Transcript Adult Medical-Surgical Nursing 2

Adult Medical-Surgical
Nursing
Musculo-skeletal Module:
Osteo-arthritis
Joint Replacement
Osteo-arthritis: Description
 Degenerative
joint disease
 Most
common and disabling joint
disorder
 Affects
hips, knees, cervical and
lumbar spine, proximal and distal
finger joints
Osteo-arthritis: Aetiology
 Genetic
susceptibility
 Increased incidence with age
 Previous joint damage/ injury
 Repetitive or exaggerated use
(sports)
 Obesity
 Anatomic deformity
Osteo-arthritis: Pathophysiology
 Aggregation
of:
 Joint
damage
 Mechanical stress
 Genetic tendency
 Leads
to:
 Chondrocyte (cartilage) response →
Osteo-arthritis: Pathophysiology
Release of cytokines (proteolytic enzymes)
causing:
 Degradation of articular cartilage of
synovial joint
 (Narrowing of joint space)
 Thinning of sub-chondrial bony plate
(reduced shock absorption)
 Osteophyte spurs
 Reactive inflammation of synovium
(increased synovial fluid)

Osteo-arthritis:
Clinical Manifestations
 Pain
from:
 Stretching of joint capsule/ ligaments
 Irritation of periosteal nerve endings
 Microfracture, bursitis, tendonitis
 Stiffness:
early morning, easing with
movement
 Functional impairment, joint swelling
 Weakness/ atrophy of surrounding
muscle
Osteo-arthritis: Diagnosis
 Clinical
picture of tender enlarged
joints, joint effusions, bony nodes
 Xray shows:
 Degree of degeneration
 Narrowing of joint space (↓ cartilage)
 Osteophytes (bony spurs at joint
margins)
 Arthrography (contrast medium)
Osteo-arthritis:
Medical Management
 Slows
rather than halts process
 Rest joints / avoid overuse
 Isometric exercises to strengthen
muscles (static quads/ straight legraising). Regular walking
 Weight reduction if relevant
 Non-steroidal anti-inflammatory
(NSAID) drugs
 Glucosamine/ chondroitin (retard
cartilage degradation)
Osteo-arthritis:
Surgical Management
 Arthrocentesis:
aspiration of excess
sterile synovial fluid (aseptic
technique)
 Intra-articular hyaluronic acid to
reconstitute viscosity of synovial fluid
 Saline joint lavage (temporary relief)
 Osteotomy (to alter force
distribution)
 Arthroplasty (joint replacement)
Osteo-arthritis:
Nursing Considerations
 Patient
education about the condition
and measures to slow down joint
degeneration
 Weight control
 Demonstrate isometric exercises
 Encourage daily walking programme
 Adequate analgesia to allow exercise
 Assessment of need for appliances to
support as walking stick
 Arthroplasty:
Joint Replacement
Arthroplasty: Joint Replacement
 Knee
and hip joint are most common
 Elective surgery: patient in optimum
health
 Performed prior to muscle wasting
 Total hip or total knee replacement:
 Metal or acrylic prostheses
 Usually patient >60 years
 Total
Hip Replacement
Total Hip Replacement:
Main Complications
 Dislocation
of hip prosthesis
 Excessive wound drainage
(haemorrhage)
 Thrombo-embolism
 Infection
 Pressure ulcers (sacrum/ heels)
Total Hip Replacement:
Nursing Considerations
 Pain
relief, support and comfort
 Prevention of complications:
 Dislocation: ensure abduction of limb
 Wedge between legs. Avoid sitting
and crossing legs (head of bed 60%
only)
 Avoid turning to affected side
 Raised toilet seat and chair when up
 Haemorrhage: monitor dressing and
wound drainage (vacuum drain)
Total Hip Replacement:
Nursing Considerations
 Prevention
of complications (cont):
 Thrombo-embolism: elastic
stockings, passive exercises, fluids,
low molecular heparin, observe.
Early ambulation
 Infection: aseptic technique,
antibiotics
 Pressure ulcers: frequent massage
and relief of pressure
 Total
Knee Replacement
Total Knee Replacement:
Main Complications
 Oedema
and haemorrhage
 Thrombo-embolism
 Peroneal nerve palsy (foot-drop)
 Infection
 Limited range of motion
Total Knee Replacement:
Nursing Considerations
 Pain
relief, support and comfort
 Prevention of complications:
 Oedema/ haemorrhage:
 Compression bandage/ ice
 Observe wound drainage (vacuum)
 Thrombo-embolism: elastic
stockings, passive exercises, fluids,
low molecular heparin, monitor
Total Knee Replacement:
Nursing Considerations (cont)
 Peroneal
nerve palsy/ circulation:
 Assess neurovascular status of leg
 Encourage hourly active flexion of
foot
 Infection: aseptic technique,
antibiotics
 Limited range of motion:
 Continuous passive motion device
 Mobilisation: Knee splint/ limited
weight-bearing/ leg elevation sitting