Bursitis: Inflammation of the fluid filled sac(bursa)
RX: Joint rest, elevation & application of the heat, analgesics
Rotator Cuff Injury: made up of four muscles that help move & stabilize the shoulder joint.
Common in people who perform repetitive motions of hand & wrists. Ex) typing on a computer
Surgery and teach prevention
Open or Compound: break skin or soft tissue—infection risk
Closed: does not break skin
Deformity, Shortening of Limb
Swelling & Bruising
PREVENTION BETTER THAN CURE!!!
Seek Medical attention
Temporary measures when operative fixation is not available for a period of time.
Applied through the skin(Skin Traction)
Through pins inserted into bones(Skeletal Traction)
Lessen or eliminate muscle spasm.
Relieve pressure on nerves, especially spinal.
Prevent or reduce skeletal deformities or muscle contractures.
Ropes & weights must be unobstructed.
Knots in the rope or footplate must not touch the pulley or foot of bed.
Perform pin site care.
**Traction setup: weights on the traction setup must be hanging freely.
Thomas Ring: Fractures of Tibia or Fibula.
Russell’s: Femur Fracture.
Balanced Suspension & Skeletal Traction
Halo-Femoral: For spinal injuries uses pins & wires.
Open Reduction with Internal Fixation: Surgically repairing a fractured bone, involves either plates & screws or an intramedullar rod to stabilize the bone.
External Fixation: Pins are inserted through skin into the bone and held in place by an external frame.
Acute Compartment Syndrome
***Fat Embolism Syndrome:
Signs & Symptoms: Respiratory distress, confusion & restlessness
Leads to tissue death from lack of O2.
Blood vessels being compressed by the raised pressure within the compartment.
Acute, Subacute, and Chronic compartment syndrome.
5. Pulsenessness/unequal pulses
Tense swollen shiny skin, bruising of the skin.
Risk for Ineffective Tissue Perfusion
Risk for Ineffective Skin Integrity
Skin Care: never scratch under a cast.
S & S Fever, Redness, Heat, Pain, Swelling & Pain.
RX: Long term Antibiotic Therapy, incision & drainage, Amputation
Prone to Fractures, spine, wrist & hip most common.
All bones affected.
Reduced quality of life
Risk of Death(During year after Fracture)
Decreased Serum Calcium: 8.5-10.5(normal)
Uric Acid: male-4.4-7.6
-Obtain Adequate Calcium and Vitamin D
-Major dietary source of calcium: milk, yogurt and a variety of cheeses.
-Fortified with calcium and Vitamin D: Orange, juice, milk
-Regular Exercises(Especially Childhood)-promotes bone
formation & improve strength
-Avoid Alcohol & Smoking
Petite Body Build
Low Testosterone & Estrogen, Low Calcium Intake
Low Vitamin D, Excessive Caffeine, Protein & Sodium
*Sedentary Lifestyle, Excessive Alcohol & Smoking
Kyphosis: Vertebrae leads to forward bending of the spine & creates a hump at the upper back.
height decreases, Back Pain & Fracture
Serum Calcium, Vitamin D Decreased
Serum Phosphorus Increased
Serum Alkaline Phosphates Increased
alendronate(Fosamax)-administer with full glass water on arising in AM. Do not lie down for 30 min after medication.
Selective Estrogen Receptor Modulator
raloxifene(Evista): side effects: Hot Flashes
Education: Diet-Increase Calcium, Vitamin D, Exercise, Medication & Fall Prevention..very important.
Disorganized Bone Deposits
No obvious Symptoms Usually
X-Ray, Bone Scan
Relieve Pain, Teach, Promote Life quality
50% Occur in Distal Femur in Young Men
Metastasizes to Lung within 2 years
Tumor:long bones of the arms & legs
Pelvis, Chest & Skull
Cancer of Cartilaginous Cells
**Do not place in a dependent position.
Monitor VS 4th hourly.
Monitor site for edema, bleeding & hematoma.
Administer oral analgesic for pain.
Surgery, Chemotherapy, Radiation.
Nursing Care: Postoperative Care, Supportive
Prostate, Breast, Lung & Thyroid
Therapeutic Interventions: Radiation
Nursing Care: Supportive care as with other cancers.
