Orthopedic Conditions and Treatments Quiz

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is a primary symptom of an Achilles tendon rupture?

Chronic joint stiffness

Prolonged swelling in the toes

Persistent numbness in the foot

Sudden pain accompanied by a 'pop' sound (correct)

Which test is specifically used to diagnose an Achilles tendon rupture?

Phalen's test

Bunnel's test

Finkelstein test

Thompson test (correct)

What initial treatment for bursitis focuses on reducing inflammation?

Corticosteroid injections

Antibiotics

Rest and ice application (correct)

Surgical intervention

In carpal tunnel syndrome, what symptom is commonly experienced?

Numbness and tingling at night Signup and view all the answers

Which type of fracture occurs when the bone shatters into multiple fragments?

Comminuted fracture Signup and view all the answers

What is a potential side effect of proton pump inhibitors relevant to bone health?

Increased fracture risk Signup and view all the answers

What does the initial stage of bone healing, hematoma formation, typically last?

1 to 3 days Signup and view all the answers

Which type of fracture has no skin break and is contained within the body?

Closed (simple) fracture Signup and view all the answers

What should be emphasized in emergency treatment for fractures?

Preventing shock and immobilization Signup and view all the answers

What is a common post-operative consideration for older adults after fracture treatment?

Regular monitoring of blood flow Signup and view all the answers

Which fracture type is commonly seen in children and is characterized by partial bending?

Greenstick fracture Signup and view all the answers

What key factor is crucial in the treatment of bursitis to prevent recurrence?

Education on activity modification Signup and view all the answers

What does 'splint it as it lies' emphasize in fracture management?

Providing immobilization in the injured position Signup and view all the answers

What is a primary complication to monitor for after knee replacement surgery?

Deep vein thrombosis (DVT) Signup and view all the answers

Which joint is least likely to be affected by a sprain?

Shoulder Signup and view all the answers

What is recommended for pain management in arthritis patients?

NSAIDs Signup and view all the answers

What does the RICE method stand for in treating sprains?

Rest, Ice, Compression, Elevation Signup and view all the answers

Which treatment option is typically not used for managing osteoporosis?

Nonsteroidal anti-inflammatory drugs (NSAIDs) Signup and view all the answers

What is a physical symptom of an anterior cruciate ligament (ACL) injury?

Joint swelling Signup and view all the answers

After how many hours can heat be applied to a strain for better healing?

48 hours Signup and view all the answers

What is the main function of the meniscus in the knee?

Provide cushioning Signup and view all the answers

What is an indicator of significant ACL injury at the time of occurrence?

A loud 'pop' sound Signup and view all the answers

Regular bone density screenings are particularly recommended for which population?

Postmenopausal women Signup and view all the answers

Which intervention can help alleviate symptoms for arthritis patients?

Heat application Signup and view all the answers

What should be monitored to prevent complications in patients using prosthetic devices?

Skin integrity Signup and view all the answers

What type of injury involves the tearing of muscles or tendons?

Strain Signup and view all the answers

What is a common post-surgical therapy used to enhance mobility after ACL surgery?

Continuous passive motion (CPM) therapy Signup and view all the answers

What is the primary characteristic that differentiates fractures from connective tissue injuries?

Deformity and severe pain Signup and view all the answers

Which method is commonly recommended for treating sprains?

RICE method Signup and view all the answers

What should patients be advised against doing with a new cast?

Inserting objects into the cast Signup and view all the answers

Which of the following is NOT a potential complication related to fractures?

Chronic instability Signup and view all the answers

What does the term 'nonunion' refer to in the context of fractures?

Failure of a fracture to heal properly Signup and view all the answers

Which is an essential step in proper cast care?

Regularly elevating the casted limb Signup and view all the answers

What is crucial for confirming the presence of a fracture during assessment?

X-rays Signup and view all the answers

What should patients watch for as signs of complications following a fracture?

The six Ps of compartment syndrome Signup and view all the answers

What is one primary reason for conducting a neurovascular assessment in patients with musculoskeletal injuries?

To establish a baseline for monitoring changes over time Signup and view all the answers

Which of the following actions is appropriate for initial cast care?

