Understanding Medical Surgical Nursing, 3rd Edition                                     Linda S. Williams / Paula D. Hoppe...
Understanding Medical Surgical Nursing, 3rd Edition                                    Linda S. Williams / Paula D. Hopper...
Understanding Medical Surgical Nursing, 3rd Edition                                     Linda S. Williams / Paula D. Hoppe...
Understanding Medical Surgical Nursing, 3rd Edition                                        Linda S. Williams / Paula D. Ho...
Understanding Medical Surgical Nursing, 3rd Edition                                     Linda S. Williams / Paula D. Hoppe...
Understanding Medical Surgical Nursing, 3rd Edition                                     Linda S. Williams / Paula D. Hoppe...
Understanding Medical Surgical Nursing, 3rd Edition                                     Linda S. Williams / Paula D. Hoppe...
Understanding Medical Surgical Nursing, 3rd Edition                                    Linda S. Williams / Paula D. Hopper...
Understanding Medical Surgical Nursing, 3rd Edition                                     Linda S. Williams / Paula D. Hoppe...
Understanding Medical Surgical Nursing, 3rd Edition                                         Linda S. Williams / Paula D. H...
Understanding Medical Surgical Nursing, 3rd Edition                                     Linda S. Williams / Paula D. Hoppe...
Understanding Medical Surgical Nursing, 3rd Edition                                        Linda S. Williams / Paula D. Ho...
Understanding Medical Surgical Nursing, 3rd Edition                                         Linda S. Williams / Paula D. H...
Understanding Medical Surgical Nursing, 3rd Edition                                      Linda S. Williams / Paula D. Hopp...
Understanding Medical Surgical Nursing, 3rd Edition                                     Linda S. Williams / Paula D. Hoppe...
Understanding Medical Surgical Nursing, 3rd Edition                                       Linda S. Williams / Paula D. Hop...
Understanding Medical Surgical Nursing, 3rd Edition                                    Linda S. Williams / Paula D. Hopper...
Understanding Medical Surgical Nursing, 3rd Edition                                    Linda S. Williams / Paula D. Hopper...
Understanding Medical Surgical Nursing, 3rd Edition                                    Linda S. Williams / Paula D. Hopper...
Understanding Medical Surgical Nursing, 3rd Edition                                      Linda S. Williams / Paula D. Hopp...
Understanding Medical Surgical Nursing, 3rd Edition                                    Linda S. Williams / Paula D. Hopper...
Understanding Medical Surgical Nursing, 3rd Edition                                     Linda S. Williams / Paula D. Hoppe...
Understanding Medical Surgical Nursing, 3rd Edition                                     Linda S. Williams / Paula D. Hoppe...
Understanding Medical Surgical Nursing, 3rd Edition                                     Linda S. Williams / Paula D. Hoppe...
Understanding Medical Surgical Nursing, 3rd Edition                                                    Linda S. Williams /...
Understanding Medical Surgical Nursing, 3rd Edition                                     Linda S. Williams / Paula D. Hoppe...
Understanding Medical Surgical Nursing, 3rd Edition                                           Linda S. Williams / Paula D....
Understanding Medical Surgical Nursing, 3rd Edition                                     Linda S. Williams / Paula D. Hoppe...
Understanding Medical Surgical Nursing, 3rd Edition                                     Linda S. Williams / Paula D. Hoppe...
Understanding Medical Surgical Nursing, 3rd Edition                                     Linda S. Williams / Paula D. Hoppe...
Understanding Medical Surgical Nursing, 3rd Edition                                     Linda S. Williams / Paula D. Hoppe...
Understanding Medical Surgical Nursing, 3rd Edition                                     Linda S. Williams / Paula D. Hoppe...
Understanding Medical Surgical Nursing, 3rd Edition                                                 Linda S. Williams / Pa...
Understanding Medical Surgical Nursing, 3rd Edition                                     Linda S. Williams / Paula D. Hoppe...
Understanding Medical Surgical Nursing, 3rd Edition                                    Linda S. Williams / Paula D. Hopper...
Understanding Medical Surgical Nursing, 3rd Edition                                                   Linda S. Williams / ...
Understanding Medical Surgical Nursing, 3rd Edition                                         Linda S. Williams / Paula D. H...
Understanding Medical Surgical Nursing, 3rd Edition                                          Linda S. Williams / Paula D. ...
Understanding Medical Surgical Nursing, 3rd Edition                                     Linda S. Williams / Paula D. Hoppe...
Understanding Medical Surgical Nursing, 3rd Edition                                                Linda S. Williams / Pau...
Understanding Medical Surgical Nursing, 3rd Edition                                                                       ...
Upcoming SlideShare
Loading in …5
×

