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Plan Nursing Care for Total Joint Replacement

  • Collaboration with surgical team for preoperative education
  • Assessment of joint function and pain level
  • Postoperative mobility plan and rehabilitation
  • Monitor for signs of complications (e.g., dislocation, infection)
  • Early ambulation and pain management

Patient Teaching for Lower Extremity Amputation and Prosthesis

  • Education on care and use of prosthesis
  • Rehabilitation exercises for strengthening
  • Techniques for monitoring skin integrity under prosthesis
  • Pain management strategies for phantom limb sensations

BONE AND SOFT TISSUE DISORDERS

Strains

  • Definition: A soft tissue injury from excessive stretching of a muscle or tendon.
  • Causes: Falls, excessive exercise, heavy lifting.
  • Degrees of Strain:
    • Mild: Minimal inflammation, swelling, tenderness.
    • Moderate: Partial tearing, pain, limited movement.
    • Severe: Complete rupture, severe pain, disability.
  • RICE Protocol: Rest, Ice, Compression, Elevation
    • Rest: Protect the injured area.
    • Ice: Apply for 15-20 minutes, four times daily.
    • Compression: Use an elastic bandage.
    • Elevation: Raise the affected area to reduce swelling.
  • Post-swelling Treatment: Apply heat to improve blood flow for healing, and limit activity until recovery.
  • Medications: NSAIDs, muscle relaxants; severe strains may require surgery.

Sprains

  • Definition: Injury from excessive ligament stretching, often due to twisting.
  • Degrees of Sprain:
    • Mild: Tears in a few fibers, tenderness present.
    • Moderate: More fibers torn but joint stability maintained, may require immobilization.
    • Severe: Complete ligament tear, typically requires surgery.
  • Treatment: RICE and NSAIDs until swelling resolves.

Dislocations

  • Definition: Joint injury with bones out of normal position due to trauma or disease.
  • Symptoms: Severe pain, loss of motion, deformity.
  • Management: Immobilization, ice, emergency treatment for functionality preservation.

Bursitis

  • Definition: Inflammation of bursae, fluid-filled sacs preventing friction between bone and tendon.
  • Causes: Arthritis, repetitive movement, sleeping positions.
  • Symptoms: Aching pain, stiffness, swelling, burning in the joint area, aggravated by activity.
  • Treatment: Joint rest, ice, heat, NSAIDs, physical therapy, possibly antibiotics.

Rotator Cuff Injury

  • Components: Multiple short tendons connected to shoulder muscles.
  • Injury Causes: Chronic impingement syndrome leading to suprahpatus tendon inflammation.
  • Symptoms: Shoulder ache, pain on lifting arm, night pain, weakness, reduced motion.
  • Diagnosis: MRI for injury assessment.
  • Treatment: Rest, ice, NSAIDs for minor cases; surgery for severe injuries.

Carpal Tunnel Syndrome

  • Definition: Compression of median nerve in the carpal tunnel due to repetitive activities.
  • Symptoms: Pain, numbness, tingling in hands and fingers, fine motor deficits.
  • Diagnosis: Patient history, physical examination, Phalen test positive.
  • Treatment: Wrist splint, NSAIDs, surgery if conservative measures fail.

Fractures

  • Definition: Bone discontinuity ranging from minor to severe injuries requiring different management.

Pathophysiology of Bone Fracture

  • Healing Steps:
    1. Hematoma formation at fracture site due to rich blood supply.
    2. Callus develops approximately one week later.
    3. Remodeling by osteoclasts and osteoblasts.
    4. Complete healing: 6 weeks for young adults; up to a year for older individuals.

Etiology and Types of Fractures

  • Types: Avulsion, communited, impacted, greenstick, interarticular, displaced, pathological, spiral, longitudinal, oblique, stress, transverse, depressed.
  • Classification by Break Type:
    • Complete: Break results in two separate pieces.
    • Incomplete: Bone remains joined.
    • Displaced: Misalignment of bone ends.
    • Closed: Skin intact.
    • Open: Skin broken, higher infection risk.

Signs and Symptoms of Fractures

  • Symptoms vary by severity and include pain, swelling, deformity, and grating sound on motion.
  • Hairline fractures may only show localized tenderness.

Diagnosis and Emergency Treatment

  • Diagnostic Tests: X-ray, CT for complex areas, MRI for associated soft tissue damage.
  • Initial care includes immobilization, splinting, and neurovascular checks.
  • Emergency measures include controlling bleeding, assessing for other injuries, and splinting the limb in its current position.

Fracture Management

  • Goals: Reduction, immobilization, soft tissue preservation, function restoration, and pain relief.
  • Treatment Types:
    • Closed Reduction: Manual alignment without surgery.
    • Splints and Casts: For stabilization during healing; apply neurovascular checks.
    • Traction: Temporary measure to align bone fragments.
    • Open Reduction with Internal Fixation: Surgical alignment with internal devices.
    • External Fixation: Used for severe fractures with soft tissue damage.

Complications of Fractures

  • Risks include compartment syndrome, hemorrhage, infection, thromboembolic events, and persistent pain.
  • Acute Compartment Syndrome: Increased pressure leading to circulation issues, requiring immediate intervention.

Osteomyelitis

  • Definition: Bone inflammation due to infection; can be acute or chronic.
  • Pathogen: Most often caused by Staphylococcus aureus.
  • Symptoms: Localized pain, swelling, fever, and drainage in acute cases.
  • Diagnostics: Elevated WBC, ESR, positive blood cultures.
  • Treatment: Antibiotics, surgical debridement; chronic cases may require amputation.

Osteoporosis

  • Definition: Metabolic disorder with reduced bone density, leading to fragility.
  • Prevalence: Affects millions, with increased risk in postmenopausal women.
  • Types: Primary (idiopathic) and secondary (due to medical conditions).
  • Prevention: Adequate calcium and vitamin D intake; weight-bearing exercises; lifestyle modifications.
  • Diagnosis: DEXA scan for bone density; management includes bisphosphonates and lifestyle changes.

Connective Tissue Disorders

Gout

  • Definition: Systemic condition due to uric acid surplus resulting in inflammation.
  • Symptoms: Joint pain, redness usually at the big toe.
  • Treatment: NSAIDs for acute attacks; chronic management uses allopurinol and dietary adjustments.

Osteoarthritis (OA)

  • Definition: Degenerative joint disease affecting cartilage and bone.
  • Symptoms: Joint pain, stiffness, especially after activity.
  • Management: NSAIDs, physical therapy, weight control, surgical options if conservative fails.

Rheumatoid Arthritis (RA)

  • Definition: Chronic autoimmune condition causing joint inflammation and systemic effects.
  • Symptoms: Swelling, symmetry, stiffness, systemic signs.
  • Management: DMARDs, NSAIDs, corticosteroids, surgery for severe cases.

Total Joint Replacement (TJR)

  • Procedures: Total hips and knees are most common, offering pain relief and improved function.
  • Patient Care: Preoperative education, postoperative monitoring for complications, early ambulation.

Amputation

  • Types: Surgical vs. traumatic; preoperative care includes preparation for psychological impacts.
  • Postoperative Care: Monitor for hemorrhage, infection, pain management including addressing phantom pain, and preparing for prosthesis fitting.

Key Points

  • Soft tissue injuries encompass strains, sprains, dislocations, and others.
  • Fractures range from minor to severe. Complications can include compartment syndrome and osteomyelitis.
  • Osteoporosis and osteoarthritis significantly affect older populations, increasing fracture risk and affecting quality of life.
  • Understanding patient care needs before and after surgeries like TJR and amputations is critical for recovery and rehabilitation.