Elevate the extremity for the first 24-48 hours Signup and view all the answers

What is a critical consideration when assessing for complications of immobility in patients?

Monitoring for signs of skin breakdown or urinary tract infections Signup and view all the answers

Which dietary recommendations should be emphasized for patients healing from musculoskeletal injuries?

Adequate protein and fluids, along with vitamins and minerals Signup and view all the answers

When conducting a capillary refill assessment, what is the normal capillary refill time?

Less than 2 seconds Signup and view all the answers

In the context of pain management, which factor is essential to monitor after fixation or casting?

Patient's pain levels Signup and view all the answers

Which clinical sign should prompt immediate attention when conducting a neurovascular assessment?

Coolness of skin around the injury site Signup and view all the answers

What can contribute to chronic complications in Lyme Disease if not treated early?

Severe swelling of joints Signup and view all the answers

What is a recommended way to relieve itching under a cast?

Use a hair dryer on a cool setting Signup and view all the answers

What must be monitored regularly post-surgery to ensure optimal outcomes?

Pin sites for signs of infection Signup and view all the answers

Which statement best describes rheumatoid arthritis?

It leads to disability and impacts quality of life. Signup and view all the answers

Which nutrient is particularly important for promoting bone healing in musculoskeletal patients?

Vitamin D Signup and view all the answers

How can engaging patients in their care plan affect outcomes?

It can improve outcomes and patient satisfaction. Signup and view all the answers

What is a primary dietary recommendation for managing gout?

Limit high-purine foods Signup and view all the answers

Which medication requires periodic liver function testing due to potential side effects?

Allopurinol Signup and view all the answers

What is the standard diagnostic tool for assessing bone density in osteoporosis?

Dual-energy x-ray absorptiometry (DEXA) Signup and view all the answers

Which of the following is not a risk factor for osteoporosis?

Regular weight-bearing exercise Signup and view all the answers

What is the estimated prevalence of osteoporosis in the U.S.?

About 10.2 million people Signup and view all the answers

What is a common symptom of osteoporosis that may indicate a fracture?

Height loss Signup and view all the answers

Which of the following statements about osteoporosis is true?

Osteoporosis is commonly diagnosed after a fracture occurs. Signup and view all the answers

To reduce the risk of kidney stones and urate crystal deposits, how much fluid intake is recommended for gout patients?

2000 to 3000 mL per day Signup and view all the answers

What is a characteristic symptom of rheumatoid arthritis?

Morning stiffness lasting over an hour Signup and view all the answers

Which treatment is primarily aimed at slowing disease progression in rheumatoid arthritis?

Disease-modifying anti-rheumatic drugs (DMARDs) Signup and view all the answers

What does the diagnosis of rheumatoid arthritis often require?

History of arthritis pain in three or more joints lasting six weeks Signup and view all the answers

What is the primary goal of total hip replacement surgery?

To alleviate chronic, uncontrollable pain Signup and view all the answers

Which alternative therapy has mixed evidence regarding its efficacy for rheumatoid arthritis?

Acupuncture Signup and view all the answers

In which age group is rheumatoid arthritis most commonly diagnosed?

30-40 years Signup and view all the answers

What type of joint involvement is typical in rheumatoid arthritis?

Bilateral and generalized Signup and view all the answers

Which imaging method is commonly used to confirm cartilage destruction in rheumatoid arthritis?

Radiographic imaging Signup and view all the answers

What is a key difference between rheumatoid arthritis and osteoarthritis?

Rheumatoid arthritis is a systemic disease with chronic inflammation Signup and view all the answers

What are patients advised to do to prevent falls after hip replacement surgery?

Use assistive devices and rise slowly Signup and view all the answers

What should be included in a care plan for a patient with altered mobility due to rheumatoid arthritis?

Teaching use of a walker and ROM exercises Signup and view all the answers

What is a common systemic symptom of rheumatoid arthritis?

Anemia resistant to iron therapy Signup and view all the answers

What should patients be advised regarding postoperative care after a total hip replacement?

