Med/Surg Unit 3
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Most common sites for arthritic involvment
- 1st- hip
- 2nd- spine
- 3rd- knee
Drugs used to decrease the risk of DVT
- low-dose unfractionated heparin (UFH)
- low-molecular-weight heparin (LMWH)
- fondaparinux (Atrixta)
- warfarin sodium-slower to reach blood but less expesive and easier to pt to take after discharge
Surgical management of hip OA
- Osteotomy-cut across a bone w/ resection of a bone fragment to correct a deformityor alter stress on a joint-performed on clients in 40's
- Arthrodesis-Joint fusion-performed on active clients <55
- Total Hip Arthroplasty/ Replacement- persormed to restore joint motion by replacing arthritic bone with metal and plastic components
What is Homan's sign?
- dorsiflexion of the foot causes discomfort in upper calf present in fewer than 1/3 of symptomatic client’s with DVT
- nonspecific indicator to assess for thrombophlebitis
- Client may have thrombophlebitis but have a negative Homan's sign
- Positive sign can result from shin splints
Early manifestations of DVT
- unilateral calf or thigh pain that results from venous
- inflammation or obstruction
- red vein track
Bone Healing Stages
- Stage I Hematoma or Inflammatory stage-warmth, vasodilation, edema, loss of function, bruising, Time: 1-3 days
- Stage II Fibrocartilage formation (cellular proliferation) -Time: 3 days-2 weeks
- Stage III Callus Formation Time: 2-6 weeks
- Stage IV Ossification-new bone Time: 3 weeks- 6 months
- Stage V Consolidation and Remodeling-comes back together Time: 6 weeks to 1 year
Factors affecting wound healing
- Adequate circulation
- Proper fragment immobilization
- Presence of systemic or bone diseases
- Age and general health of pt
- Type of fractureTreatment
If a client is taking warfarin what should the nurse reinforce?
The importance of consistent intake of foods that contain Vit K (ex green, leafy veggies)
What is used in for the diagnosis of DVT
- Doppler ultrasound of the leg
what is warfarin used for?
long term home use to prevent clot recurrence
Disorders that alter bony equilibrium and affect bony turnover
- estrogen deficiency
- parathyroid gland abnormalities
- vitamin deficiency
- physical activity
- low bone mineral density compared with that expected for the person's age and gender
- caused by steroid use or Cushing's Syndrome
Categories for Osteporosis
- low bone mass (osteopenia)
- severe (established osteoporosis)
Tissue Damage Grading
- Grade I The wound is smaller than 1cm; contamination is minimal
- Grade II The wound is larger than 1 cm; contamination is moderate
- Grade III The wound exceeds 6-8 cm; extensive damage to soft tissue, nerve, and tendon; high degree of contamination
- Closed: intact skin over site of injury
- Open: break in skin over the bone injury **serious because once the skin is broken, infection in both the wound and bone can occur
Describe Reducing Fractures
the manipulation of bone to restore alignment, position, and length by bringing the bony fragments into close approximation.
- also called bone setting
- alleviates compression or stretching of nerves and blood vessels.
Osteprorsis can result from underlying medical conditions such as....
- Cushing's syndrome
- anorexia nervosa
- long-term use of meds such as thyroid hormone, anticonvulsants, furosemide and corticosteroids
Major risk factors for Osteoporosis
- personal history of fracture as an adult
- Hx of fragility (low trauma) fracture in a first degree relative
- Low body weight (less than 128 lbs)
- Current cig smoking
- Use of oral corticosteroid therapy for more than 3 months
Describe Skin Traction
- involves the application of a pulling force directly to the skin through the use of skin strips, boots, or foam splints. Do not move extremity out of alignment, rarely used
- a. Bears a low longitudinal force load (5-7lbs)
- b. Only used temporarily due to risk of skin breakdown
Describe Skeletal Traction
- uses pins or wires to apply force to the bone. A direct force can be applied after the physician inserts stainless-steel pins through the bone itself.
- a.Most common sites are: the distal femur, the proximal tibia, and the proximal ulna
- b. Can be tolerated for longer periods than can skin traction
- c. Weights over 10 lbs are commonly used
Major Types of Traction
- a. Buck’s traction: most common form-a foam boot is applied to the clients’ affected extremity and attached to a weight that is suspended off the foot of the bed, form of skin traction
- b. Russell’s traction: modification of Buck’s, short-term
- c. Cervical traction: collar with weights, being used to treat sprain or strain or cervical fracture. Can cause damage to spinal cord
- d. Pelvic traction: put device around pelvis, ropes pull hip off bed
Two principal functions of bone remodeling
- Replaces old bone with new so that the biomechanical properties of the skeleton are not compromised by continuous use
- Plays a role in mineral homeostasis by transferring calcium and other ions into and out of the skeletal reservoir
Descrine Compartment Syndrome
- Cast in place, due to prolonged compression swelling occurs and there is increased pressure.
- Condition of compromised circulation related to progressively increased pressure in a confined space.
- Irreversible after 24 hours, after 4-6 muscle damage will occur, nerve damage 12-24 hours if swelling is left untreated
what is Paget's Disease?
- an idiopathic bone disorder characterized by abnormal and accelerated bone resorption and formation in one or more bones
- normal bone is replaced by abnormal, structurally weaker bone that is prone to fractures
- most frequently produces deformities of the femur, tibia, lower spine, pelvis and cranium
- cause is unkown
- rarely seen in people under 40
Most common presenting complaints of Paget's Disease
- deep, aching bone pain
- skeletal deformity such as barrel shaped chest, bowing of tibia or femur, or kyphosis
- changes in skin temp
- pathological fractures through diseased bone
- manifestations related to nerve compression
What is Volkmann’s Contracture?
untreated compartment syndrome
What is Fat Embolism syndrome?
similar to PE but fat not blood, released atsite of fracture, released into blood and travels. Pt is apprehensive, anxious, confused
Where does Osteomyelitis most frequently occur?
- pressure ulcers
- other chronic open wounds
What is Osteomyelitis?
- - severe pyogenic infection of bone and surrounding tissues
- -generally bacterial but can be caused by a fungus or virus
- -Staphylococcus aureus-most common infecting organism
What meds/therapies can be used to control pain associated with Paget's Disease?
- NSAIDS such as ibuprofen
- heat therapy
Long Term Complications of Fractures
- Joint stiffness or Traumatic arthritis- can happen years later
- Avascular necrosis- most frequently seen in femur
- Nonfunctional union
- Delayed Union
- Fibrous Union
- Complex Regional Pain Syndrome
Manifestaions of cast Syndrome
- abdominal pressure and vague abdominal pain
- feelings of bloating or tightness
- inability to take a deep breath.
What is gout?
a metabolic bone disorder in which purine (protein) metabolism is altered and the by-product, uric acid, accumulates.
Classifications of gout
- Primary- caused by inherited defect of purine metabolism, leading to increased renal excretion
- Secondary- acquired condition that occurs following hematopoetic or renal disorders
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