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What is the cause of dysplasia of the hip?
variety of conditions in which the femoral head and the acetabulum are improperly aligned
What can cause dysplasia of the hip?
- acetabular dysplasia
what are risk factors to developing dysplasia of the hip?
- 1st degree relative
- intrauterine postioning
- maternal increased estrogen levels
What will be seen in a child with dysplasia of the hip?
- limited abduction
- affected hip can not be pressed back to hit the table
- knee is lower
- "click" heard as femoral head slips into acetabulum under gentle pressure
- asymmetry gluteal and thigh fat fold
- telescoping or pistoning of the thigh
What is the overall management of a child with dysplasia of the hip?
attempt to form a normal joint
What type of treatment can be done at attempting to form a normal joint for a dysplasia hips?
- keeping the head of the femur within the hip acetabulum
- constant pressure to enlarge & deepen the acetabulum
In order to try to correct dysplasia of the hip in a newborn what will be done?
abduct the hips by using a Pavlick harness for 24 hours/day
In order to try to correct dysplasia of the hip in a 3 months-3 years old what will be done?
- Bryant traction for 20 hours/day for 3-4 weeks
- stretches the soft tissue to allow the hip to be placed in the acetabulum
In order to try to correct dysplasia of the hip in a 3 year old or older what will be done?
- if its dislocated its reduced under general anesthesia
- and spica cast to hold abduction for 5-9 months and changed every 6 weeks and may wear a brace after for 1-2 months
What are factors of a congenital club foot?
- bilateral or unilateral
What will a child foot look like in a congenital club foot?
- foot is directed downward, inward, forefoot adducted
- foot is shorter with a shortened Achilles tendon
- lower leg muscle atrophy
- child walks on toes & outer borders of the feet
How is congenital club foot treated at birth?
long leg cast for 12 weeks and change every 1-2 weeks
In mild cases of congenital club foot how is it treated?
proper shoe to correct
In sever cases of congenital club foot how is it treated?
- surgery in 4-12 months followed by casting and corrective shoes
- surgery to cut tendon and add pins in bones
What are the responsibility of the nurse for a patient after surgery to correct club foot?
- assessments (VS)
- pain manamgement
- emotional support
What is the manifestations of scoliosis?
lateral, curvature, flexing laterally and rotating around it longitudinal axis
Who is more likely to develop scoliosis?
- 2-4% adolescents
- 10-13 years of age
What is the cause of scoliosis?
- soft tissue shortening
- vertebral shape and disk space abnormalities
- fixed rotational deformity
- thoracic curvature
How might the ribs on the convex side of a patient with scoliosis be seen as?
displaced posteriorly and widely spaced
How might the ribs on the concave side of a patient with scoliosis be seen as?
displaced anteriorly and narrowly spaced
What are the main problems that can occur with a patient with scoliosis?
- chronic pain
How do we treat mild scoliosis curvature <20 degrees?
- frequent evaluations
- exercise program
- may or may not wear brace
How do we treat moderate curvature scoliosis 20-45 degree?
- Milwaukee brace worn for 23 hrs/day
- taken off for one hour to bathe or swim
- Lateral electrical surface stimulation (LESS)
How do we treat severe curvature scoliosis >45 degrees?
- surgery-spinal fusion, done in stages, and Harrington rods in place until fusion is solid
- after surgery wear a body cast for 6-9 months
- after body cast wear a brace
What happens when an individual has back pain?
disk's central portion slips through the surrounding annulus fibrosus into the spinal canal, putting pressure on the nerve root
What are causes of a patient having back pain?
- direct injury
- degenerating disk due to old age
- weakened anulus
Where is the most common back pain located at?
What are the risk factors for developing back pain?
- increased age
- Lumbar herniation 20-45 yrs
- Cervical herniation over 50 yrs
- pregnant women
What type of symptoms might a patient state they have with back pain?
- pain worsening with activity, subsides with rest
- unilateral or bilateral pain
- sciatic never pain radiating down the leg
- muscle spasms
- sensory deficit (losing bladder control)
How can we diagnose back pain?
What is the best way to prevent back pain?
- Prevent back pain
- good body mechanics
- core conditioning
- normal body weight
What can you tell a patient to do to help treat their back pain?
- bed rest with body alignment
- muscle strengthening exercise ASAP
- muscle relaxants
What is the purpose of having a Laminectomy?
- treats bony impingement on the nerve root when neuro involovment
- removes lamina over the nerve root, then removal of the herniated nucleus pulposus
Where is the incision located if your having a cervical laminectomy?
Where is the incision located if your having a lumbar laminectomy?
- non systemic
- non inflammatory
- bone & joint degeneration
Which joints are affected with osteoarthritis?
weight bearing joints: knee, hip, cervical and lumbar vertebrae & great toe, and also hands
What are the reasons of having a primary cause of osteoarthritis?
- no predisposing factors
What are the reasons of having a secondary cause of osteoarthritis?
- congenital or developmental defects
- other arthritic types
- diabetes mellitus
What are risk factors for developing osteoarthritis?
- family history
- history of excess use of same joint
- history of joint injury
What are complications of having osteoarthritis?
- flexion contractures
- bony cysts, gross bony overgrowth
- nerve root compression
What do we want to tell the patient to do to treat osteoarthritis?
- activity balanced with rest
- physical therapy
- assistive devices
- drug therapy
- surgery for joint replacement
Define rheumatoid arthritis?
- progressive inflammatory disease
- immunologic changes
which patients are more likely to have rheumatoid arthritis?