Use a pillow between the legs when rolling over Signup and view all the answers

What is a key characteristic of fiberglass casts compared to plaster casts?

Less moldable and quicker to dry Signup and view all the answers

Which type of traction uses pins or wires inserted through the bone?

Skeletal traction Signup and view all the answers

What complication may arise from improper immobilization of fractures?

Delayed healing or nonunion Signup and view all the answers

Which of the following is a sign of compartment syndrome?

Severe pain and pallor Signup and view all the answers

What treatment is often required for osteomyelitis?

Surgical intervention and antibiotic therapy Signup and view all the answers

What is a common risk factor for fat embolism syndrome?

Multiple fractures or long bone fractures Signup and view all the answers

What can be used to assess for the presence of infection related to a suspected diagnosis of osteomyelitis?

Radiographic imaging Signup and view all the answers

Which of the following casts is typically used primarily in children?

Spica cast Signup and view all the answers

What is the necessary action if a cast becomes wet?

Change the cast immediately Signup and view all the answers

What management technique focuses on preventing thrombus formation in patients with hip fractures?

Use of compression stockings Signup and view all the answers

What is the purpose of electrical bone growth stimulation in nonunion fractures?

To stimulate bone growth Signup and view all the answers

Which of the following is a critical nursing intervention for assessing limb circulation and sensation?

Assessing the six Ps of compartment syndrome Signup and view all the answers

What are the signs of infection that a healthcare provider should monitor for in cases of open fractures?

Elevated white blood cell count and local swelling Signup and view all the answers

Which of the following is a common method for immediate postoperative pain management?

Patient-controlled analgesia (PCA) pumps Signup and view all the answers

What is a critical sign to monitor for potential medication toxicity?

Excessive sedation Signup and view all the answers

Which action is crucial for preventing Deep Vein Thrombosis (DVT) after surgery?

Encouraging foot and calf exercises every 2 hours Signup and view all the answers

What should patients be educated to report following a total hip replacement?

Any pain in the hip, buttock, or thigh Signup and view all the answers

Which team members are typically included in the rehabilitation team?

Patient, family, surgeon, nurse, physical therapist, and occupational therapist Signup and view all the answers

What is a recommended interval for repositioning patients to enhance comfort?

Every 2 hours Signup and view all the answers

Which of the following is NOT a recommended comfort measure for patient care?

Restricting fluid intake Signup and view all the answers

Which condition may NOT be a consideration during the assessment for rheumatoid arthritis?

Age-related vision decline Signup and view all the answers

How can nurses ensure patient safety concerning medication?

By educating about signs of toxicity Signup and view all the answers

What is one of the goals set for a patient post-total hip replacement?

To verbalize movement restrictions within 24 hours Signup and view all the answers

What might indicate a need for intervention during patient monitoring?

A decrease in patient mobility Signup and view all the answers

What is the purpose of using written instructions for patients post-surgery?

To reinforce understanding of movement restrictions Signup and view all the answers

What is a common reason for administering low-molecular-weight heparin injections post-surgery?

To reduce the risk of clotting Signup and view all the answers

What is an essential part of preventing complications after total hip replacement?

Providing open communication with the patient Signup and view all the answers

What is the primary focus for managing a patient's fatigue level related to arthritis?

Implementing a balanced approach of rest and exercise Signup and view all the answers

Which method of joint protection is NOT recommended for patients with arthritis?

Using weights to strengthen joints Signup and view all the answers

What is the best dietary consideration for managing arthritis symptoms?

Balanced diet and weight management Signup and view all the answers

In treating gout, which of the following is recognized as a primary treatment approach?

Administration of NSAIDs for pain management Signup and view all the answers

What is an essential patient education point regarding heat therapy?

Moist heat and dry heat both require caution to prevent burns Signup and view all the answers

Which symptom is particularly associated with gout attacks?

Reddish and inflamed skin over joints Signup and view all the answers

How should patients manage activities to cope with arthritis symptoms effectively?

Set personal limits and focus on self-competition Signup and view all the answers

To confirm the diagnosis of gout, which procedure is typically used?

Arthrocentesis to analyze joint fluid Signup and view all the answers

What role does psychosocial support play in managing chronic illnesses like arthritis?