Uric Acid Buildup
Urate Crystals deposited in joints/connective tissue
Severe Inflammation….Very Painful
Secondary: Another health problem.
Chronic Gout: Urate deposits under skin, Renal Stones.
Joint Fluid-Uric Acid Crystals
allopurinol(Zyloprim)- Maintain fluid intake 2000ml/3000ml/day
Give with food
Therapeutic effect occurs after a week or longer.
Avoid foods with high in Purine.
Diet: Avoid foods high in Purine.(sardines, scallops, yeast, organ meat, legumes, spinach, gravies)
Avoid Asprin, Diuretics, Alcohol
Increase Fluids, Bed rest in acute stage.
Affects Connective Tissue
Arthralgia(joint pain), Myalgia(muscle pain)
Mucosal Ulcers, Alopecia, Skin Lesions
Erythrocyte Sedimentation Rate(ESR)
Immunological Tests: Antinuclear Antibody Titers & Antibodies Against SR Proteins
Topical Cortisone & Chloroquine(Aralen)
Stress Reduction & Community Support Groups
Progresses very rapidly
Sclerderma: Pitting edema, tightening, hardening, thickening of skin tissue
Loss of ROM & Contractures
Skin Protective-Mild Soaps & Lotions
Brittle bone disease, Pathological Fractures
Collagen Synthesized Abnormally
Scoliosis: Curvature of the Spine.
Britlle or Discolored Teeth
Smooth, Thin Skin
Physical & Skin Biopsy
Support Groups-Osteogenesis Imperfecta Foundation
Woman greater than Men
Progressive Muscle Weakness, Genetic
Ineffective Breathing Pattern
Self Care Deficit
Cartilage wears down over time
Degeneration of articular Cartilage
Most commonly affects joints in: Hands, Hips, Knees, Neck, Lower Back
Risk Factors: Aging, Obesity, Excessive Wear & Tear on Synovial Joints
Heberden’s & Bouchard’s Nodes- Bony nodes on joints of fingers.
Destroys Synovial Joints and other Connective Tissue
Includes Major Organs
Bilateral, Symmetrical Joint Inflammation
Reddened, Warm, Swollen, Stiff & Painful
Stiffness at Resting
Activity Decreases Pain & Stiffness
Low Grade Fever, Weakness, Fatigue
Red Blood Cell (RBC)
Erythrocyte Sedimentation Rate (ESR)
Antinuclear Antibody (ANA)
C-reactive Protein (CRP)
****Sometime RF may be negative but they still have Arthritis.
Patient Education: Disease Process, Medication Management
Rest & Exercise, Vocational Counselor, Community Resources
Femoral Component Inserted Into Femur
Post Operative Care to Prevent Complications:
***Do not flex hip more than 90 degrees
Skin Breakdown, Prevent Pressure Ulcers
Bleeding: Monitor incision/drainage from drain
Neurovascular Compromise: Neurovascular Checks
Pain, Pulses, Paraesthesia, Paralysis & Pallor
Look for signs of capillary refill
Check coloring in fingers & toes, they should be pink.
White coloring means inadequate arterial blood perfusion.
Bluish means inadequate venous blood return.
**Post op: The nurse needs to get physical therapy to get patient up after hip replacemet for the first time.
Compression Device, Leg Exercises & enoxaparin (Lovenox)
Self Care: Assistive dressing devices, Raised toilet seat, Rehabilitation
**Report s/s of infection, any changes in the shape of the knee
Metal Implant: anticoagulant bleeding (needs to be notified by caregiver)
Continuous Passive Motion Machine (CPM)
Below the Knee(BKA)
Above the Knee(AKA)
Below the Elbow(BEA)
Above the Elbow(AEA)
**Use a mirror to visualize all area of residual limb.
No oils, creams, lotions or alchohol rub
Use clean woolen sock
Pain Control: Phantom Pain
Mobility & Ambulation
Medications to reduce the pain: antidepressants/anti-platelets
Light massage, electrical stimulation, and hot & cold therapy
Nursing Care:Prosthesis, Lifestyle Adaptation