Download NSG 224 Notes

Unit 2 NSG 224
Lupus - malar rash - butterfly shaped rash on the face - avoid sun exposure
3 S's of Arthritis (related conditions) - Sjogren Syndrome, Scleradermis, systemic lupus
Sjogren's disease - dryness of mouth and eyes - relieve with eye drops and/or artificial saliva;
palliative symptomatic care
Arthritis - palliative moist heat, cold therapy
Drug therapy for all arthritis table 63.3 (Osteo gets APAP, intra-articular steroids; RA does not
get those, does get systemic steroids); opioids are late;
See arthro surgeries Ch 61
 Synovectomy - removal of synovial membrane and clean up of synovial space (RA)
 Osteotomy - remove a slice of bone to change its alignment and correct deformities (RA)
 Arthroplasty - general umbrella term for all joint surgery involved in repair and replacement
(partial or complete) (use hemi-arthroplasty if partial) (Total hip, total knee) (Osteoarthritis)
 Arthrodesis - surgical fusion of the joint
Subloxation - in and out dislocation; Dislocation is out and stays out until reduced
 Crepitus - grating sounds of joints
Dx
 Synovial fluid analysis
 Arthoscopy
 MRI
 CT
 Flouroscopy
 X-ray
PC: Ortho surgery
 Infection (prophylactic antibiotics - 1o prior to surgery, and after surgery for 48o, strict aseptic
technique)
 Hemorrhage
 DVT (SCD, anticoagulant therapy, TED - unaffected side if LE surgery - low molecular
weight or fractionated heparin, PT/INR - see physician order for therapeutic parameters)
 PE (see DVT)
Care of total knee replacement patient
 Position - per order - either flat and elevated 1 pillow -or- CPM immediately for 20+ hours
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o CPM - special mattress, will be on back full course of tx
o Straight leg and good fluid movement
o Give patient control in case it becomes too painful
Weight bearing - know order
Possible immobilizer depending on order and activity
Ambulatory aid - know what type and have it available, teach appropriate use
ND: Risk for injury: fall, Impaired skin integrity/tissue integrity
Probably a wound drain, closed system RAT: prevent hematoma and use for autotransfusion if
sterile
Complication of autotransfusion RAT: ABO and Rh incombaptibility avoided; no risk of viral
contamination from donor blood
o Hemolyzed blood - transfuse within 6 hours
o Recirculate cancer and cause metastasis
o Infection due to contamination of closed system
 Transfused every 300cc or 3 hours(if a good amount), whichever is first
Wound care: per order:
 Austin-Moore - hemiarthroplasty, replace only femoral head, not ascetabulum
Total hip
 Activity progression slower
o If cemented - progress faster with ambulation but breaks down faster, must be
replaced more often
o Non-cemented - fibrin needs to stabilize it first, slower progression, harder to do a
repeat or repair
o Progression
 Non or toe-touch
 Partial
 Full
 Avoid extreme flexion immediately post-op, if up in chair, maximum angle is 90 - no low
chair, may need raised toilet seat
 When turning patient, use ¼ turns, avoid adduction of operative leg which can dislocate joint;
use trapeze when there is a restriction for the extremity
o S&S of Dislocation - misalignment, pain, operative leg shorter (knees will not be
level)
 Be generous with pain medications - acute pain does not lead to addiction unless there is a
history of addiction
Fracture
 Loss of continuity of the bone
 Trauma injuries are #1
 Type
o Stable
 Transverse
 Oblique
 Longitudinal
 Impacted
 Stress
o Unstable
 Comminuted - shattered, longer management, soft tissue/nerve damage
o Communication - open fracture (communication through skin)
o Noncommunication - closed fracture
o Anatomical location
 Manifestations
o Pain
o Loss of function
o Guarding
o May not be accompanied by obvious deformation
o Excessive motion
o Crepitus
o Soft tissue edema
o Inflammatory changes
o Ecchymosis
o Sensory changes
 Peripheral Neurovascular Assessment
o Sensory
o Motor
o Color
o Temp
o Pulse distal to affected area
o Cap refill
o Peripheral edema
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