It addresses feelings of isolation and promotes self-esteem Signup and view all the answers

Which statement about cold therapy is accurate for managing acute inflammation?

Strict time limits must be observed to avoid skin damage Signup and view all the answers

What is the expected outcome from encouraging participation in physical therapy for arthritis patients?

Enhanced mobility and independence Signup and view all the answers

What is a common misconception about serum uric acid levels in the diagnosis of gout?

Elevated levels are always present during an attack Signup and view all the answers

Which advice is crucial for patients regarding adaptive equipment for joint protection?

Select equipment designed for ease of use, such as built-up handles Signup and view all the answers

What is the recommended activity modification for patients suffering from arthritis?

Alternate between standing, sitting, and lying down Signup and view all the answers

Study Notes

Connective Tissue Injuries vs. Fractures

Connective tissue injuries (sprains/strains) affect ligaments, tendons, or muscles. Fractures are bone breaks.
Connective tissue injuries show swelling, pain, and limited movement. Fractures may have deformity, crepitus (a grating sound), and severe pain.
X-rays confirm fractures; physical exams often suffice for sprains/strains.
Injury mechanisms differ: falls cause fractures, twisting causes sprains.
Fracture treatment often includes immobilization or surgery. Sprains commonly use RICE (Rest, Ice, Compression, Elevation).
Complications include fracture nonunion and sprain instability.

Cast Care

Proper cast care prevents skin sores, infections, and poor circulation.
Keep casts dry; avoid inserting objects.
Check regularly for increased pain, swelling, or discoloration.
Elevate the casted limb to reduce swelling.
Avoid weight-bearing until cleared by a doctor.
Follow-up appointments are necessary.

Compartment syndrome: Swelling increases pressure in muscle compartments, causing tissue damage.
Nonunion: Fracture fails to heal properly.
Malunion: Improper bone alignment during healing.
Infection: Post-surgery or in open fractures.
Monitor the "six Ps": Pain, Pallor, Pulselessness, Paresthesia, Paralysis, Pressure.

Surgical Interventions and Postoperative Care

Preoperative care: Patient education, comorbidity assessment, and health optimization.
Postoperative knee replacement often requires longer rehabilitation due to weight-bearing restrictions.
Pain management varies, knee replacement may involve localized pain control.
Monitor for DVT (deep vein thrombosis) in both procedures.
Patients need education on specific mobility aids and exercises.
Follow-up care assesses joint function and recovery.

Nursing Interventions for Arthritis Patients

Arthritis patients experience chronic pain, stiffness, and reduced mobility.
Educate on joint protection and energy conservation.
Medications: NSAIDs, corticosteroids, DMARDs (disease-modifying antirheumatic drugs).
Physical therapy referrals help maintain mobility and strength.
Consider complementary therapies (heat, gentle exercise).
Regular pain and function assessments.

Understanding and Managing Sprains and Strains

Etiology and Pathophysiology of Sprains and Strains

Sprains involve ligament tears; strains involve muscle/tendon tears.
Common sprain sites: ankle, knee, wrist.
Common strain sites: back, hamstring, quadriceps.
Injury mechanisms: trauma, overuse, exceeding normal movement range.
Sprains graded as I, II, or III (III requiring surgery).
Strains may mimic sprains, but include muscle spasms and bruising.

Treatment Protocols for Sprains and Strains

RICE method (Rest, Ice, Compression, Elevation) is fundamental for sprains.
Apply ice 10-20 minutes every 1-2 hours for first 72 hours.
Elastic bandages help with compression, monitor circulation.
Heat may follow 48 hours for strains.
NSAIDs are common for pain.
Education on correct lifting techniques helps prevent reinjury.

Special Considerations in Musculoskeletal Disorders

Osteoporosis: Pathophysiology and Management

Osteoporosis: Reduced bone density, increased fracture risk; linked to age, hormones, nutrition.
Bone imbalance: Resorption surpasses formation.
Prevention: Adequate calcium, vitamin D, weight-bearing exercise, lifestyle change.
Treatments: Bisphosphonates, hormone therapy, etc.
Bone density screenings are essential.
Education on fall prevention is crucial.