Unit c musculoskeletal_chpt_46 part iii voice and no underline

284 views

Published on

Published in: Health & Medicine, Business
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
284
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
10
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Unit c musculoskeletal_chpt_46 part iii voice and no underline

  1. 1. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Rheumatoid Arthritis Chronic, Progressive, Systemic Inflammatory Disease Destroys Synovial Joints and Other Connective Tissues includes Major Organs Juvenile rheumatoid arthritis is also known as Stills disease
  2. 2. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Rheumatoid Arthritis
  3. 3. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Pathophysiology Synovitis Synovium Thickens, Fluid Accumulates Destructive Pannus (new growth) Erodes Joint Cartilage, Destroys Joint Bone Pannus Converted to Bony Tissue Joint Deformity Other Connective Tissue Affected
  4. 4. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Etiology Unknown Genetic Predisposition Environmental Autoimmune Response - Antibodies (Rheumatoid Factor) ◆ Local and Systemic Inflammation
  5. 5. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Signs and Symptoms Remissions and Exacerbations Varies by Individual
  6. 6. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Signs and Symptoms Early Symptoms ◆ Bilateral, Symmetrical Joint Inflammation ◆ Reddened, Warm, Swollen, Stiff, Painful ◆ Stiffness After Resting ◆ Activity Decreases Pain and Stiffness ◆ Low Grade Fever, Weakness, Fatigue, Anorexia
  7. 7. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Signs and Symptoms Late Symptoms ◆ Joint Deformity ◆ Secondary Osteoporosis
  8. 8. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Joint Abnormalities in Rheumatoid Arthritis
  9. 9. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Therapeutic Interventions Medication ◆ Disease-modifying antirheumatic drugs • Leflunomide (Arava) • Etanercept (Enbrel) ◆ Gold salts have been used but may not produce results for 2-4 months.
  10. 10. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Therapeutic Interventions Medication con’t ◆ Methotrexate ◆ Gold ◆ Prednisone ◆ NSAIDS ◆ Aspirin has anti inflammatory properties which makes it a good drug for rheumatoid arthritis patients. ◆ Large does of aspirin may cause tinnitus (ringing of the ears)
  11. 11. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Therapeutic Interventions Heat/cold Balanced Rest and Activity Surgery – Total Joint Replacement Rehabilitative procedures are used to primarily help keep the patient as independent as possible. Range of motion exercise will help patients from developing contractures
  12. 12. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Nursing Diagnoses Acute Pain Disturbed Body Image Fatigue Self-care Deficit Impaired Physical Mobility Deficient Knowledge
  13. 13. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Patient Education Disease Process Medication Management Rest and Exercise ◆ Exercise helps to prevent the joints from becoming immobile ◆ When resting joints should be support in a position of extention Vocational Counselor Community Resources
  14. 14. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Total Hip Replacement Acetabular Cup Inserted Into Pelvic Acetabulum Femoral Component Inserted Into Femurhttp://medicalimages.allrefer.com/large/7019.jpg
  15. 15. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Total Hip Replacement Preoperative Care ◆ Total Joint Education Programs ◆ Autologous Blood Donation
  16. 16. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Total Hip Replacement Postoperative Care to Prevent Complications ◆ Hip Dislocation • Prevent Adduction or Hyperflexion • Usually a maximum of 60 degree flexion is allowed • Internal rotation is also restricted ◆ Skin Breakdown • Prevent Pressure Ulcers
  17. 17. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Abductor Pillow
  18. 18. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Hip Flexion after Total Hip Replacement
  19. 19. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Total Hip Replacement ◆ Pain • Provide Pain Relief ◆ Infection • Prophylactic Antibiotics • Coughing and Deep Breathing • Incisional Care
  20. 20. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Total Hip Replacement ◆ Bleeding • Monitor Incision/drainage From Drain ◆ Neurovascular Compromise • Neurovascular Checks
  21. 21. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Total Hip Replacement ◆ Ambulation • Physical Therapy • Use Walker/crutches
  22. 22. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Total Hip Replacement Thromboembolitic Complications ◆ Compression Devices ◆ Leg Exercises • Enoxaparin (Lovenox) ◆ The chief cause of mortality for total hip patients is pulmonary embolism.
  23. 23. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Total Hip Replacement Postop care includes: ◆ Proper positioning to maintain abduction ◆ Monitoring amount of wound drainage ◆ Planned administration of an analgesic prior to exercise
