“Fracture Of The Hips” plus 2 more nursing article(s): NursingCrib.com Updates
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| Fracture Of The Hips Posted: 04 Oct 2010 09:23 PM PDT 
 Hip Fracture Etiology And Pathophysiology - Fractures of the head or neck of the femur (intracapsular fracture) or trochanteric area (extracapsular fracture).
- Incidence highest in elderly females because of osteoporosis and degenerative joint disease.
Signs and Symptoms - Pain
- Changes in sensation
- Affected leg appears shorter
- External rotation of the affected limb
Diagnostic Procedure - X-ray examination reveals lack of continuity of the bone.
Therapeutic Interventions - Buck's extension or Russell traction as a temporary measure to relieve the pain of muscle spasm or if surgery is contraindicated.
- Closed reduction with a hip spica cast in fractures of the intertrochanteric region.
- Open reduction and internal fixation.
- Austism Moore prosthesis
- Thompson prosthesis
- Smith-Petersen nail
- Jewert nail
- Zickel nail
- Total hip replacement when joint degeneration will not permit an internal fixation.
Assessment - Shortening and external rotation of leg.
- Degree and nature of pain.
- Baseline vital signs
- Neurovascular status of involved extremity.
- Other health problems that may affect recovery.
Nursing Diagnosis - Constipation
- Fear
- Risk for injury
- Pain
- Impaired physical mobility
- Altered role performance
- Self-care deficit
- Situation low self-esteem
- Risk for impaired skin integrity
Nursing Interventions - Assess for complications of immobility.
- Encourage the use of a trapeze or side rails to facilitate movement.
- Use the fracture pan for elimination.
- Inspect dressing and linen for bleeding.
- Use a trochanter roll to prevent external rotation of legs.
- Do not turn client on the affected side unless specifically ordered.
- Place pillow between legs when turning on the unaffected side.
- Use pillows or abductor pillow to maintain the legs in slight abduction; after hip replacement it prevents dislodging of the prosthesis.
- Encourage quadriceps setting exercises.
- Assist the client to ambulate by using a walker and eventually progressing to a cane; follow orders for extent of weight bearing permitted on affected extremity because this will depend on the type of surgery performed and the type of device inserted.
- Support on unaffected side.
- Avoid flexing the hips of a client with a total hip replacement, assist to a lounge chair position when permitted to sit.
- Prevent complication of thromboembolism:
- Administer prescribed anticoagulants, observe for bleeding.
- Apply antiembolism stockings.
- Encourage dorsiflexion of feet.
- Prevent pulmonary complication.
- Encourage coughing and deep breathing exercises.
- Explain use of incentive spirometry.
- Assist with frequent position changes.
image from hygenicblog.com Related posts: - Tibial Fracture
- Nursing Care Plan – Fracture
- Osteosarcoma
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| Osteosarcoma Posted: 04 Oct 2010 09:11 PM PDT 
 Osteosarcoma Osteosarcoma - Type of bone cancer that develops in the cells (forms the outer covering of the bone).
- Most common and fatal in children and males between 10-25 years old.
- 5% of all childhood cancers.
- Common sites: long bones, knee, upper leg, thigh bone, lower leg and upper arm.
Etiology Causes: - Unknown
- DNA mutation – either inherited or acquired after birth.
- Familial susceptibility
- Injury
- Infection
- Metabolic or hormonal disturbance
Risk Factors: Children - Teenage growth spurt
- Tall for the age
- Previous treatment with radiation
- Benign and non-cancerous bone tumors
- Retinoblastoma
Adult - High fat diet
- Lack of exercise
- Smoking
- Drinking alcohol
Pathophysiology - Osteoblast
- DNA mutation
- Malignant osteoblast (abnormal)
- Proliferation of abnormal osteoblast
- Formation of osteoid or immature bone
- Signs and symptoms are then observed such as pain, swelling, and tenderness.
Assessment - Encourage patient to discuss problem and course of symptoms.
- Note patient and family's understanding of the disease, coping with the problem and management of pain.
- Palpate mass gently on physical examination.
- Note size and associated soft-tissue swelling, pain and tenderness of the mass.
- Assess neuromascular status and range of motion extremity.