- 20-50 years old
- inherent tendency
Which joints are most affected in rheumatoid arthritis?
hands most affected bilateral
What's the difference of how the joints on the hand will look like in rheumatoid vs. osteoarthritis?
- rheumatoid: warm, tender swollen, and decreased ROM
- osteoarthritis: not warm, not swollen
What is the cause of rheumatoid arthritis?
auto immune response within the synovial tissue inflamed>increased fluid>causing thickening synovia>causing granulated tissue>damages the cartilage, joint tissue, tendons, ligaments, and subcutaneous tissue>causes proteolytic enzymes are released>causing more destruction of the disease
What are complications of rheumatoid arthritis?
- flexion contractures: fingers flexed, turned laterally
- tendon/muscle weakness
- septic arthritis
- nerve compression
- skin ulceration
- pleural disease
- interstitial fibrosis
What type of treatment are used for rheumatoid arthritis?
- surgery for joint replacement
- drug therapy: NSAIDs, steroids, gold containing agents, immunosuppressive drugs
What is the primary cause of Gout?
uric acid over production &/or retention
What is the secondary cause of gout?
drugs or other disease state
What types of symptoms will a person with gout be seen having?
- abrupt swelling tenderness & pain in joint that last several weeks
- very painful want nothing to touch
- symptoms worse with each attack
What are causes of a GOUT flare up?
- minor trauma
- excessive alcohol
- foods high in fats/proteind
which joint is most affected by GOUT?
What type of treatment will be given for a patient with a GOUT attack?
- colchicine-acute phase
- diet change
- weight loss
What is the indication for allopurinol?
reduces uric acid production taken every day
What is the indication for sulfinpyrazone?
decrease serum uric acid
Define systemic lupus erythematose?
- chronic collagen vascular disease
- autoimmune disease
Which type of the body systems does lupus affects?
- multiple body systems affected (changes from individual to individual)
- producing widespread to connective tissues, blood vessels, and serous/mucous membranes
what type of symptoms would a patient complain of if the have lupus?
- facial erythematic (butterfly rash)
- stiff aching joints
- musculoskeletal deformity/pain
- weight loss
- remissions & exacerbations
What are other complications that can arise from Lupus?
- pleural effusions (lungs)
- heart problems
- Lupus nephritis (kidney)
- Raynaud's phenomenon (fingers)
What are primary treatments for a patient with lupus?
- NO CURE
- prevent exacerbations
- suppress inflammation
- relieve symptoms
- immunosuppressive medications
- emotional support
What are the primary cause of hip fractures?
- TIA's (cardiac problem)
- poor vision
what are risk factors for a patient of having a hip fracture?
- increased age
- sedentary lifestyle
- weakened quadriceps
What type of fracture is a intracapsular fracture and what is the problem with this one?
- fracture of the femurs head and neck
- has slow healing due to limited blood supply
What type of fracture is a extra capsular fracture and what is the problem with this one?
- fracture in femurs trochanteric region
- has good healing due to good blood supply
What type of things would you see in a patient with a hip fracture?
- pain in hip, groin, or knee that worse with movment
- affected limb is rotated and shortened
- muscle spasms
- hematoma and ecchymosed
what tings can we use to diagnose a hip fracture?
- decreased hemoglobin
- elevated enzymes & blood glucose
What types of treatments are we going to do for a patient with a hip fracture?
- Bucks traction especially before surgery
- surgery (open reduction, internal fixation or replacement)
- pain meds
What are complications of a patient with a hip fracture?
- skin & soft tissue injuries
- nerve injuries
- vascular complications
- delayed, incorrect or non union of bone
- secondary infections
- adhesions and joint stiffness
- fat emboli syndrome
What are the causes of having a joint replacement?
- 1. arthritic or injury induced inflammation
- 2. abnormalities after fracture healing
- 3. physiologic changes from aging
- 4. cartilage degeneration
What patients are most like to have a hip replacement with a shell mesh replacement and why?
- younger patients
- they work longer
- but patient cant walk for 3 months after surgery
What patients are most like to have a hip replacement with a glue cup replacement and why?
- older patients
- they can get up and walk next day
After surgery of a patient with a hip replacement what is the nurse going to mainly focus on?
- pain management
- position patient with abductor pillow & hip rolls
- teach them not to cross legs
- monitor dressing and drains
- monitor for signs of dislocation
What are signs of a hip replacement being dislocated?
- worsening pain
- shortening of leg
- popping sound
What types of things are going to be used when a patient has had a total knee replacement?
- Auto transfusion (during surgery)
What are the causes of a person getting an extremity amputated?
- vascular insufficiency (diabetes)
After a patient had a amputation what things is a nurse going to teach them?
- elevate extremity for first 24 hours after
- start ROM after 24 hours
- avoid external rotation or abduction
What are the main complications of having an amputation?
- phantom pain
- wound dehiscent
When should a nurse be most concern with a patient developing compartment syndrome?
2 hours to 6 days following surgery or trauma
What are signs/symptoms that a patient might experience with compartment syndrome?
What is the priority treatment for compartment syndrome?
release pressure by doing a surgery to split the fascia envelope
What are complications of compartment syndrome?
- ischemia (histamine release>edema>blood vessel compression
- neurologic (due to pressed damaged nerves
- contractures (fibrous tissue that replaces ischemic muscles & tendons
What types of things cause compartment syndrome?
- crushing injuries
- internal pressure or bleeding
What areas are most affected by compartment syndrome?
- lower leg
- others: shoulder, hand, butt, and foot
How does compartment syndrome occur?
fascia is unable to expand for the blood and causes muscles to swell pressing occluding nerves & blood vessels