chapter 46
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Chapter 46. Nursing Care of Patients with Musculoskeletal and Connective Tissue Disorders. Bone and Soft Tissue Disorders. Strain Sprain Dislocation Bursitis Rotator Cuff Injury. Carpal Tunnel Syndrome. Median Nerve Compression in Wrist’s Carpal Tunnel - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Chapter 46](https://reader036.vdocuments.site/reader036/viewer/2022062321/56813b9d550346895da4d49d/html5/thumbnails/1.jpg)
Linda S. Williams / Paula D. Hopper
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition
Chapter 46
Nursing Care of Patients withMusculoskeletal and Connective Tissue
Disorders
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Copyright © 2011. F.A. Davis Company
Linda S. Williams / Paula D. HopperUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition
Bone and Soft Tissue Disorders
Strain Sprain Dislocation Bursitis Rotator Cuff Injury
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Linda S. Williams / Paula D. HopperUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition
Carpal Tunnel Syndrome Median Nerve Compression in Wrist’s
Carpal Tunnel Occurs with Swelling in Tunnel Finger, Hand, Arm Pain/Numbness
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Carpal Tunnel Syndrome (cont’d) Relieve Inflammation and Rest Wrist
Splint Anti-inflammatory Surgery
Teach Prevention
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Fractures Break in a Bone Cause
Trauma Pathological (From Disease )
Open – Breaks Skin Closed – Does Not Break Skin
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Types of Fractures
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Signs and Symptoms Pain Decreased ROM Limb Rotation Deformity, Shortening of Limb Swelling Bruising
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Diagnostic Tests X-Ray CT scan
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Emergency Treatment Splint It As It Lies! Seek Medical Treatment
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Fracture Management Goals
Realignment of Bone Ends Immobilization
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Fracture Healing Phases
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Closed Reduction Manual Realignment Bandages/Splints Casts Traction
Skin Skeletal
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Types of Skin Traction
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Balanced Suspension and Skeletal Traction
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Fracture Management (cont’d) Open Reduction with Internal Fixation External Fixation
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External Fixation
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Complications of Fractures Nonunion Neurovascular compromise Hemorrhage Infection Thromboembolitic Complications Acute Compartment Syndrome Fat Embolism Syndrome
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Compartment Syndrome
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Bivalving Cast
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Nursing Diagnoses Acute Pain Impaired Physical Mobility Impaired Walking Ineffective Health Maintenance Risk for Peripheral Neurovascular
Dysfunction
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Nursing Diagnoses (cont’d) Risk for Ineffective Tissue Perfusion Risk for Ineffective Skin Integrity
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Palming the Cast
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Nursing Care Cast Care Traction Care Pain Control Neurovascular Checks Skin Care Nutrition
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Nursing Care (cont’d) Self Care Deficits Psychosocial
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Patient Education Cast Care Pin Care Nutrition
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Osteomyelitis Infection of Bone Prevention is Key! Fever, Redness, Heat, Pain, Swelling, Pain Long-term Antibiotic Therapy Incision and Drainage Amputation
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Osteomyelitis (cont’d)
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Osteomyelitis (cont’d) Nursing Care
Medication Teaching Hand Hygiene Sterile Dressing Changes
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Osteoporosis Low Bone Mass as Bone Loses Density Prone to Fractures Occur Spine, Wrist, Hip Most Common All Bones Affected
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Osteoporosis Prevalence 10 Million People
8 Million Females 2 Million Males
Over Age 50 Fractures 1 in 2 Women 1 in 4 Men
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Osteoporosis Fracture Effects Hip/Vertebral Fractures
Reduced Quality of Life Increased Disability Risk of Death (During Year After Fracture)
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Osteoporosis Prevention Build Bone Through Age 30 Obtain Adequate Calcium and Vitamin D Exercise (Especially Childhood ) Avoid Alcohol and Smoking
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Osteoporosis (cont’d) Imbalanced Remodeling Process
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Osteoporosis Risk Factors Aging Female Caucasian/Asian Fracture History Family History Petite Body Build Postmenopausal Women
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Osteoporosis Risk Factors (cont’d) Low Testosterone and Estrogen Low Calcium Intake Low Vitamin D Excessive Caffeine, Protein, Sodium Sedentary Lifestyle Excessive Alcohol Use Cigarette Smoking
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Osteoporosis (cont’d) Signs and Symptoms
Dowager’s Hump Kyphosis Height Decreases Back Pain Fracture
