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N126-U5-Joint Replac
Dobrisky-U5-Joint Replacement
| Question | Answer |
|---|---|
| Arthrotomy | surgical incision into a joint |
| arthroscopy | direct joint visualization via an arthroscope |
| total hip replacement | surgicalprocedure where head of femur and acetabulum are replaced with metal components, acetabulum covered with plastic |
| reasons for joint replacement | reduce pain and deformity from arthritis, osteoarthritis, avascular necrosis, break |
| hip fracture fixation | uses cannulated hip screw, compression hip screw or total hip is replaced |
| materials used for prostheic implants | metal; high-density polyethylene, ceramic, synthetic materials |
| are protheses cemented or uncemented into place? | both |
| what types of metal are used for prosthetic implants | titanium or cobalt-chrome alloy |
| ceramic prosthetics are associated with | lower friction and longer wear |
| uncemented prstheses are treated with | a porous coating that promotes bony in-growth |
| what factors need to be considered in whether cement is used or not | bone quality, age, ability to comply with weight-bearing restrictions after surgery |
| which type of joint is easier to replace, uncemented or cemented? | uncemented |
| which is considered to last longer? cemented or uncemented | uncemented |
| why is the uncemented component thought to last longer? | the bony growth lessens the likelihood of the prosthesis loosening |
| the porous coating applied to uncemented prostheses promotes | bony in-growth |
| bony in-growth results in | less likelihood of a loose prosthesis |
| what is the life span of today's majority of joint implants | 20 years |
| what is the greatest risk involved in joint implants | infection |
| revision surgery to repair an implant failure often results in what change in joint function | less function |
| revision surgery in comparison to the original surgery | lasts longer and involves more blood loss |
| preventing what is a priority with joint replacement surgery? | infection |
| total hip infection rate | 1% |
| total knee infection rate | 2% |
| total ankle infection rate | 5-10% |
| which surgery has a higher infection rate: knee or hip? | knee |
| which surgery has a higher infection rate: ankle or knee? | ankle |
| 50-80% of infections r/t joint replacement surgery originate where? | in the operating room by direct wound contamination |
| to prevent surgically acquired infection what is often used? | laminar airflow systems; body exhausts for scrubbed & circulating personnel; limited traffic in OR; antibiotic impregnated cement and prophylactic perioperative antibiotics |
| the initial assessment of a patient with decreased hip mobility will show signs/symptoms of | pain, adl problems, deformity, ROM, contractures, limb length shortening, walking tolerance, use of assistive devices |
| NSAIDS should be stopped for how long before surgery and why? | stop 7 days prior to surgery due to effects on clotting time |
| if the patient scheduled for joint surgery is currently on corticosteroids how are they changed? | still give but usually IV |
| a baseline neurovascular assessment of the extremity to be operated on should include | cap refill, temp, color of extremity |
| the pre-op patient should be assessed for | capillary refill, circulation, movement and sensation |
| diagnostic tests for pre-op patients over 40 shoudl always include | an ECG |
| what types of xrays should be taken before joint surgery? | CXR and disease specific |
| serum labs to be run before operating are | CBC, PT & PTT |
| UA labs to be run before operating are | BUN, creatinine |
| the patient's blood should be | typed and cross-matched |
| an autotransfusion may be used to | transfuse hemo-vac drainage |
| giving your own blood prior to surgery is considered what type of blood donation? | autologous |
| the positioning of a post-op patient with hip surgery should be | on their back or on the unoperated side with an abductor pillow |
| what type of bedpan should be used for the post-op hip replacement pt? | fracture bedpan |
| paint control may be given via | PCA or IM |
| the post op pt may experience severe | muscle spasms |
| antibiotic therapy begins and ends when? | in pre-op holding area and post-op for 48 hours |
| ****heparin or lovenox cause less | inactivation of thrombin, inhibition of platelets & bleeding than heparin****** |
| *****heparin or lovenox do not usually influence | PT or APTT***** |
| patient teaching should include what to support a healthy respiratory system in the post op patient? | TCDB-turn cough deep breath |
| TCDB should be encouraged how often | q 1-2 hours |
| the most common anesthesia used is | spinal |
| common complications related to general anesthesia include | n/v and/or respiratory depression |
| neurovascular assessments for the post op patient should occur how often in recovery? | VS q 15 min |
| Once the patient is on the ortho unit post op neurovascular assessments should be completed | q 30 min for 2 hours ??????? slide 14 |
| once the post op patient is stable how often should neurovascular assessments be taken? | q 4-8 hours |
| the circulation portion of the neurovascular assessment should include | skin temp and color, edema and pulses |
| the movement portion of the neurovascular assessment should include | ability to move legs and toes |
| the sensation you are focusing on during the neurovascular assessment is | numbness or tingling |
| drains should be assessed post op for | patency and amount of drainage |
| drains provide for the | elimination of excess blood/fluid |
| excess blood/fluid is called | hematoma |
| to assess the wound dressing check | under the hip for bleeding |
| what labs should be monitored for the post op patient? | Hbg and Hct |
| the post op patient should be assessed for signs of what volume complication? | hypovolemia |
| narrowed pulse pressure; increased HR, RR and anxiety, decreased systolic BP are signs of | hypovolemia |
| If a patient is on anticoagulants check the mucus membranes, the | iv site, the urine and stool for blood |
| what is the expected drainage for the first 24 hours post-op? | 200-500ml |
