legs for first 6 weeks after surgery when lying on nonoperative side or when supine.
• •Keep hip in neutral, straight position when sitting, walking, or lying.
• •Notify surgeon if severe pain, deformity, or loss of function occurs.
• •Inform dentist of presence of prosthesis before dental work so that prophylactic antibiotics can be given if indicated. |
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Term
| When and Why are most Amputation’s performed? |
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Definition
| An estimated 1.7 million people in the United States are living with limb loss.32 The middle and older age-groups have the highest incidence of amputation because of the effects of peripheral vascular disease, atherosclerosis, and vascular changes related to diabetes mellitus. Amputation in the young is usually secondary to trauma (e.g., motor vehicle collisions, land mines, farm-related injury). |
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Term
| -What is the difference for the patient between an “elective” amputation and a traumatic amputation? |
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Definition
| If amputation is to be considered “elective,” the patient's general health is carefully assessed. Chronic illnesses and the presence of infection are important considerations. Assist the patient and caregiver to understand the need for the amputation and assure them that rehabilitation can result in an active, useful life. If the amputation is performed on an emergency basis as a result of trauma, management of the patient is physically and emotionally more complicated. |
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Term
| -What is the collaborative management goal of amputation surgery? |
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Definition
| The goal of amputation surgery is to preserve extremity length and function while removing all infected, pathologic, or ischemic tissue. |
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Term
| -(Think about how you would communicate with a patient in regards to anxiety and pain.) |
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Definition
| It is important for you to recognize the tremendous psychologic and social implications that an amputation has for a person. The disruption in body image caused by an amputation often causes a patient to go through the psychologic stages of the grieving process. Allow the patient to go through the grieving process. Also help the patient's caregiver to work through the transitional process to arrive at a realistic and positive attitude about the future. The reasons for an amputation and the rehabilitation potential depend on age, diagnosis, occupation, personality, resources, and support systems. |
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Term
| What is phantom limb pain and how is it addressed and treated? |
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Definition
| Warn the patient that the amputated limb may feel like it is still present after surgery. This phenomenon, termed phantom limb sensation, occurs in 90% of amputees.33 The patient may also complain of feelings of coldness and heaviness, cramping, shooting, burning, or crushing pain. Often, the patient may be extremely anxious about this sensation because the patient knows the limb is gone but pain is still perceived in the missing portion of the limb. As recovery and ambulation progress, phantom limb sensation and pain usually subside, although the pain may become chronic. |
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Term
| You should include the following instructions when teaching the patient after an amputation and the caregiver. |
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Definition
• 1.Inspect the residual limb daily for signs of skin irritation, especially erythema, excoriation, and odor. Pay particular attention to areas prone to pressure.
• 2.Discontinue use of the prosthesis if an irritation develops. Have the area checked before resuming use of the prosthesis.
• 3.Wash residual limb thoroughly each night with warm water and a bacteriostatic soap. Rinse thoroughly and dry gently. Expose the residual limb to air for 20 minutes.
• 4.Do not use any substance such as lotions, alcohol, powders, or oil on residual limb unless prescribed by the health care provider.
• 5.Wear only a residual limb sock that is in good condition and supplied by the prosthetist.
• 6.Change residual limb sock daily. Launder in a mild soap, squeeze, and lay flat to dry.
• 7.Use prescribed pain management techniques.
• 8.Perform ROM to all joints daily. Perform general strengthening exercises including the upper extremities daily.
• 9.Do not elevate the residual limb on a pillow.