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Osteoporosis (cont’d) Body System Effects Functional Effects Emotional effects Socialization
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Osteoporosis Diagnostic Tests
Dual-energy X-Ray Absorptiometry Serum Calcium, Vitamin D Decreased Serum Phosphorus Increased Serum Alkaline Phosphatase Increased
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Osteoporosis Therapeutic Interventions
Reduce Risk Factors Calcium Supplements Vitamin D Supplements Medications
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Antiresorptive Medications Bisphosphonates
Alendronate (Fosamax) Ibandronate (Boniva) Risedronate (Actonel) Zoledronic acid (Reclast)
Calcitonin (Fortical, Miacalcin)
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Antiresorptive Medications (cont’d)
Selective Estrogen Receptor Modulator Raloxifene (Evista)
Estrogen Therapy
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Anabolic (Bone Forming) Teriparatide (Forteo)
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Osteoporosis Nursing Care Pain Relief Symptom Management Education
Diet: Increase Calcium, Vitamin D Exercise Medication
Fall Prevention
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Paget's Disease Increased Bone Loss Disorganized Bone Deposits No Obvious Symptoms Usually X-Ray, Bone Scan Calcitonin (Calcimar) Relieve Pain, Teach, Promote Life Quality
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Bone Cancer Primary Malignant Tumors
Osteosarcoma Most Common 50% Occur in Distal Femur in Young Men Metastasizes to Lung Within 2 Years
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Bone Cancer (cont’d) Primary Malignant Tumors
Ewing’s Sarcoma Most Malignant
Chrondrosarcoma Cancer of Cartilaginous Cells Better Prognosis
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Primary Bone Cancer Therapeutic Interventions
Surgery, Chemotherapy, Radiation
Nursing Care Postoperative Care Supportive
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Metastatic Bone Disease Bone-seeking Cancers
Prostate, Breast, Lung, Thyroid
Pathological Fractures Severe Pain Therapeutic Interventions
Radiation
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Metastatic Bone Disease (cont’d) Nursing Care
Supportive Care as with Other Cancers
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Gout Pathophysiology
Systemic Connective Tissue Disorder Uric Acid Build Up Urate Crystals Deposited in Joints/Connective
Tissues Severe Inflammation
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Causes and Types Primary – Inherited Problem with Purine
Metabolism Secondary – Another Health Problem
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Signs and Symptoms Acute
Swollen, Red, Hot, Painful Inflamed Joints Great Toe
Chronic Gout Urate Deposits Under Skin Renal Stones
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Diagnostic Tests Serum Uric Acid Joint Fluid – Uric Acid Crystals
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Therapeutic Interventions Medication
Colchicine NSAIDs Allopurinol (Zyloprim) Probenecid (Benemid)
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Nursing Care Teaching
Diet: Avoid Foods High in Purines Avoid Aspirin, Diuretics, Alcohol Increase Fluids
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Systemic Lupus Erythematosus
Autoimmune Disease Genetic Link Remissions and Exacerbations Systemic Type Skin Type – Discoid Lupus Erythematosus
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Pathophysiology Abnormal Antibodies Immune Complex Formation Complement System Activation Affects Connective Tissue
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Signs and Symptoms Butterfly Rash Photosensitive Fever Fatigue, Malaise Arthralgia, Myalgia Weight Loss
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Signs and Symptoms (cont’d) Mucosal Ulcers Alopecia Skin Lesions
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Diagnostic Tests Biopsy Erythrocyte Sedimentation Rate Immunological Tests
Antinuclear Antibody Titers Antibodies Against SR Proteins
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Therapeutic Interventions NSAIDs Corticosteroids Antimalarials Immunomodulating Drugs Topical Cortisone Chloroquine (Aralen)
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Nursing Diagnoses Acute Pain Chronic Sorrow Fatigue Disturbed Body Image
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Nursing Diagnoses (cont’d) Ineffective Coping Ineffective Health Maintenance Powerlessness Risk for Impaired Skin Integrity Self-care Deficit
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Patient Education Skin Care Avoid Prolonged Exposure to Sunlight Exercise Immunization Stress Reduction Community Support Groups
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Scleroderma Inflammation Develops into Fibrosis and
Sclerosis of Tissues Autoimmune Response Progress Very Rapidly Remissions and Exacerbations Poor Prognosis
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Signs and Symptoms Arthritis, Fatigue Scleroderma
Pitting Edema, Tightening, Hardening, Thickening of Skin Tissue
Loss of ROM Contractures
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Diagnosis History Physical
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Therapeutic Interventions Steroids Immunosuppressant Antacids, Histamine Blockers Rehabilitative Therapy
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Nursing Care Pain Control
Bed Cradle Sock/Gloves
Skin Protective Mild Soaps and Lotions
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Nursing Care (cont’d) Small, Frequent, Bland Meals
Cut Food into Small Pieces Thicker Liquids
