1. Musculoskeletal Problems Mona Garrett NURS 210

2. Fractures of the Hip Incidence S/S: External rotation Extremity shortening Pain Bruising Diagnosis: Xrays

3. Treatment of Hip Fractures Preoperative management Buck’s traction with 5-7 lbs of weight Turn to unaffected side Trapeze Neurovascular checks Surgery Open Reduction Internal Fixation (ORIF) Total Hip Arthroplasty (THR)

4. ORIF of the Hip Most common surgical procedure for repairing hip fractures Used for inter and subtrochanter fractures Fracture realigned and secured with hardware Postoperative care Maintain good limb alignment Early mobility; PT; adequate pain control Rehabilitation

5. Total Hip Arthroplasty (THR) Used for femoral head fractures If only femoral head or acetabulum replaced, called partial / hemi-arthroplasty Postoperative care Abduction pillow Hemovac or other drain for 2 days Urinary catheter for 2 days Hip precautions Pain management

6. Complications of Hip Fractures DVT - SCD’s, TED’s, anticoagulants, early mobility Atelectasis/pneumonia Skin breakdown UTI or unable to void Constipation Confusion

7. Interventions for Clients with Connective Tissue Disease Osteoarthritis Rheumatoid Arthritis Lupus Gout Other

8. Osteoarthritis Most common form of arthritis Progressive deterioration of joint cartilage Also called Degenerative Joint Disease (DJD) Affects weight bearing joints (hips, knees, spine, hands) Risk factors: Aging, obesity, repetitive joint overuse

9. Osteoarthritis S/S: Joint pain usually aggravated by use, loss of function, decreased ROM, crepitus (grating), enlarged joints are hard and cool to touch Diagnostic Tests Lab values usually normal Xrays; CT or MRI for vertebral Synovial fluid analysis to R/O rheumatoid

10. Treatment of Osteoarthritis Acetaminophen NSAIDS COX 2 Inhibitors (Celebrex and Bextra) Intra-articular corticosteroids Weight loss Exercise after heat application Surgery: Arthroscopy, osteotomy, arthrodesis, joint replacement (total joint arthroplasty)

11. Total Joint Replacement Goal: Restores mobility and relieves pain Hip, knee, shoulder, elbow, fingers, toes Cemented versus non-cemented Complications Infection Loosening Dislocation Contraindications: Infection or advanced osteoporosis Nursing Implications

12. Total Knee Replacement Replacement with 3 parts: femoral component, tibial plate, patellar button Bilateral TKRs possible Postoperative care: Drain and pressure dressing Hot/ice machine or ice packs Pain management Blood transfusions Continuous Passive Motion (CPM) machine Rehabilitation

13. Rheumatoid Arthritis Chronic, systemic inflammatory disease that affects synovial joints Spontaneous remissions & exacerbations S/S: Systemic signs of inflammation Joint swelling with stiffness, warmth, tenderness Affects wrists, elbows, knees, ankles, PIP and MCP joints usually bilaterally

14. Diagnosis of Rheumatoid Arthritis Positive rheumatoid factor Elevated ESR Synovial fluid analysis (arthrocentesis) Xrays

15. Medications for RA ASA and NSAIDS (Celebrex, Bextra) DMARDS (Disease modifying drugs) Plaquenil, Azulfidine, Minocycline Cytotoxic drugs (Methotrexate) Biological Response Modifiers Enbrel, Remicade, Humira, Kineret Long term steroids Gold salts

16. Rheumatoid Arthritis Treatment: Moist heat or ice Joint rest with progressive exercise Cortisone injections Diet with omega 3 fatty acids & antioxidants Assistive devices Management of fatigue and stress Alternative therapies Plasmapheresis Surgery: Arthroplasty, arthrodesis

17. Systemic Lupus Erythematosus Chronic inflammatory autoimmune disorder affecting the connective tissues Antibody-antigen reaction Characterized by recurrent seasonal remissions and exacerbations S/S: Similar to RA in beginning Red butterfly rash; wolf bite “lupus” Photosensitivity; alopecia

18. Systemic Lupus Erythematosus Diagnosis: Positive rheumatoid factor Antinuclear antibody; elevated ESR Treatment: Goal is to control symptoms ASA and NSAIDS for arthritis symptoms Topical medications and sunscreen Corticosteroids for systemic symptoms Dialysis or kidney transplant for ESRD Plasmapheresis

19. Client Teaching for SLE Protect the skin Monitor body temperature Psychological support for unpredictability of life Balance life and stress Pregnancy issues Refer to Lupus Foundation of America

20. Gout (Gouty Arthritis) Results from decreased renal excretion of uric acid or genetic defect in purine metabolism that causes overproduction of uric acid Red, swollen, and acutely painful joints Intermittent attacks early Chronic gout results in tophi (urate deposits) on outer ear, arms and fingers near joints; and kidney stones

21. Gout Diagnosis: Synovial fluid analysis Elevated serum uric acid, WBC’s and ESR Treatment: Bedrest; immobilization of painful joints Application of cold; analgesics NSAIDS especially Indocin; corticosteroids Colchicine for acute Allopurinol or Benemid for chronic Lots of fluid to prevent renal calculi Avoid diuretics and ASA; excess alcohol and fad “starvation” diets

22. Other Connective Tissue Diseases Progressive Systemic Sclerosis (Scleroderma) - hardening of the skin Lyme Disease - has an identified cause If not diagnosed and treated early, chronic complications and arthritis occur Fibromyalgia Trunk, extremity, and facial pain Associated with Chronic Fatigue Syndrome