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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 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