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Osteogenesis Imperfecta Congenital Abnormality Characterized by
Skeletal Bone Fragility Brittle Bones Disease Pathological Fractures Collagen Synthesized Abnormally
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Osteogenesis Imperfecta (cont’d) Signs and Symptoms
Fragile Bones Triangular Shaped Face Potential Hearing Loss Scoliosis Loose Joints
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Osteogenesis Imperfecta (cont’d) Signs and Symptoms (cont’d)
Alterations in Muscle Tone or Development Blue, Purple, Grey Tint to Sclera Brittle or Discolored Teeth Smooth, Thin Skin
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Osteogenesis Imperfecta (cont’d) Diagnosis
History of Fractures Physical Skin Biopsy
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Osteogenesis Imperfecta (cont’d) Therapeutic Interventions
No Treatment Fracture Care
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Osteogenesis Imperfecta (cont’d) Nursing Care
Careful Handling Teaching Support Groups
Osteogensis Imperfecta Foundation
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Polymyositis Diffuse Inflammation of Skeletal Muscle Dermatomyositis – with Rash Progressive Remissions and Exacerbations Women Greater Than Men Treatment: Prednisone
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Polymyositis (cont’d) Nursing Care
Supportive Care Education
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Muscular Dystrophy Group of Nine Disorders Loss of Muscle Tissue Progressive Muscle Weakness Genetic Skeletal Muscle Fibers Degenerate,
Atrophy
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Therapeutic Interventions Supportive Care Prevention of Complications Gene Therapy Research
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Nursing Diagnoses Impaired Physical Mobility Ineffective Breathing Pattern Self-care Deficits Deficient Knowledge
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Osteoarthritis Degenerative Joint Disease (DJD) Common
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Pathophysiology Articular Cartilage/Joints Bone Ends
Deteriorate Joint Space Narrows, Bone Spurs Develop,
Joint Inflamed Joint Deformities, Pain, Immobility Weight-bearing Joints
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Joints Affected by Osteoarthritis
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Causes Unknown Risk Factors
Aging Obesity Excessive “Wear and Tear” on Synovial Joints
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Signs and Symptoms Joint Pain
Intensifies After Physical Activity
Stiffness Heberden’s and Bouchard’s Nodes
Bony Nodes on Joints of Fingers
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Diagnostic Tests X-Rays CT scan MRI Synovial Fluid Analysis
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Therapeutic Interventions No Cure Medication
NSAIDs
Rest and Exercise Heat or Cold Weight Control
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Therapeutic Interventions (cont’d) Complementary Therapies
Imagery, Music Therapy, Acupressure, Acupuncture
Surgery Total Joint Replacement
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Nursing Diagnoses Chronic Pain Activity Intolerance Chronic Sorrow Disturbed Body Image Impaired Physical Mobility
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Nursing Diagnoses (cont’d) Self-care Deficit Ineffective Health Maintenance
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Patient Education Protect Joints Conserve Energy
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Rheumatoid Arthritis Chronic, Progressive, Systemic
Inflammatory Disease Destroys Synovial Joints and Other
Connective Tissues Includes Major Organs
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Rheumatoid Arthritis (cont’d)
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Pathophysiology Synovitis Synovium Thickens, Fluid Accumulates Destructive Pannus Erodes Joint Cartilage,
Destroys Joint Bone Pannus Converted to Bony Tissue
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Pathophysiology (cont’d) Joint Deformity Other Connective Tissue Affected
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Etiology Unknown Genetic Predisposition Environmental Autoimmune Response – Antibodies
(Rheumatoid Factor) Local and Systemic Inflammation
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Signs and Symptoms Remissions and Exacerbations Varies by Individual
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Signs and Symptoms (cont’d) Early Symptoms
Bilateral, Symmetrical Joint Inflammation Reddened, Warm, Swollen, Stiff, Painful Stiffness After Resting Activity Decreases Pain and Stiffness Low Grade Fever, Weakness, Fatigue,
Anorexia
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Signs and Symptoms (cont’d) Late Symptoms
Joint Deformity Secondary Osteoporosis
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Joint Abnormalities in Rheumatoid Arthritis
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Diagnosis Rheumatoid Factor (RF) Red Blood Cell (RBC) C4 Complement Decreased
Erythrocyte Sedimentation Rate (ESR) Antinuclear Antibody (ANA) C-reactive Protein (CRP)
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Therapeutic Interventions Medication
Disease-modifying Antirheumatic Drugs Leflunomide (Arava) Etanercept (Enbrel)
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Therapeutic Interventions (cont’d) Medication (cont’d)
Methotrexate Gold Prednisone NSAIDs
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Therapeutic Interventions (cont’d) Heat/Cold Balanced Rest and Activity Surgery – Total Joint Replacement
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Nursing Diagnoses Acute Pain Disturbed Body Image Fatigue Self-care Deficit Impaired Physical Mobility Deficient Knowledge
