Musculoskeletal Disorders and Care

Joint Replacement

Treatment for pain, necrosis, fracture

Goal for Joint Replacement Treatment

Improved mobility, decreased pain, improved quality of life

What are the joints frequently replaced (per text)?

Shoulders, Fingers, Hips, Knees

What are the major nursing care aspects for the post-joint replacement patient?

Blood loss, Venous Thromboembolism (VTE), Infection, Pain Management

What are key aspects of mobility and ambulation for hip replacement patients?

Early ambulation, assistive device, weight-bearing

What types of pain management are used for hip replacement patients?

Nerve blocks, Opioids, Nonpharmacological methods

How can hip prosthesis dislocation be prevented after surgery?

Correct positioning, abduction, limited flexing of the hip (<90 degrees)

What patient education is crucial for avoding hip dislocation after arthroplasty (posterior or posterolateral approach)? *8*

• Keep your knees apart at all times

• Use a pillow between your legs when sleeping

• Do not cross your legs when sitting

• Avoid bending forward while sitting

• Do not bend over to pick things up from the floor

• Use a high-seated chair

• Use a raised toilet seat

• Avoid bending your hip to put on pants, stockings, socks, or shoes

What are key considerations for preventing infection after hip replacement surgery?

Strict hygiene practices, patients at risk for up to 24 months, prophylactic antibiotic may be given (started in the OR)

What are key considerations for preventing DVT after hip replacement surgery?

Appropraite prophylaxis (action taken to prevent disease), monitoring the patient, hydration

What are immediate postoperative nursing case aspects for knee replacement surgery?

Compression bandage on knee, assess neurovascular status every 2 to 4 hours, monitor complications (VTE, infection, bleeding)

What should be monitored regarding the wound suction drain after knee replacement surgery?

Check the wound and dressing (usually stitched). Change dressing if dirty. Watch the fluid: how much, thick or thin, and color. Write it down. Tell the doctor if more than 250 ml drains in 8 hours or if the color changes to bright red with more fluid.

What is the typical physical therapy progression after knee replacement surgery?

Focus on strength and ROM, use of assistive devices, ambulate first post-op day

Total recovery time for knee replacement

Approximately 6 weeks

Causes of Amputation

Congenital, traumatic, infection, disease related

Goals of Amputation

Relieve symptoms, improve function, and improve quality of life

What are potential complications of amputation?

• Hemorrhage: Excessive bleeding

• Infection: Germs causing wounds to get worse

• Skin Breakdown: Skin gets damaged or sores develop

• Phantom Limb Pain: Feeling pain in the amputated limb that’s no longer there

• Joint Contracture: Joints stiffen and lose movement

What are key rehabilitation needs for patients with amputations?

Psychological support, prostheses fitting and use, physical therapy,

What should be assessed for a patient with an amputation?

Neurovascular status and function, signs and symptoms of infection, nutrtional status, concurrent health problems, psychological status and coping

What are priority patient problems for a patient with an amputation?

Acute pain, impaired skin integrity, ditrubed body image, grieving, self-care deficit, impaired physical mobility

What are the major goals in the care plan for a patient with an amputation?

Relief of pain, absence of altered sensory perceptions, wound healing, acceptance of altered body image, resolution of greiving processes, restoration of physical mobility, absence of complications

What are interventions for relieving pain in an amputation patient?

Adminster analgesics, changing position, sandbag, nonpharmacologic

How can wound healing be promoted for an amputation patient?

Handle limb gently, residual limb shaping

How can grief be resolved and body image enhanced for an amputation patient?

Provide support and listen, encourage communication, and expression of feelings, create an accepting, supportice atmosphere, encourage the patient to look at, feel, and care for residual limb, help patient set realistic goals, help patient resume self-care and independence, refer to counselors and support groups

What interventions help achieve physical mobility for an amputation patient?

Proper positioning of limb (avoid abduction, external rotation and flexion), turn frequently (prone positioning if possible), use of assistive devices, ROM exercises, muscle strengtherning exercises, “Periprosthetic care” (proper bandaging, massage, and toughening” of the residual limb