  24. 24. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Total Hip Replacement Self-care ◆ Assistive Dressing Devices ◆ Raised Toilet Seat ◆ Rehabilitation
  25. 25. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Total Knee Replacement Femoral Component, Tibial Component, Patellar Button Dislocation Not a Concern Care like Total Hip Replacement Frequent monitoring of vital signs is essential Continuous Passive Motion Machine (CPM) http://www.kneereplacement.co.i n/images/2%20Knee %20replacement %20implant.JPG Knee Arthroplasty is surgery to reshape, reconstruct, or replace a diseased or damaged knee joint. (A new knee joint made with a prosthesis)
  26. 26. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Total Knee Replacement The nerve that could be compromised in the total knee patient is the peroneal or fibular nerve The peroneal nerves wraps around the head of the fibula and innervates the knee joint, skin of the lateral calf and dorsum of the foot. Also the muscles that dorsiflex the foot are innervated.
  27. 27. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Total Knee Replacement Nursing care after total knee surgery ◆ Obtain a walker to minimize weight-bearing on the affected leg ◆ Apply knee immobilizer brace before getting the patient up (primary method of protecting knee joint) ◆ elevate the leg while sitting in a chair
  28. 28. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Continuous Passive Motion MachineFlexion andextension areimportant inthe overallrehabilitationprocess fortotal kneereplacementpatients.
  29. 29. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Amputation Surgical Amputations ◆ Ischemia From Peripheral Vascular Disease ◆ Bone Tumor or cancer of the bone ◆ Frostbite ◆ Congenital Problems ◆ Infections ◆ Burn injury
  30. 30. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Amputation Traumatic Amputations ◆ Accidents
  31. 31. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Amputation Replantation ◆ Wrap Severed Body Part in Cool, Slightly Moist Cloth ◆ Place in Sealed Plastic Bag Submerged in Cold Water ◆ Transported to Hospital
  32. 32. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Amputation Levels Of Amputation ◆ Below-the-knee (BKA) ◆ Above-the-knee (AKA) ◆ Below-the-elbow (BEA) ◆ Above-the-elbow (AEA)
  33. 33. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Amputation Nursing Care Preoperative ◆ Deficient Knowledge • Teach Preoperative Procedures ◆ Disturbed Body Image ◆ Begin Support Services Factors that can influence a persons reaction to an amputation include: ◆ Previous dealings with loss ◆ Economic status ◆ Emotional stability
  34. 34. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Amputation Nursing Care Postoperative ◆ Hemorrhage Prevention ◆ Infection ◆ Pain Control • Phantom Pain ◆ Mobility and Ambulation
  35. 35. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Bandaging for Above-the- Knee Amputation
  36. 36. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Amputation Nursing Care Postoperative ◆ Prosthesis • Fitting a patient for a prosthesis at the time of surgery – Helps to get the patient out of bed as soon as possible – Improve the patients mental outlook and reduce anxiety • Patient can not be hurried through the stages of grieving and acceptance ◆ Lifestyle Adaptation • New amputees are very likely to be concerned about their dependence on family and friends.
  37. 37. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Amputation Nursing Care Postoperative ◆ The patient will be scheduled to spend some time in the prone position each day to prevent contractures of the hip ◆ Exercise of operative as well as unoperative side prevents muscle weakness and atrophy ◆ Patients usually begin walking in 2 – 4 days after an amputated leg.
  38. 38. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Congenital Hip Dysplasia Abnormal development of tissue in hip Affected side knee may be higher than the unaffected side Skin folds of the thigh of the affected are deeper than the unaffected side http://www.pediatric- orthopedics.com/Topics/Bones/Hip/Gal.jpg
  39. 39. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Congenital hip dysplasia Treatment may include: ◆ Surgery ◆ Splints or braces ◆ Traction
  40. 40. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Scoliosis A lateral curvature of the spine http://img.youtube.com/vi/BR5XHARFmoA/0.jpg 80% are attributed to idiopathic causes A Milwaukee Brace and exercise is frequently the treatment of choice Treatment is aimed a correcting the curvature
  41. 41. Understanding Medical Surgical Nursing, 3rd Edition Linda S. Williams / Paula D. Hopper Temporomandibular Joint Dysfunction Painful condition involving the joint that opens and closes the mouth, the temporomandibular joints Patient may experience clicking and popping when moving jaw during chewing Medical management includes moist heat or cold therapy http://www.aurorahealthcare.org/yourhealth/healthgate/getcontent.asp? URLhealthgate=%2211502.html%22

×