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Patient Education Disease Process Medication Management Rest and Exercise Vocational Counselor Community Resources
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Total Hip Replacement Acetabular Cup Inserted Into Pelvic
Acetabulum Femoral Component Inserted Into Femur
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Total Hip Replacement (cont’d) Preoperative Care
Total Joint Education Programs Autologous Blood Donation
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Total Hip Replacement (cont’d) Postoperative Care to Prevent
Complications Hip Dislocation
Prevent Adduction or Hyperflexion
Skin Breakdown Prevent Pressure Ulcers
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Abductor Pillow
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Linda S. Williams / Paula D. HopperUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition
Hip Flexion After Total Hip Replacement
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Copyright © 2011. F.A. Davis Company
Linda S. Williams / Paula D. HopperUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition
Total Hip Replacement (cont’d) Pain
Provide Pain Relief
Infection Prophylactic Antibiotics
Coughing and Deep Breathing Incisional Care
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Copyright © 2011. F.A. Davis Company
Linda S. Williams / Paula D. HopperUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition
Total Hip Replacement (cont’d) Bleeding
Monitor Incision/Drainage from Drain
Neurovascular Compromise Neurovascular Checks
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Copyright © 2011. F.A. Davis Company
Linda S. Williams / Paula D. HopperUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition
Total Hip Replacement (cont’d) Ambulation
Physical Therapy Use Walker/Crutches
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Copyright © 2011. F.A. Davis Company
Linda S. Williams / Paula D. HopperUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition
Total Hip Replacement (cont’d) Thromboembolitic Complications
Compression Devices Leg Exercises
Enoxaparin (Lovenox)
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Copyright © 2011. F.A. Davis Company
Linda S. Williams / Paula D. HopperUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition
Total Hip Replacement (cont’d) Self-care
Assistive Dressing Devices Raised Toilet Seat Rehabilitation
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Copyright © 2011. F.A. Davis Company
Linda S. Williams / Paula D. HopperUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition
Total Knee Replacement Femoral Component, Tibial Component,
Patellar Button Dislocation Not a Concern Care like Total Hip Replacement Continuous Passive Motion Machine
(CPM)
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Copyright © 2011. F.A. Davis Company
Linda S. Williams / Paula D. HopperUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition
Continuous Passive Motion Machine
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Copyright © 2011. F.A. Davis Company
Linda S. Williams / Paula D. HopperUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition
AmputationRemoval of a body part
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Copyright © 2011. F.A. Davis Company
Linda S. Williams / Paula D. HopperUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition
Amputation (cont’d) Surgical Amputations
Ischemia from Peripheral Vascular Disease Bone Tumor, Frostbite, Congenital Problems,
Infections
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Copyright © 2011. F.A. Davis Company
Linda S. Williams / Paula D. HopperUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition
Amputation (cont’d) Traumatic Amputations
Accidents
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Copyright © 2011. F.A. Davis Company
Linda S. Williams / Paula D. HopperUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition
Amputation (cont’d) Replantation
Wrap Severed Body Part in Cool, Slightly Moist Cloth
Place in Sealed Plastic Bag Submerged in Cold Water
Transported to Hospital
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Copyright © 2011. F.A. Davis Company
Linda S. Williams / Paula D. HopperUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition
Amputation (cont’d) Levels of Amputation
Below-the-knee (BKA) Above-the-knee (AKA) Below-the-elbow (BEA) Above-the-elbow (AEA)
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Copyright © 2011. F.A. Davis Company
Linda S. Williams / Paula D. HopperUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition
Amputation Nursing Care Preoperative Nursing Diagnoses
Deficient Knowledge Teach Preoperative Procedures
Disturbed Body Image Begin Support Services
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Copyright © 2011. F.A. Davis Company
Linda S. Williams / Paula D. HopperUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition
Amputation Nursing Care (cont’d)
Postoperative Hemorrhage Prevention Infection Pain Control
Phantom Pain
Mobility and Ambulation
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Copyright © 2011. F.A. Davis Company
Linda S. Williams / Paula D. HopperUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition
Bandaging for Above-the-Knee Amputation
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Copyright © 2011. F.A. Davis Company
Linda S. Williams / Paula D. HopperUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th EditionUnderstanding Medical Surgical Nursing, 4th Edition
Amputation Nursing Care (cont’d)
Postoperative Nursing Diagnoses Prosthesis Lifestyle Adaptation