Adult Mobility

Osteoarthritis

Slowly progressive deterioration of articular cartilage

Weight bearing joints (hip, knees)

where is OA typically seen?

1. previous accident

2. sports

3. other injury

known events/conditions that can be risk factors for OA [3]

inflammatory conditions that can impact joints

genetic conditions that can increase risk for OA;

1. pain

2. stiffness (in the ornign)

3. tender joints

4. deformity (late sign)

S+S of OA

If one side is effected, use of the other side increases to alleviate pain. Can lead to wear and tear of the other side and can progress to OA

How can OA become symmetrical over time?

would see narrowing of the joint space

What would a scan of OA joint look like?

1. look for pain, swelling, and muscoluskeletal assessment

2. ever had an injury?

3. Other co-morbidities (inflammatory

4. medications?

5. family hx

Health assessment questions to ask to determine OA diagnosis: [5]

1. increased WBC

2. increased ESR

3. increased c-reactive protein

lab results that can support OA diagnosis but cannot necessarily diagnose [3]

1. bone scan

2. CT

3. MRI

4. Xray

scans that can diagnose OA: [4]

improve/manage pain, optimize function, and prevent disability

goal for OA

1. heat/cold

2. activity that they can tolerate without pushing too far

3. lose weight

non-pharm lifestyle measures to treat OA:

1. massage

2. accupncutre

complementary and alternative therapies to treat OA: [2]

lowest dose possible to get maximal results

GOal for meds when managing OA:

can get worse over time/needs increase and can build a tolerance to meds over time

why want to give lowest dose possible to treat oa?

Know their normal to see if condiiton is improving/deteriorating

why is it important to get a baseline for OA assessments?

1. swimming

2. walking

3. light weight-bearing to strengthen joints

good exercises for people with OA:

1. fall hazards (rugs, bars, lightig, etc.)

2. proper footwear

home modifications for OA: [2]

Osteoporosis

bone disorder resulting in low bone density where the rate of boen reabsorption exceeds formation

1. spine

2. hips

3. wrist

Most common OP areas: [3]

primary OP

OP where there is no underlying cause, just something the person developed. Related to aging, poor bone development

seondary OP

OP caused by something else. Ex: long-term corticosteroids. When cause is removed can slow/stop the progression f the disease but not restore bone density

spontaneous fracture

normally the first sign of OP:

1. loss of height

2. back pain

3. restricted movement

4. fractures

5. pain on palpation

S+S of OP [5]

hip and spine

bones that give good representation of overall bone health: [2]

bone mineral density test (DEXA scan)

low-energy x-ray to evaluate bone density of hip and spine

need normal stress and strain on bones, the more the body gets used to repairing the bones

how can exercise treat OP?

Fosomax

medication often prescribed for OP

take on an empty stomach (absorption), with a full glass of water and sit up 30 mins after (reflux and esophageal damage)

things to educate patient on who is taking fosomax

reduction

Realigning fracture

Closed reduction

cast or manual reduction (no surgery)

Open reduction

Surgical reduction

Maintain alignment (immobilize)

priority for fractures:

1. cast

2. backslab

3. traction

how to maintain immobilization of fracture [3]

1. full weight baring

2. touch toe weight baring

3. partial weight baring

4. non-weight baring

levels of weight baring: [4]

1. infection

2. compartment syndroe

3. venous thromboembolism

4. fat embolism

5. elimination

complications associated with fractures: [5]

osteomyelitis

infection of the bone, occurs most often in open fractures

Can become systemic. Blood drawn from multiple sites to compare

Why are blood cultures taken for bone infection?

6 weeks around the clock IV antibiotics

treatment for osteomyelitis:

Surgical debridement

When the affected area is cut open and cleaned out. Whatever was causing the issue is removed.

keep site clean with sterile water/NS

How to prevent osteomyelitis:

1. Decrease in compartment size (tight cast/dressing)

2. Increase in compartment content (swelling, inflammaiton)

compartment syndrome is caused by two things:

intracompartmental pressure monitor

device that monitors pressure for compartment syndrome

fasciotomy

procedure done when intracompartmental pressure is too high. the fascia is opened to let eveything breath and get blood flow returned.

1. skin graft

2. long term antibiotics

3. vac dressing

4. wound left open

post op patient for fasciotomy gets:

1. redness

2. swelling

3. warmth

4. tightness in calf

signs of DVT [4]

1. early ambulation

2. anti-embolism stockings

3. anti-coagulants

4. monitor for S+S

how to prevent DVT [4]

1. low SPO2

2. SOB, winded

3. chest pain

4. coughing up blood

sign for pulmonary embolus [4]

1. anticoagulants

2. oxygen

treatment for pulmonary embolism:

fat embolism

when fat globule release from bone marrow into blood vessels and starts to cause problems

cutaneous petechiae: little bruises in upper chest area because it blocks capillaries

Sign that differentiates fat embolism:

1. dyspnea, increased RR, decreased SPO2

2. headache, confusion

3. tachycardia, chest pain

4. cutaneous petechiae

signs of fat embolism [4]

CT scan

how is fat embolism diagnosed?

until it is fixed/set properly to prevent fat embolism and keep the bone immobilized

how long are femur fracture patients on bedrest?

symptoms are treated and eventually body will absorb the fat

1. O2

2. fluids

3. pain/anti-anxiet meds

how is fat embolism treated?

reduces lung collapse and risk of pulmonary embolism

why is it important to have patients do lung exercises when in bed rest?

screen respiratory system for potential infection and make sure lungs are okay

why do patients get chest xray before surgery?

to catch any heart abnormalities and abnormal rhythms

why get preop ecg?

to catch infections, pregnancy, and check idney function

why get preop urines?

The person performing the operation

who gets consent before surgery?