- Evaluate motility and ability to perform activities of daily living.
Diagnostic Procedures - X-ray
- MRI
- CT scan
- Biopsy
- CBC
- Blood chemistry
- Urine analysis
- Sternal marrow puncture
Nursing Diagnosis - Acute or chronic pain
- Risk for injury: pathologic fracture related to tumor
- Ineffective coping
- Activity intolerance
Nursing Intervention - Provide quiet environment and calm activities to prevent or lessen pain.
- Provide comfort measure such as back rub, change position and use of heat or cold application.
- Encourage diversional activities
- Administer analgesics as indicated to maximal dose as needed.
- Encourage the patient to increase fluid intake.
- Encourage rest periods to prevent fatigue.
- Provide accurate information about the situation, medication and treatment.
- Assess muscle strength, gross and fine motor coordination.
- Provide pillows for cushion and support.
- Keep side rails up all the time.
Complications - Alopecia
- Reduction in number of leucocytes and platelets
- Septicemia
- Bleeding
- Anemia
- Kidney damage
- Hearing loss
image from www.nlm.nih.gov Related posts: - Osteoarthritis
- Fracture Of The Hips
- Gastric Cancer
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| Kidney Transplantation Posted: 04 Oct 2010 08:22 PM PDT 
 Kidney Transplatation Definition - The implantation of a kidney from a living donor or cadaver donor (kidney harvesting) to a tissue-matched recipient.
Discussion - Kidney transplantation is usually performed on an otherwise healthy patient who suffers from renal failure.
- The donor should be a close family member (twin, sibling, parent).
- Two surgical teams may work simultaneously if the procedure involves a living donor.
- If the transplant is from a cadaver donor, a team from the transplant centers removes the cadaver's donor's kidney for external perfusion prior to implantation, to minimize the time that elapses between the recipient's nephrectomy and the implantation of the donor kidney (4-6 hours after removal, with a maximum time of 72 hours).
- Contraindications for kidney transplantation include:
- Systemic disease that precludes major surgery.
- Active cancer.
- Oxalosis (an autosomal recessive hereditary disease).
- Fabry's disease (an inherited metabolic disease resulting in excessive amounts of glycolipids in the kidney).
Positioning Packs/ Drapes - Basin sets
- Blades
- Foley catheter with drainage unit
- Suction
- Needle counter
- Drain
- Solutions
- Sutures
- Medication
Procedure - The kidney is brought to the recipient team by the donor's surgeon or designee.
- The recipient's surgeon makes a long inguinal incision that is carried down to the iliac fossa by blunt and sharp dissection.
- The kidney is usually placed in the patient's iliac fossa to avoid peritonitis.
- The surgeon identifies the external iliac vein and hypogastric artery.
- Anastomoses are then performed between the renal artery and hypogastric artery and between the remal vein and external iliac vein (4-0 or 5-0) non absorbable vascular suture.
- Prior to anastomoses, the patient is given a systemic dose of I.V. heparin by the anesthesiologist.
- The surgeon will implant the donor ureter into the bladder.
- The bladder is grasped with two or more Allis clamos and then incised.
- A separate incision is made to accommodate the ureter.
- The surgeon sutures the ureter through the first incision (3-0 or 4-0 chromic; Dexon).
- A penrose drain is placed near the bladder wall, and the first incision is closed in three layers.
- The wound is closed in three layers as for an inguinal hernia repair.
Perioperative Nursing Considerations - Permission to harvest the kidney must be obtained from the family and the medical examiner.
- Support systems for the families of the donor family especially following a traumatic death, the recipient family, and the patient should be activated since psychologic changes may develop that need professional intervention.
- A harvesting procedure (cadaver donor), especially on a young patient, may be traumatic on the participating nursing staff, since once the kidney is out, the need for life support from anesthesia is no longer required.
- Ample support should be available to assist the staff in overcoming any potential psychologic problems that could interfere with the efficient execution of care required.
- Following the harvesting procedure, postmortem care is performed according to hospital protocol.
image from dartmouth-hitchcock.org Related posts: - Nephrectomy
- Percutaneous Transluminal Coronary Angioplasty
- Open Prostatectomy
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