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Arthography
used to see acute or chronic tears of the joint capsule or ligaments of the knee, shoulder, ankle, or wrist
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Arthography procedure
- radioplaque injected to joint cavity
- joint put to ROM to distribute agent
- x-rays are taken
*note - contrast agent will leak from joint cavity if tear is present for 1-2 days
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rnsg interventions
- normal to hear clicking/cracking in joint for 1-2 days
- joint rested for 12 hrs
- compression elastic bandage applied
- assess for allergies to contrast agent if used
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arthrography contraindications
- pregnancy
- claustrophobia
- inability to tolerate position due to age
- debility or disability
- metal implants
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Bone densitometry
used to estimate bone mineral density (BMD)
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DXA or DEXA
used to estimate extent of osteoporosis and monitor pt's response to osteoporosis tx
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Bone scan
to detect metastatic & primary bone tumors, osteomyelitis, fractures, & aseptic necrosis
*radioisotope injected IV - scan done 2-3 hrs after injection
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bone scan interventions
- possible allergies to radioisotope
- contraindicated to pregnant women
- drink lots of fluids to distribute & eliminate the isotope
- empty bladder bec a full bladder interferes w/ accurate scanning of pelvic bones
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Arthroscopy
- direct visualization of a joint (joint structures, synovium, articular surfaces)
- used to diagnose joint disorders
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Arthroscopy can?
repair/treat tears, defects, and disease process through arthroscope
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arthroscopy complications (rare)
- infection
- hemarthrosis
- neurovascular compromise
- thrombophlebitis
- stiffness
- effusion
- adhesions
- delayed wound healing
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arthroscopy interventions
- joint wrapped w/ compression dressing to control swelling
- ice to control edema & promote comfort
- joint extended/elevated to reduce swelling
- adm analgesics
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arthroscopy s/s of complications
- swelling
- numbness
- cool skin
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Arthrocentesis
joint aspiration to obtain synovial fld for examination or relieve pain d/t effusion
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arthrocentesis helpful to diagnose what?
- (synovial fluid)
- septic arthritis
- inflammatory arthopathies
- bleeding
- pain from effusion
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Synovial fld
- clear
- pale
- straw colored
- scanty in volume
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arthrocentesis rnsg
- sterile dressing applied
- risk for infection
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Casts
- used to
- immobilize reduced fracture
- correct deformity
- apply uniform pressure on soft tissue
- support and stabilize weakend joints
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Fiberglass cast
- let pt know to expect increasing warmth
- don't put on hard/sharp edges while drying
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Plaster cast
- less costly
- better mold than fiberglass
- will also produce heat
- crystallization process takes 15-20 mins
- 24-72 hrs to completely dry
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Splints and braces
may be used after cast
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Splints
- do not require rigid immobilization
- used when swelling is anticipated or require special skin care
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Braces
- used to provide support, control movement, prevent addtl injury
- for longer use than splints
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General nrsg mngt for cast, splint, brace
- assess neurovascular status
- consider swelling, bruising, skin abrasions
- let pt know what to expect with procedure
- assess pain (character & intensity)
- most pain can be relieved by elevation, cold packs, analgesics
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Potential complications r/t casts, braces, splints
compartment syndrome: vascular insufficiency & nerve compression d/t unrelieved swelling can result in compartment syndrome. it occurs when there is increased tissue pressure w/in a limited space that compromises circulation and fn of tissue
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to relieve pressure compartment syndrome
- call md
- bivalve cast while extremity elevated no highter than the heart
- if pressure not relieved - fasciotomy required
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Other complications - pressure ulcers
- pressure or inappropriate application may cause tissue anoxia or pressure ulcers.
- lower extremities are more susceptible - heel, malleoli, dorsum of foot, head of fibulla, and anterior surface of patella
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S/S of pressure ulcer with cast
- a warm area suggests erythema
- may give foul odor
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External fixation device
- used to manage open fractures w/ soft tissue damage
- provides stable support for severe comminuted fractures while permitting active tx
- fracture is reduced, aligned, immobilized by pins in bone (humerus, forearm, femur, tibia & pelvis)
- facilitates pt comfort, early mobility, active exercise of adjacent uninvolved joints
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external fixation implications
- *disturbed body image and risk for infection
- neurovascular status q 2-4 hrs
- assess pin site q 2-4 hrs for redness, drainage, tenderness, pain and loosening of pins
- clean each pin 1-2x a day w/ cotton w/ chlorhexidine
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Traction
application of pulling force to part of body
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traction is used to
- minimize muscle spasms
- reduce, align, and immobilize fractures
- reduce deformity
- increase space between opposing surfaces
- may need to use more than one to achieve desired line of pull (vector force)
- used until external/internal fixation are possible (-> short term)
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Principles of effective traction
- counter-traction must be used
- must be continuous
- never interrupted (skeletal)
- weights not removed unless intermittent
- good body alignment
- ropes unobstructed
- weights freely hanging
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Buck's traction
- is a type of skin traction (non-invasive)
- controls spasms
- immobilizes area before sx
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skin traction interventions
- avoid wrinkling, slipping of traction bandage
- maintain counter traction & positioning (don't turn side2side)
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skin breakdown prevention - skin traction
- remove boot & inspect skin 3x daily
- palpate area to detect tenderness
- provide back care q2 hrs
- use air-filled mattress
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Nerve damage prevention - skin traction
- avoid pressure on peroneal nerve --> foot drop
- assess toe & foot movement, sensation, pallor, temp, cap refill
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circulatory impairment prevention - skin traction
- assess circulation w/in 15-30 min after traction is first applied then q 1-2 hrs
- assess peripheral pulses, color, cap refill, temp,
- **assess for DVT - calf tenderness, warmth, redness, swelling
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