Common Joint Replacements n Fingers n Shoulder –Dec. pain, inc. mobility –Slow rehabilitation –Post-op care
Shoulder Post-op Care n Assessment CMS n Pain Management n Wound Drainage n CPM n Infection Prevention n EXERCISE
KNEE REPLACEMENT n Pre-Post-op care –Pain management –Assess CMS, drainage –Prevent resp. complications, DVT –EXERCISES Knee replacement, patient guide
Normal and diseased knee joint
Components of knee joint: femoral, tibial (metal tray and plastic tray), patellar (button)
Porous-coated components needed for knee replacement
Identify post-op knee replacement patient care priorities!
Hip, Hip Hooray!
Hip Fracture/Hip Replacement n Causes of Falls n Hip anatomy –Intracapsular –Extracapsular n Ligaments n Intracapsular –capital –subcapital –basilar –transcervical n Extracapsular –Shortened, externally rotated, flexed, abducted –Strong abductors displace –Intertrochanteric
Intracapsular capital subcapital basilar transcervical Extracapsular Intertrochanteric
Hip Fracture/Hip Replacement n Blood supply –Medial circumflex –Lateral circumflex –Fovealar n Blood supply determines healing!
Initial Assessment for Hip Fracture n What factors should your assess? n What is Priority? n Treatment Options: –ORIF: pins, plates, screws –Femoral head replacement –Maybe total joint replacement n Pre-op Care
Post-op Care: ORIF/Joint Replacement n Post-op ORIF –Blood loss –Pain –Positioning –Tissue perfusion –Complications –Exercise
Repair of Hip Fractures; ORIF or Prosthesis Compare the nursing care of patient with joint prosthesis and Joint Replacement.
Total Hip n Types of Prosthesis n Pre-op Preparation n Intra-op considerations: approach, methylmethracrylate n Post-op Nursing Care: –Complications: blood loss –Neurovascular integrity –Potential dislocation: Prevent hip flexion, internal rotation –Weight bearing –Prevent DVT –Heterotrophic ossification
Preparing for Insertion of the Prosthesis
Total Hip Replacement Total hip replacement, patient guide
Describe the surgical process of insertion of hip prosthesis.
Critical Pathways! n Fx Hip/ORIF/Partial Hip Replacement –Day 1 (ER): 0-4 hrs Eval& schedule surgery; pain control; assess; consults; tests; etc –4-23 hours –Day 2 )Post-op Day 1) –Day 3 (Post-op Day 2) –Day 4 (Post-op Day 3) –Day 5 (Post-op Day 4) –Discharge by 2 pm!
Why is this called a total joint replacement?
Keys to Care n Prevent dislocation! n Progressive activity n Prevent infection! Long term considerations n ? If little or no drainage post-op, what to do?
Discharge Instructions Total Hip n Do Not –Force hip more than 90 degrees –Force into adduction –No internal rotation –Put on own shoes, stockings for 8 wks n Do –Use elevated toilet seat –Sleep with pillow between legs for 1st. 8 wks –Keep hip neutral –Use prophylactic antibiotics –EXERCISE