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
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Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding 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.
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding 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
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Continuous Passive Motion Machine
Flexion and extension are important in the overall rehabilitation process for total knee replacement patients.
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding 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
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Amputation Traumatic Amputations
◆Accidents
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding 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
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding 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
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding 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
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding Medical Surgical Nursing, 3rd Edition
Linda S. Williams / Paula D. Hopper
Bandaging for Above-the-Knee Amputation
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding 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.
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding 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.
Understanding Medical Surgical Nursing, 3rd EditionUnderstanding 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