Mobility Exemplars

What are the most common cause of hip fracture?

falls

What are some disease processes that can contribute to fractures?

osteoporosis, hyperthyroidism, balance issues, steroids, sleep medications, nutrition imbalances, tobacco or alcohol use

Hip fractures typically manifest with which three signs?

shortened, abducted, externally rotated affected leg

What are some manifestations of a hip fracture?

inability to get up from a fall, severe pain, inability to weight bare, bruising or swelling

What are some important assessments for hip fracture?

neurovascular status, blood loss, 5 Ps of neurovascular impairment

5 Ps of Neurovascular Impairment

pain, pallor, paresthesia, paralysis, pulselessness

What are some treatment options for a hip fracture?

surgery, immobilize leg, manage pain

Avascular Necrosis

bone loses blood supply and dies, leading to bony collapse and destruction of the joint

Compartment Syndrome

swelling or bleeding within muscle compartment which restricts blood flow to tissues; leads to blood and nerve damage and limb compromise

Fat Embolism

fat globule (perhaps from the bone marrow) floating through the blood

Manifestations of Fat Embolus

altered mental status, hypoxia, petechiae

What is a top complication with hip replacement surgery?

dislocation

How do we prevent hip dislocation?

maintain position, use of trochanter rolls, maintain abduction, use ambulatory aids, avoid overflexion, do not roll onto affected side

What are some patient education points for preventing hip dislocation?

do not cross legs, do not bend past 90 degrees, do not rotate leg inward

Osteomyelitis

inflammation and infection of bone and bone marrow

What are some complications of hip fracture?

avascular necrosis, infection, osteomyelitis, compartment syndrome, VTE, dislocation, shock

What are some components of pre-op care?

instruct on use of IS, routine lab work and tests, teach about post op care, ensure consents are signed

What are some components of post-op care?

pain control, incision site care, assessments and monitoring

Hip fracture patients are at higher risk for _______.

VTE, DVT, PE (due to immobility and blood flow changes)

Arthritis

joint inflammation

Osteoarthritis

degeneration of the joints due to overuse; results in loss of synovium

What is the more common type of arthritis?

osteoarthritis

What are the types of arthritis?

osteoarthritis, rheumatoid arthritis

What are some manifestations of osteoarthritis?

stiffness lasting less than 30 minutes, pain, functional impairment, herberdens nodes, bouchards nodes

Herberdens Nodes

hard nodules or enlargements

of the distal joints (osteoarthritis)

Bouchards Nodes

enlargements of the proximal joints (osteoarthritis)

What are some nursing interventions for osteoarthritis?

halt progression, exercise and strength training, analgesia, weight loss (if applicable)

Rheumatoid Arthritis

systemic, autoimmune disease which results in swelling of the joints

What are some manifestations of rhuematoid arthritis?

bilateral pain, pain at rest, stiffness lasting more than 30 minutes, swelling, begins in small joints and progresses to larger joints, swan neck deformities, deviation

Swan Neck Deformities

flexion, extension, flexion at each of the finger joints

What are some nursing interventions for rheumatoid arthritis?

pain management, anti-inflammatories, energy conservation, PT/OT referral

What are some pharmacologic agents for rheumatoid arthritis?

NSAIDs, steroids, DMARDs (disease modifying anti-rheumatic drugs)