| drainage should decrease to 30ml or less for 8 hours by what time frame postoperatively? | 48 hours |
| when can the drain be removed? | when drainage decreases to 30ml or less in an 8 hour period |
| blood transfusions are indicated for an Hct of | <28 |
| complete this nursing diagnosis for the post-op hip replacement patient: alteration in comfort; pain r/t | muscle spasm, surgical trauma |
| the PCA should be evaluated for effectiveness and | the dosage adjusted as needed |
| the patient should be medicated how soon before activity/therapy? | 1/2 or 1 hour |
| progress to oral meds from IV is usually tolerated within the first | 72-96 hours |
| ice packs may be applied to the operative area for | 24-48 hours |
| turn every 2 hours if the patient is allowed on their side while maintaining | abduction |
| how should turning a post op patient be performed? | smooth, gently motion when moving operative limb |
| no adduction is permitted in the post op patient beyond midline for how long | 2-3 months |
| adduction is not permitted beyond | midline |
| extremes of flexion, adduction or rotation should be avoided in order to prevent | dislocation |
| flexion is generally limited to | 60 degrees for 6-7 days then 90 degrees for 2-3 months |
| flexion is limited to 60 degrees for how long postop? | 6-7 days |
| flexion is limited to 90 degrees for how long postop? | 2-3 months |
| until flexion restrictions are removed how is toileting changed? | raised toilet seats should be used in the hospital and at home |
| an abductor pillow is placed where? | between the legs |
| to prevent DVT & PE the patient should be encouraged to | calf pump and ankle rotate hourly while awake |
| calves should be assessed for what when monitoring for DVT? | redness, swelling/edema, heat, deep tenderness plus Homan sign |
| what is the antidote for heparin? | Protamine (protamine sulfate) |
| when a patient is on heparin and coumadin therapy what labs should be monitored daily? | PTT & PT |
| what is the normal range for PT? | 10-14....preteen....PT |
| what is the normal range for PTT? | 24-36...PTT....PT x Two |
| signs of a PE include | difficulty breathing and restlessness |
| the risk for DVT lasts how long post-op? | 4-6 weeks |
| what percent of of surgical patients develop a DVT? | 40-60 |
| If not treated prophylactically after surgery what percent of patients will develop PE? | 20 |
| how long are IV antibiotics prophylactically used after surgery? | 24-48 hours |
| what sign of infection is usually increased but may be decreased in the elderly? | temperature |
| signs of infection include | temperature change, wound redness, swelling, heat, pain, purulent drainage |
| a hemovac is used to prevent what? | hematoma formation under or near incisional site |
| an alternative to post-op blood transfusions is | autotransfusion drain (stryker) |
| a closed drainage system that collects and filters blood and can be reinfused back to the patient | autotransfusion drain (stryker) |
| what supplement is usually given post-op to increase blood counts? | iron |
| cloudy urine may indicate | infection |
| if bone infection at prosthesis site occurs the patient may | need to return to the OR |
| what are the most frequent post-op cultured organisms from infected hips and knees? | staphylococcus aureus & staphylococcus epidermidis |
| urinary and bowel elimination for the post op patient should be performed with | a fracture pan |
| post op diet should progress from clear liquids on day one to regular diet if | bowel sounds are present |
| the post op patient should be taught to always pivot on which leg when getting out of bed? | unoperative leg |
| to prevent flexion contractures the patient should | lie prone for 15 minutes each day |
| what position should the affected leg be in while in the prone position? | abducted |
| the post op hip surgical patient should bend at the hip only to what type of angle? | to a right angle 90 degrees or less |
| inability to move the affected leg or abnormal rotation of the leg may indicate | dislocation |
| increased localized discomfort or inability to move the leg may indicate | dislocation |
| leg shortening or malalignment may indicate | dislocation |
| to prevent adduction after total hip replacement what type of pillow should be used? | an abduction pillow |
| what common sign of infection cannot be used to determine infection in the elderly? | geriatric clients |
| the postop client should move slowly out of bed to prevent what | orthostatic hypotension |
| TCDB and IS should be performed q 2 hours to prevent | atelectasis and pneumonia |
| pain meds are needed for the geriatric post op patient but may | confuse them |
| due to confusion from pain meds the geriatric patient should be | reoriented frequently |
| patients being discharged should be taught to bend the hip only to | 90 degrees |
| post op xrays of the hip are taken | at 6 weeks, 6 months then annually |
| physician office visits for follow up after total hip replacement should occur | at 2 weeks, 6 weeks, 3 months, 6 months and annually |
| what labs are drawn during the follow up visits? | Hgb, Hct and Pt |
| a knee immobilizer is often in place over a bulky knee dressing after knee replacement surgery unless | the CPM (continuous passive motion) machine is being used |
| should the operative leg be elevated on pillows after knee surgery and why or why not? | yes, to decrease swelling |
| what position do you not want the knee/leg to be in while elevated? | avoid flexing or bending the knee |
| elevation is used to decrease swelling for the first | 48 hours |
| the CPM machine is used to | reduce swelling, prevent adhesions, decrease pain and facilitate early mobility |
| the dr will prescribe what limits for the CPM machine | flexion-extension |
| the CPM will help the patient work up to what degree bend? | 90 |
| the knee replacement patient may have a polar pack and a drain of what kind? | hemovac |
| the knee post op patient will need to avoid driving for how long and with what condition? | 1 to 1 1/2 months if off narcotics |
Created by:
Lori Dobrisky
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