Postoperative Care for Amputation Patients

Postoperative observations: infection, bleeding, limb positioning.
Pain management: crucial due to possible phantom limb pain.
Nursing intervention: promote mobility and independence.
Skin assessments for prosthetic users to prevent pressure ulcers.
Education on prosthetics and adjustments.
Psychological support may be necessary.

Anterior Cruciate Ligament (ACL) Injury

Overview of ACL Injuries

ACL injuries often in athletes from sports, falls, or accidents.
Mechanisms: hyperextension, internal rotation, deceleration.
Commonly results in a significant ligament tear.
Symptoms: swelling, instability, difficulty straightening leg.

Diagnosis and Treatment of ACL Injuries

Diagnosis through physical exam, X-rays, and/or MRI.
Arthroscopy: surgical repair with tissue graft.
Post-injury: immobilization, pain reduction, swelling control.
Continuous passive motion (CPM) therapy.

Rehabilitation and Recovery

Isometric exercises focus on quad and gluteal muscle strengthening.
Long-leg brace may maintain knee stability.
Structured exercise program to restore strength and mobility.

Meniscal Injury

Understanding Meniscal Tears

Meniscus: shock absorber in the knee, key for stability.
Often accompanies ACL injuries, common in sports with twisting.
Symptoms: pain, mild swelling, popping or catching.

Diagnosis and Surgical Intervention

Diagnosis primarily through physical exam, MRI most specific.
Arthroscopic surgery: restores joint function.
Post-operative: pain management, muscle-strengthening exercise program.

Achilles Tendon Rupture

Mechanisms and Symptoms of Injury

Achilles tendon connects calf muscles to the heel.
Rupture during high-stress activities (jumping, running).
Symptoms: sudden ankle or calf pain, 'pop' sound, visible heel indentation.
Swelling, bruising, inability to point toes/stand on tip-toes.

Diagnosis and Treatment Options

Diagnosis: physical exam (Thompson test assesses calf contraction).
Splinting, casting, or surgery depending on severity.
Recovery typically 6-8 weeks, followed by physical therapy.

Bursitis

Bursitis: inflammation of bursae (fluid-filled sacs) due to injury/overuse, common in joints.
Symptoms: localized tenderness, aching pain, joint activity aggravation.
Diagnosis based on patient history and examination.
Treatment: rest, anti-inflammatories, ice, compression.
Cortisone injections if conservative methods fail; activity modification important.

Carpal Tunnel Syndrome

Carpal tunnel syndrome: median nerve compression, leading to pain, numbness, tingling (often at night).
Risk factors: repetitive wrist movements (typing, factory work).
Symptoms can progress to muscle atrophy if untreated.
Diagnosis: physical exam, compression test, electromyography.
Treatment: rest, splinting, steroid injections; surgery in severe cases.
Post-op care: monitor circulation, immobilization, gradual activity return.

Fractures

Fractures: bone breaks, from trauma or conditions like osteoporosis.
Mechanisms of injury can help determine fracture types (e.g., 'boxer's fracture').
Pain, swelling, tissue damage possible.
Safety Alert: PPIs may increase fracture risk in older adults due to reducing calcium absorption, consider calcium supplements for at-risk patients.
Diagnosis: physical examination, imaging (X-rays).
Treatment varies based on fracture type, location, and severity; immobilization or surgery may be required.

Signs, Symptoms, and Diagnosis of Fractures

Fracture symptoms: varying pain, swelling, deformity, bruising, creaking, loss of function.
Diagnosis: physical examination, X-rays (or other imaging for complex fractures).

Types of Fractures

Complete: Bone splits into two.
Incomplete: Partially connected break.
Comminuted: Bone shatters into many pieces.
Closed (simple): No skin break.
Open (compound): Skin break, bone exposed.
Greesntick: Partial bend-and-break, common in children.

Diagnostic Techniques

Physical examination: assesses pain, swelling, deformity.
X-rays visualize fracture and determine type/extent.
CT or MRI used for complex cases.

