Aseptic Necrosis

MEDICAL HISTORY: Includes osteoarthritis, frequent urinary tract infections, hysterectomy 20 years ago, and some TMJ (The temporomandibular joint)

S.P. is admitted to the orthopedic ward. She has fallen at home and she has sustained an intracapsular fracture of the hip at the femoral neck. The following history is obtained from her: She is a 75-year-old widow with three children living nearby. Her father died of cancer at age 62; mother died of heart failure at age 79. Her height is 5’3 and weighs 118 pounds. She has a 50 pack year smoking history and denies alcohol use. She has severe Rheumatoid Arthritis (RA) and had an upper GI bleed in 1993 and had Coronary Artery Disease with CABG 9 months ago. Since that time, she has engaged in “very mild exercise at home.” Vital signs are 128/60, 98, 14, 99 degree farenheight (32.7 degrees C) SAO2 94%

SKIN: She has some mild ecchymosis on her skin, and some erythema. She has patches but no obvious skin breakdown. She has some fissuring in the buttocks crease. PULMONARY: Clear to percussion and auscultation bilaterally. CARDIOVASCULAR: No murmurs or gallops noted. ABDOMEN: Soft, nontender, protuberant, no orgonomegaly, and positive bowel sounds. NEUROLOGIC EXAM: Cranial nerves II through XII are grossly intact. Diffuse hyporeflexia. MUSCULOSKELETAL: Erosive, destructive changes in the elbows, wrists, and hands consistent with rheumatoid arthritis. Has bilateral total knee replacements with stovepipe legs, and perimalleolar pitting edema 1 +. I feel no pulses distally in either leg. PSYCHIATRIC: Patient is a little anxious about these new symptoms and their significance. We discussed her situation and I offered her psychologic services. She refused for now.

When I entered the client’s room for wound care; I saw that she was on her bed, in semi-fowler position with the bottom of the bed elevated as well. I pressed the bed remote to bring the bottom of the bed down and straight. We had everything ready on the table for the procedure; we washed our hands and wore PPE, gloves. Client’s legs were very stiff and contracted, we tried to extend but it didn’t work. It was documented on client’s chart that she has severe contracture which “is an abnormal flexion and fixation of a joint caused by muscle atrophy and shortening” (LeMone, p. 1330). When I assisted client with passive ROM exercises before wound care, it was very difficult to straighten her legs. We perform aseptic technique for cleaning and dressing the wound. We placed extra bed pad under client’s leg and I used the

HISTORY OF PRESENT ILLNESS: Patient is a candidate for a total right hip revision. She has 2 units of directed packed red blood cells. It is not autologous. She does had Hepatitis B. She has arthrogryposis. She had a right total hip replacement many years ago by Dr. Dodd at the University of Miami. She has had multiple other surgical procedures as follows. A: She had bilateral foot surgery In the remote past. B: She had left hip surgery a year ago. C: She had right foot

Test results demonstrated dangerously low bone density levels that confirmed osteoporosis, which eventually led to a spinal fracture. Too old for surgery, she struggled through her day as she continued to shop, drive, cook, and clean for herself. Watching her health decline at such a rapid rate inspired me to explore the field of rheumatology as a Master’s student at Touro University Nevada. It was there that I shadowed a rheumatologist, an experience that not only improved my understanding of the physical complications endured by individuals with this condition, but also provided me with insight into the emotional struggles faced by both the patient and their families. Under the mentorship of this physician, I also completed my Master’s thesis on Joint Hypermobility Syndrome. It was engaging to be able to apply what I observed in the clinic with current research studies to create a tool to assist primary care physicians in the diagnosis of this condition. As research has always been an important component of my academic career, I hope to further explore aspects of clinical research as a

Surgical Asepsis is the absence of all microorganisms within an invasive procedure. It includes, sterile technique, which is a specific set of practices, procedures to make equipment, instruments, and the surgical environment free from all microorganisms. Surgical asepsis relates to surgical technologist because their responsibility is to practice aseptic technique by remaining sterile and maintaining a sterile environment during a procedure. https://opentextbc.ca/clinicalskills/chapter/surgical-asepsis/.