• 10.Lay prone with hip in extension for 30 minutes three or four times daily. |
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Term
| Have a basic understanding of joint Arthroplasty? |
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Definition
| Arthroplasty is the reconstruction or replacement of a joint to relieve pain, improve or maintain ROM, and correct deformity. The most common uses of arthroplasty are for patients with osteoarthritis (OA), RA, avascular necrosis, congenital deformities or dislocations, and other systemic problems. There are several types of arthroplasty, including replacement of part of a joint (hemiarthroplasty), surgical reshaping of the bones of the joints, and total joint replacement. Replacement arthroplasty is available for the elbow, shoulder, phalangeal joints of the fingers, wrist, hip, knee, ankle, and foot. Over 700,000 Americans have hip or knee replacement surgery every year. Newer technology and techniques for lumbar disk arthroplasty have recently shown positive clinical outcomes. |
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Term
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Definition
| Unremitting pain and instability as a result of severe destructive deterioration of the knee joint is the main indication for total knee arthroplasty (TKA). The presence of osteoporosis may necessitate bone grafting to augment defects and to correct bone deficiencies. Either part of or the entire knee joint may be replaced with a metal and plastic prosthetic device. A compression dressing may be used to immobilize the knee in extension immediately after the operation. This is removed before discharge and may be replaced with a knee immobilizer or posterior plastic shell, which maintains extension during ambulation and at rest for about 4 weeks. |
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Term
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Definition
Although available, total replacement of elbow and shoulder joints is not as common as other forms of arthroplasty. Shoulder replacements are performed in patients with severe pain because of RA, OA, avascular necrosis, or previous trauma. The shoulder replacement is usually considered if the patient has adequate surrounding muscle strength and bone stock. If joint replacement is necessary for both elbow and shoulder, the elbow is usually done first because a severely painful elbow interferes with the shoulder rehabilitation program.
Significant pain relief has been achieved following arthroplasty, with most patients having no pain at rest or minimal pain with activity. Functional improvements have also resulted in better hygiene and increased ability of the patient to perform activities of daily living. Rehabilitation is longer and more difficult than with other joint surgeries. |
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Term
| What are some potential complications of joint surgery |
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Definition
Infection is a serious complication of joint surgery, particularly joint replacement surgery. The most common causative organisms are gram-positive aerobic streptococci and staphylococci. Infection may lead to pain and loosening of the prosthesis, generally requiring extensive surgery. Efforts to reduce the incidence of infection include the use of specially designed self-contained operating suites, operating rooms with laminar airflow, and prophylactic antibiotic administration.
Thromboembolism is another potentially serious complication after joint surgeries, particularly those involving the lower extremities. Prophylactic measures such as warfarin, LMWH, and sequential compression devices of the legs are usually instituted. Patients may be followed postoperatively with venous Doppler ultrasound to detect DVT, the source of most pulmonary emboli. |
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Term
| -What significant points are there in the nursing management of joint surgery? |
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Definition
The nursing management of the patient undergoing joint surgery begins with preoperative teaching and realistic goal setting. It is important that the patient understands and accepts the limitations of the proposed surgery and realizes that it in some cases will not remove or treat the underlying disease. Explain postoperative procedures such as turning, deep breathing, use of bedpan and bedside commode, and use of abductor pillows. Provide opportunities for practice. Reassure the patient that pain relief will be available. Patient-controlled analgesia can be helpful. A preoperative visit from a physical therapist allows practice of postoperative exercises and measurement for crutches or other assistive devices.
Discharge planning begins immediately. Discuss the duration of the hospital stay and the expected postoperative events because the patient and caregiver must prepare ahead. The home environment must be assessed for safety (e.g., presence of scatter rugs and electric cords) and accessibility. Are the bathroom and bedroom on the first floor? Are door frames wide enough to accommodate a walker? Assess the patient's social support. Is a friend or family member available to assist the patient in the home? Will the patient require homemaker or meal services? The elderly patient may need the rehabilitation services of a subacute or extended care facility for a few weeks postoperatively to progressively develop independent living skills. Specific nursing interventions related to surgery for the patient having orthopedic surgery are summarized in NCP 63-2. |
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Term
| -What significant points are there in the nursing management of joint surgery? Role of the REGISTERED NURSE |
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Definition
• •Perform neurovascular assessments on the affected extremity.
• •Assess for clinical manifestations of compartment syndrome.
• •Monitor cast during drying for denting or flattening.
• •Teach patient and caregiver about cast care and complications of casting.
• •Determine correct body alignment to enhance traction.
• •Instruct patient and caregiver about traction and correct body positioning.
• •Teach patient and caregiver range-of-motion (ROM) exercises.
• •Assess for complications associated with immobility or fracture (e.g., wound infection, constipation, deep vein thrombosis, renal calculi, atelectasis).
• •Develop plan to minimize complications associated with immobility or fracture. |
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Term
| -think discharge teaching; |
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Definition
| Instruct the patient on reporting complications, including infection (fever, increased pain, drainage) and dislocation of the prosthesis (pain, loss of function, shortening or malalignment of an extremity). The nurse in the home care setting acts as the liaison between the patient and the surgeon, while monitoring for postoperative complications, assessing comfort and ROM, and facilitating improvements in functional performance. |
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