Treatment of Fractures

Emergency Treatment and Nursing Care

Initial care avoids shock/hemorrhage, immediate immobilization to minimize further soft tissue damage. Ice for initial swelling.

Stages of Bone Healing

Stage	Description	Duration
1	Hematoma Formation	1-3 days
2	Granulation Tissue Formation	3 days - 2 weeks
3	Callus Formation	2-6 weeks
4	Ossification	3 weeks - 6 months
5	Remodeling	6 weeks - 1 year

Reduction and Stabilization Methods

Closed Reduction: realigns bones non-surgically.
Open Reduction: surgically realigns bones, especially for compound fractures.
Internal Fixation: uses pins, screws, plates to stabilize post-surgery.
External Fixation: uses external frame with pins for support.

Special Considerations in Older Adults

Increased fracture risk due to decreased reaction time, vision, agility, muscle tone.
Fall risk assessments and precautions are key.
Balance exercises and assistive devices.
Special attention for internal fixation due to brittle bones.
Post-operative care: pain management, alignment, prevent immobility complications.
Physical therapy for enhanced recovery and mobility.

Overview of Fracture Management

Psychological Impact of Fractures

Long-term fixators can negatively impact self-image and cause embarrassment.
Emotional distress can hinder recovery and rehabilitation.
Support systems and counseling may be needed.

Types of Fracture Stabilization

Casts: immobilize fractures; fiberglass and plaster.
Braces and Splints: Support, allow skin assessment; removable.
Traction: mechanical pull to maintain alignment; less common today in hip fracture management.

Casts: Types and Applications

Fiberglass casts: Lightweight, quick drying; suitable for weight-bearing earlier. Fewer moldable than plaster.
Plaster casts: Heavier, longer drying time; more supporting for lower extremities.
Spica casts: Primarily in children, cover torso/extremities.

Application and Care of Casts

Keep casts dry to prevent infections.
Monitor for plaster cast edge crumbling.

Braces, Splints, and Traction

Braces: Skin assessment possible.
Backslab splints: support without full encasement; helpful in injuries with swelling.
Knee immobilizers: restrict motion, reduce pain/swelling.
Traction:
- Skeletal traction: pins/wires through bone, heavy weights.
- Skin traction: lighter weights, external application, regular skin checks.

Complications Associated with Fractures

Delayed Healing and Complications

Improper alignment, poor immobilization, nutritional deficiencies may cause delayed healing.
Blood vessel/nerve damage can impair healing and affect mobility.

Infection and Osteomyelitis

Infection hinders healing; open fractures require prompt surgery to reduce infection risk.
Osteomyelitis: severe bone infection (e.g., by Staphylococcus aureus); needs aggressive treatment (antibiotics, possible surgery).
Diagnosis: lab tests, X-rays, history (previous injury or infections like boils).

Diagnosis and Management of Osteomyelitis

Diagnostic criteria: lab findings, radiographic evidence, patient history.
Biopsy confirms necrosis (tissue death); confirms diagnosis or infection.
Treatment: antibiotics (IV for a prolonged duration), surgery (incision, drainage, debridement), immobilization.

Nonunion of Fractures

Nonunion: fractured bone fails to heal properly.
Electrical bone growth stimulation: a treatment option for stimulating bone growth.
Use cases include preventing further surgeries or bone grafts.

Fat Embolism Syndrome

Risk factors: multiple fractures, involving long bones, pelvis, ribs.
Pathophysiology: Fat globules enter bloodstream, occlude vessels.
Clinical manifestations: altered mental status, respiratory distress, tachypnea, petechiae.

Venous Thrombosis

Risk factors: Hip fractures (immobility and surgery).
Prevention: compression stockings, sequential compression devices, ROM exercises, anticoagulant medications

Compartment Syndrome

Compartment syndrome: increased pressure in muscle compartments reduces blood flow, potentially leading to tissue necrosis.
Causes: external/internal pressure (tight dressings, swelling).
Signs/Symptoms: Severe pain, pallor, numbness, no pulses, paralysis, cold skin.
Nursing Intervention
- Assessment: 6 Ps regularly
- Actions: limb elevation , notify healthcare provider promptly.
- Surgical option: fasciotomy (surgical opening to relieve pressure).