no problems with mobility noted, patient ambulates w/o assistance, ROM of joints intact, patient pt able to rotate feet,

“Bonnie Bowser, eighty-two years old, fell and severely injured her elbow. She was examined at the Emergency Department of the Miraculous Regional Health System and diagnosed with a fractured olecranon process, and referred to an orthopedic surgeon. The surgeon who examined Mrs. Bowser scheduled her for corrective surgery the next day. He noted in his examination that she had a past medical history of hypertension, diabetes mellitus, two myocardial infarctions with quadruple bypass surgery, and a cerebrovascular accident affecting her left side. She was taking several medications including Lasix (a diuretic), Vasotec (for treatment of hypertension and symptomatic congestive heart failure), Kylotrix (potassium supplement),

One afternoon a 67 year-old man presented to the emergency department of a small, rural hospital complaining of severe left leg and hip pain following a fall at home. The patient had no past history of falls. He had a history of impaired glucose intolerance, prostate cancer, hypercholesterolemia and hyperlipidemia. The patient’s current medications were atorvastatin and oxycodone for chronic back pain. The patient stated his pain was ten out of ten on a scale of one to ten with ten being the worst. The left leg appeared shorter than the right, edema was present in the calf, as was ecchymosis and he had limited range of motion. After an evaluation in triage by a registered nurse and a subsequent examination by the emergency department physician, a plan was established to sedate the patient using moderation sedation protocol and perform a manual reduction of the hip.

An attending physician statement completed by Dr. Peter Chweyah (Internal Medicine), dated 06/16/2016, indicated that the claimant presented with complaints of lower extremity weakness, neuropathy, weight loss, acute renal failure, and gout, as well as anemia. Objective findings showed an extreme weakness of the legs and pain in the feet. He also had diabetes mellitus type 2, chronic kidney disease, and hypertension. It was noted that the claimant was totally disabled from 05/30/2017 through 06/15/2017 and 05/23/2017 - 05/26/2017 secondary to gout.

The patient is a 72 year old female. She has been experiencing progressively worse pain and stiffness in her joints. She is reports that she is having decreased range of motion, redness, and swelling in her joints. She is reports symptoms occur in the same joints on both sides of her body. She is also reporting the symptoms are worse when she first wakes up in the morning.

The growth of Room 40’s atherosclerosis progressed until an acute arterial occlusion was formed, which stopped blood flow to the tissue. The atherosclerosis consisted of complicated lesions that led to a decrease in blood flow and the presence of a thrombus, ultimately resulting in thea lack of blood flow to the right foot and lower leg. Thrombi often appear after a rupture of an atherosclerotic plaque (Coneliue, 2014). This lack of blood flow led to necrosis of the tissues in the right foot and lower leg and ultimately resulted in the need for the AKA.

Impaired skin integrity related to limited mobility, impaired tissue perfusion, decreased cardiac output, altered nutritional and hydration status, increased moisture, decreased sensory perception and excess weight as evidenced by patient being bed reddened 95% of the day, +2-+3 peripheral edema, stage III- IV coccyx pressure ulcer, drainage from the coccyx ulcer, high blood pressure, decreased oxygen saturation between 85-95 % 2L NP, weak peripheral pulses, obesity, excessively dry skin, sores on both legs (blister-like), denial of pain regarding dressing changes, and excessive diaphoresis with movement secondary to CHF, hypertension, hyperlipidemia, and non-insulin dependent type II diabetes.

Ivy, a 60 years old Asian woman sustains an ankle fracture from a fall in a shopping mall. After the surgery, Ivy goes to an Orthopedic surgeon for follow up, who does an initial history and physical checkup. Ivy has an active life. She walks every day about two miles and stays busy with household works. She has habits of drinking a few cups of coffee and a moderate amount of wine and also smoking. About two years ago she was diagnosed with rheumatoid arthritis.