-
fx of the proximal end of femur
hip fx
-
main cause of hip fx
falls
-
may degenerative disease may predispose one to hip fx
- osteoporosis
- osteoarthritis
- rheumatoid arthritis
-
pathophysiology of hip fx
- femoral neck fracture (intracapsular)
- intertrochanteric or subtrochanteric (extracapsular - located below the femoral neck)
-
hip fx:
why can a femoral neck fx be more serious?
arterial blood supply is usually disrupted --> high risk for avacular necrosis of femoral head
-
what's the difference between a femoral neck fx vs inter- or subtrochanteric fx?
- femoral neck fx - blood supply usually disrupted (may be displaced, comminuted, compacted)
- inter- or subtrochanteric fx - severe and difficult to fixate but blood supply usually is NOT disrupted (almost always comminuted)
-
hip fx:
manifestations
- pain
- bruising
- immobility
- leg shortened on injured side and may be externally rotated
-
hip fx
dx test:
- x rays
- routine screening lab work
-
hip fx:
collaborative management
- bucks traction before surgery - maintain alignment and decrease musc spasm
- surgery
- prothetic implant
- total hip replacement
- hemiarthroplasty
-
complications of hip fx
- hemorrhage; SHOCK!
- delayed healing
- avascular necrosis of femoral head
- dvt/pe
- dislocation or loosening of prosthesis, secondary arthritis, infection, confusion, uti , pressure ulcers
-
what is the most potentially life threating complication of post hip or knee replacement surgery?
DVT/ PE!!!!
*need to give lovenox, SCDs, TEDs
-
nurse management post op hip replacement
- monitor/prevent complications:
- blood loss/ anemia
- infection
- confusion
- complications of immobility
- dvt prevention
- atelectasis/pneumonia
-
other nurse interventions post hip surgery
- monitor neurovascular compromise
- position and moblity
- rehabilitation
- pain management
-
what are some post-prosthetic implant restriction
- avoid hip flexion >45-90%
- avoidance of adduction of affected leg past midline (abduction pillow used)
- avoidance of internal or external hip rotation
- partial weight-bearing
-
what is the purpose of a total knee replacement
increase stability and function on knee joint w/c has been damaged (usually r/t osteo or rheumatoid arthritis etc)
-
knee replacement surgery:
post-operative management
emphasis on mobilization of the joint (CPM, early ambulation w/ partial weight bearing w/t crutches and knee immobilizing brace)
-
complications of post knee surgery
- hemorrhage/SHOCK
- DVT/ PE
- infection
-
name 4 degenerative diseases of the spine
- 1. herniated nucleus pulposus (bulging disc)
- 2. osteophyte (bone spurs from osteoarthritis)
- 3. spinal stenosis (narrowing of intervertebral foramina)
- 4. degenerative/rheumatoid involvement (pain/limited motion)
-
pathophysiology of degenerative disease of the spine
degeneration of vertabrae or intervertebral disks as a result of defect, infection, trauma, herniated, disc, arthritis, or aging
-
clinical manifestation:
neurological changes of degenerative diseases of the spine depends on what?
level of nerve root involved
-
neuro changes involved with degen dz of spine may include:
- numbess/tingling/paresthesia/pain
- weakness of one or more extremities
- muscle wasting
- depression of deep tendon reflexes
- partial or complete loss of bowel/bladder control (lumbar/sacral)
-
what tests are done to dx degen dz of spine?
- x ray
- CT or MRI
- myelography
- EMG
-
collaborative management of spinal surgery
- conservative
- bed rest
- supportive corsets
- heat
- analgesics/anti-inflammatory meds
- traction
- back strengthening exercise/ PT
- epidural steroid infections
- Williams position
- compl and alternative tx
-
surgical management of degen spinal dz
- minimally invasive surgery:
- percutaneous lumbar diskectomy
- microdiskectomy
- convetional open surgery:
- laminectomy
- diskectomy
- spinal fusion
-
nursing management - conservative tx for spinal issues
- teaching:
- activity restriction and proper body mechanics
- promote comfort:
- slightly elevate HOB
- flex knees
pain management:
-
nusre management of post-surgical pt (spinal surgery)
- neuro function (motion, strength, sensory abnormalities)
- airway patency and swallow (cervical)
- assess dressing for CSF leakage or bleeding
-
what position should one be post cervical (spinal) surgery?
elevate HOB 30-45
*w/ soft-rigid cervical collar
-
what position should one be post lumbar/sacral surgery
- HOB FLAT, or slightly elevated
- spine streight w/t hips/knees flexed
- log roll
-
how would be promote comfort post spinal surgery?
- analgesics
- firm mattress
- brace for suport/comfort
- lumbar: fx pan
- cervical: ice chips, progress diet slowly
-
promoting mobility for lumbar/sacral surgery
- OOB 1st post op day for simple laminectomy
- log roll side to side
- if surgery more extensive: maintain spine in straight position w/o bending or twisting
-
promote mobility for cervical
- make sure neck brace is on
- OOB 1st post op day or next am
-
complications post spinal surgery
- bleeding/hematoma
- airway
- progressive neurodysfunction
- CSF leak (HA, clear drainage, about 1 wk after surgery)
- urinary retention (common lumbar/sacral)
- impaired bowel functino/constipation
- DVT infection
- laryngeal nerve damage w/ cervical surgery (loss of voice or persistent hoarseness)
-
discharge teaching post spinal surgery (cervical)
- wear brace
- no driving while wearing brace
-
discharge teaching post spinal injury (lumbar/sacral)
- don't lift/carry objects >5lbs
- avoid twisting trunk
- bneding over knees w/ back straight
- no prolonged sitting
|
|