Nursing Management and Patient Care

Data Collection: mechanism, physical exam, safety in open fractures.
Post-treatment considerations
- Pain management
- immobility complications assessment
- Nutritional support

Neurovascular Assessment

Establishes baseline for musculoskeletal injuries; monitoring changes over time, frequency of checks at least once per shift, every 2-4 hours for fresh fractures.
Detects complications like compartment syndrome.
Components: skin color/temperature, pulses, movement, sensation, pain.
Capillary refill time (normal < 2 seconds).

Care of Patients with Casts

Initial cast care: handle with palms, monitor temperature, elevate limb.
Daily cast inspection: for damage (flattening, soft spots, cracks).
Patient education: keep cast dry, avoid scratching.

Nutrition Considerations for Musculoskeletal Patients

Protein intake: 1 g/kg body weight for tissue repair.
Vitamins D, C, B, and Calcium support healing.
Adequate hydration.
High-fiber diet

Inflammatory Disorders of the Musculoskeletal System

Lyme Disease Overview

Lyme disease: Borrelia burgdorferi spirochete; Lyme arthritis often a characteristic.
Early detection and treatment crucial to prevent chronic complications.

Evaluation of Patient Outcomes

Pain management, ADLs (activities of daily living) improvement are expected.
Watch for immobility complications (skin breakdown, constipation, atelectasis, DVT).
Revise care plans as needed based on patient outcomes and feedback.

Importance of Revising Care Plans

Continuously evaluate, involve patients, use evidence-based practice, and collaborate with interdisciplinary teams.
Document changes to track progress and plan future interventions.

Overview of Rheumatoid Arthritis

Definition and General Characteristics

Rheumatoid arthritis (RA): autoimmune inflammatory disease involving joints.
Occurs largely in older women; periods of remission/exacerbation impact quality of life.

Etiology and Pathophysiology

Unknown cause; likely triggered by a combination of factors (hormonal, environmental, genetic).
Autoimmune response leads to synovial membrane inflammation.
Pannus formation erodes cartilage, causes joint deformities.

Signs and Symptoms

Joint pain, warmth, swelling, stiffness (especially in the morning, lasting over an hour).
Systemic symptoms (low-grade fever, malaise, anemia resistant to iron therapy).
Joint deformities significantly impact self-care and mobility.

Diagnosis and Treatment

Diagnosis: arthritis in three or more joints for over six weeks, positive RF/anti-CCP tests.
Elevated inflammatory markers (CRP, ESR).
Imaging for cartilage/bone damage.
Treatment: pain relief, minimize joint damage, maintain function (rest, exercise, medication).
- NSAIDs initially, DMARDs (like methotrexate) to prevent progression.
- Surgery may be necessary in severe cases.

Complementary and Alternative Therapies

Evaluate alternative treatments alongside conventional care, assess for safety and suitability.

Comparison with Osteoarthritis

Rheumatoid Arthritis vs. Osteoarthritis (Table - provided in text).

Management and Care for Older Adults

Educate older adults on medication side effects; risk of falls.
Assistive devices (walkers, canes, grab bars).

Patient Care and Safety Measures

Mobility advice: Slow rises from sitting/lying, hold onto something, wait out dizziness.
Importance and use of assistive devices (walkers, canes).

Overview of Total Hip Replacement (THR)

Indications for THR: Severe, uncontrolled arthritis/pain.
Procedure: partial or total joint replacement.
Postoperative exercise crucial.
Significant improvement in mobility and pain relief are possible.

Surgical Approaches and Precautions

Abduction wedge used to prevent dislocation; placement is critical.

Postoperative Care and Patient Teaching

Home care instructions: lying on operated side, avoid crossing legs, bending restrictions, proper seating.

Nursing Management for Total Hip Replacement

Assessment and Data Collection

Comprehensive patient assessment (social history, health status).
Understanding patient's pain and mobility limitations.
DVT monitoring, especially in patients with limited mobility.

