The clinic nurse evaluates the treatment plan of a client with long-standing rheumatoid arthritis

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Residual limb care following an above-knee amputation (AKA) or below knee amputation (BKA) is an important component of rehabilitation and focuses on maintaining skin integrity, controlling pain, preventing infection, and restoring mobility. It is also important for the nurse to consider that the client may experience grief due to disturbed body image

The nurse should include the following residual limb care instructions:
-Clean the limb by washing it daily with soap and warm water. Thoroughly dry after washing to prevent skin maceration
-Thoroughly inspect the limb for signs of infection
-Keep limb socks, warps, and appliances/prostheses clean and dry
-Perform daily range of motion exercises to improve muscle strength and mobility

HIP FLEXION CONTRACTURES are a common complication during the recovery process. Nurses should teach clients to LIE PRONE several times each day and to AVOID SITTING in a chair for more than an hour

Option 4:
Clients should be taught to avoid applying potential irritants (alcohol, lotion, powder) to the residual limb

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Fat embolism syndrome is a life-threatening condition that has no specific treatment. Therefore, prevention, early diagnosis, and immediate management of symptoms are critical. When a long bone is fractured, pressure within the bone marrow leads to release of fat globules into the bloodstream. These combine with platelets (fat embolus) and can travel to the brain, lungs, and kidneys, leading to small-vessel occlusion and tissue ischemia. Therefore, early stabilization of the injury and surgery as soon as possible to repair long bone (humerus, radius, ulna, femur, tibia, fibula) fractures is recommended to reduce further injury to soft tissue

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Clients with orthopedic injuries, particularly pelvic and long bone injuries (femoral fracture) may develop a FAT EMBOLUS. Fat emboli are thought to occur from the release of fat globules (lipids) from bone marrow or the systemic release of triglycerides into the bloodstream following a mechanical insult. The circulating lipids can OCCLUDE SMALL VESSELS in the lungs, brain, and skin, which impair circulation and oxygenation, leading to:

-Respiratory distress syndrome (dyspnea, tachycardia, sudden and worsening chest pain, hypoxemia, restlessness, anxiety)
-Altered mental status
-Petechial hemorrhages in the arms, chest and/or neck

Option 3:
Pitting edema may occur in clients with impaired mobility (hip fracture) and often relates to fluid volume excess. HTN may also be related to the fluid volume excess in clients receiving IV fluids

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FES is a rare, but life-threatening complication that occurs in clients with long bone and pelvis fractures. It can also occur in nontrauma-related conditions, such as pancreatitis and liposuction. It usually develops 24-72 hours following the injury or surgical repair

There are no specific diagnostic tests to identify FES. However, the initial characteristic signs and symptoms include:

-Respiratory problems (dyspnea, tachypnea, hypoxemia) after a fat embolus travels through the pulmonary circulation and lodges in a pulmonary capillary, leading to impaired gas exchange and acute respiratory failure

-Neuro changes (altered mental status, confusion, restlessness), which occur due to cerebral embolism and hypoxia

-Petechial rash (pin-sized purplish spots that do not blanch with pressure), which appears on the neck, chest, and axilla due to microvascular occlusion. This defining characteristic differentiates a fat embolus from a PE

-Fever (>101.4 F) which is due to a cerebral embolism leading to hypothalamus dysfunction

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Osteoarthritis is a degenerative disorder of the synovial joints (knee, hip, fingers) that causes progressive erosion of the articular (joint) cartilage and bone beneath the cartilage. As the degenerative process continues, bone spurs (osteophytes), calcifications, and ulcerations develop within the joint space, and the "cushion" between the ends of the bones breaks down

Clinical manifestations of OA of the knee include:
-Pain exacerbated by weight-bearing activities. Results from synovial inflammation, muscle spasms, and nerve irritation
-Crepitus, a grating noise or sensation with movement that can be heard or palpated; results from the presence of bone and cartilage fragments that float in the joint space
-Morning stiffness that subsides within 30 minutes of arising
-Decreased joint mobility and range of motion
-Atrophy of the muscles that support the joint (quadriceps, hamstring) due to disuse

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Osteopenia is more than normal bone loss for the client's age and sex. Adequate dietary intake of calcium and vitamin D is necessary to promote bone growth, prevent resorption (bone loss), and prevent progression to osteoporosis. Other food sources that are high in calcium are fish (sardines, salmon, trout), tofu, some green veggies (spinach, kale, broccoli), and almonds. Good food sources of vitamin D include egg yolk and oily fish (salmon, sardines, tuna)