Nursing Diagnoses and Care Plans

Common diagnoses: chronic pain, altered mobility, fall risk.
Care plans should address mobility improvement, pain management (with specific goals and interventions listed).

Pain Management Strategies

Pain control priority, PCA pumps often used.
Regular pain assessments, adjust medication as needed.
Comfort measures (repositioning, quiet environment).

Complications and Rehabilitation

Potential Complications (DVT, acute pain, immobility, infection, dislocation).
Prophylactic medications
Rehabilitation team involvement (patient, family, surgeon, nurses, physical therapist, occupational therapist).
Outpatient/in-home physical therapy post-discharge.

Patient Education and Self-Management

Medication and exercise self-management.
Awareness of limitations and adherence to precautions.
Ongoing support for self-managed recovery.

Patient Monitoring and Comfort Measures

Medication toxicity monitoring (sedation, LOC changes).
Regular assessments for safety and complication prevention.
Comfort measures: smooth linens, repositioning, quiet environment, warmth (socks with slip-resistant soles)..
Family involvement for comfort and support.

Post-Operative Care for Total Hip Replacement

Nursing Diagnosis and Goals

Insufficient knowledge about precautions to prevent dislocation.
Patient should verbalize hip movement restrictions in 24 hours.

Patient Education and Discharge Planning

Pain reporting, avoidance of leg crossing/bending restrictions.
Discharge precautions and resources (community support, rehabilitation).
Readiness for discharge evaluation by understanding the restrictions and readiness to manage at home.

Prevention of Deep Vein Thrombosis (DVT)

Risk assessment and interventions for altered tissue perfusion secondary to DVT.
Goal: prevent DVT before discharge.
Encourage leg exercises, administer LMWH (low-molecular-weight heparin) as prescribed, monitoring for DVT signs (swelling, warmth, pain).
Document findings and interventions for care continuity.

Clinical Judgment and Complications

Assessing for potential complications (infection, dislocation, delayed healing).
Addressing patient anxiety regarding discharge with education and reassurance.
Open communication to understand and address concerns.
Collaboration with healthcare team for comprehensive care before discharge.
Effective intervention evaluation, plan adjustment as needed.
Documentation of assessments and interventions for continuity of care.

Focused Assessment for Rheumatoid Arthritis

Data Collection and Patient History

Inquire about pain patterns, medications, coping mechanisms.
Assess morning stiffness duration.
Family history of RA or immune disorders.
Identify any accompanying disorders or complications.
Evaluate fatigue levels and coping strategies.
Assess ADLs and adaptive equipment usage.

Expected Outcomes and Interventions

Pain control, mobility improvement, self-acceptance goals.
Balanced approach (rest, exercise) to manage symptoms and promote healing; pacing for fatigue management.
Encouragement for physical therapy, monitoring for progress.
Document interventions and patient responses.

Patient Teaching for Joint Protection

Stop exercises at pain; use larger muscle groups, rest breaks, low-impact exercises.
Move slowly and smoothly to avoid injury; rest for swollen/painful joints.

Arthritis Management Strategies

Joint Care and Activity Modification

Avoid lifting heavy items with one hand; limit use of affected joints, change positions to avoid pressure.
Setting personal activity limits and focusing on self-improvement; utilize adaptive equipment (Velcro, built-up handles).

Applications of Heat and Cold

Heat for chronic/subacute inflammation; cold for acute.
Methods: moist/dry heat; cold applications.
Safety Precautions: test heat, use barriers, time limits. Proper use of heat and cold to avoid burns or harm.

Dietary Considerations

No specific diet cures arthritis; some avoid nightshade vegetables; balanced diet, weight management are essential, especially for weight-bearing joints.

Psychosocial Support

Address social isolation and depression in chronic illness; support groups, counseling, clothing, appearances.
Encourage emotional expression.

Gout: Etiology and Pathophysiology

Gout: elevated serum uric acid levels, urate crystals in joints/connective tissues, high-protein, alcohol, genetic factors may contribute.

Signs and Symptoms of Gout

Elevated serum uric acid levels, joint inflammation (redness, tightness), extreme pain (often in the big toe), fever, swelling.