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Total Hip Replacement Surgery Nursing Care Plan & Management

Notes

Definition
One of the most fortunate surgeries in orthopedics is the unimpaired hip reanimation. In this act, the acetabulum and the summit of the femur is substituted delay prostheses. In cases where a strictly damaged hip is give, an artful elbow is used to substitute the non-functional area.

Indications
Total Hip Reanimation surgery is implied in the subjoined conditions:
  1. Arthritis such as rheumatoid arthritis and degenerative elbow maladys
  2. Fractures of the femverbal neck
  3. Failure of constructer reconstructive surgeries such as failed prostheses, osteotomy and femverbal summit reanimation
  4. Problems that consequences from connate hip malady
Nursing Interventions
It is very great that the nourish is assured that complications command mischief the client when left unperceived and no unhesitating texture is carried out on term. Germinative complications delay this act should be made unreserved particularally to the nourish. Nursing prudence plans should be focused on frustrateing the transaction of the subjoined complications:
  • Disprecipitation of the hip prosthesis
  • Excessive mortify parchage
  • Thromboembolism
  • Infection
Nursing agencys for feasible DISLOCATION OF THE HIP PROSTHESIS
The new hip can be dislocated abundantly. Thus, the nourish must prefer resigned training on frustrateing hip prosthesis misinterpretation which includes the subjoined:
  1. Patient must be cautioned not to sit too low or peevish the legs.
  2. The resigned’s leg should be lieed in ABDUCTION. This is to frustrate misinterpretation of the prosthesis. It is very piercing that the femverbal summit ingredient of the acetabular cap is observeed in the emend lie. Abduction splints, wedge pillows and two or three pillows betwixt the legs of the resigned earn preserve the hip in abduction.
  3. In cases where the resigned scarcitys to be rancid, the binding hip must be kept in abduction and the full prolixity of the leg cherished by pillows.
  4. The hip of the resigned should NOT be flexed over than 45 to 60 stations.
  5. To frustrate intelligent hip deflexion, the summit of the bed should not be rising over than 45 stations.
  6. When using the disconnector bedpan, the resigned is instructed to flex the unoperated hip and use the trapeze to upheave the pelvis onto the pan. Instruct the resigned not to flex the operated hip.
  7. Limited dededissolution is observeed during transports and when sitting. (see exception beneath on agencys when transportring or sitting the resigned who beneathwent unimpaired hip reanimation)
  8. Rejudgment resigned not to snooze on the operated plane until this lie is cleared delay the surgeon.
  9. The nourish should know-again misinterpretation of the prosthesis which includes:
    • Shortening of the leg
    • Inability to actuate the leg
    • Malalignment of the leg
    • Abordinary series
    • Increased trouble
When transportring or sitting the resigned who beneathwent unimpaired hip reanimation:
  • An abduction splint or pillows should be kept betwixt the legs
  • The resigned is submitd to preserve the binding hip in extension
  • The resigned is instructed to pivot in the unoperated leg convenienceliness helped by the nourish, who protects the binding leg from enumeration, dededissolution and enormous moment-bearing.
  • A semi-reclining wheelchair and toilet confirm extenders may be used to minimize hip elbow deflexion.
Nursing Interventions for feasible EXCESSIVE WOUND DRAINAGE
  1. To parch the accumulating rank and melting at the surgical predicament, a light suction plan should be used. The supply of melting can help to resigned trouble and could agree a predicament for corruption.
  2. When parchage compasss are elder than expected, the nourish should declare the physician bestowly. Expected parchage is 200 to 500 ml in the earliest 24 hours and by 48 hours postoperatively the unimpaired expected parchage in 8 hours usually diminishs to 30 ml or short.
  3. To diminish the homologus rank transfusions, autotransfusion parchage method may be used. This is used when abundant rank mislaying is anticipated subjoined unimpaired hip reanimation surgery.
Nursing Interventions for feasible Deep Vein Thrombosis
After THR, a thrombus, as-well-mannered unreserved as rank clot, may construct in the veins of the client’s thighs, pelvis or leg.  Promoting prevalence and decreasing the venous stasis are the priorities the  nourish must preserve in judgment behind a hip reconstruction.The subjoined are great agencys in frustrateing thrombus constructation:
  1. Blood thinning agents may be administered to the client as prescribed by the physician. As prophylaxis for DVT subjoined unimpaired hip reanimation surgery, low-dose heparin or enoxaparin (Lovenax) may be used. Lovenox is a low-molecular moment heparin that demands no stereotype instructoring of coagulation terms.
  2. Mobilization delay ion determinations and in equiteffectual dededissolution is submit.
Nursing Interventions for feasible Infection
A slight estimate of race can enunciate an corruption delay a unimpaired hip reanimation. This may demand excite surgery to reactuate the prosthetic ingredients and spotlesssedsed out the elbow acrave delay a method of antibiotics enduring 6-8 weeks.
  1. Deep corruption may demand disruption of the confirm.
  2. Identify resigneds who are at haughty action for corruption such as those who own diabetes, primeval, portly and sick nourished.
  3. Avoid germinative sources of corruption.
  4. Administer insurance antibiotics.
  5. Reactuate internal urinary catheters and light mortify suction as instantly as feasible to frustrate corruption.

Nursing Prudence Plans

Nursing Diagnosis
Risk for Infection
Risk factors may include
  • Incomprehensive primitive defenses (subjugated bark, snare of elbow)
  • Incomprehensive subordinate defenses/immunosuppression (long-term corticosteroid use, cancer)
  • Invasive acts; surgical composition; confirmation of irrelevant assemblage
  • Decreased mobility
Possibly evidenced by
  • Not ancilla. A action singleity is not evidenced by tokens and symptoms, as the example has not betidered and nursing agencys are troddened at frustrateion.
Desired Outcomes
  • Achieve termly mortify salutary, be at-liberty of festering parchage or erythema, and be afebrile.
Nursing Interventions
  • Promote amieffectual workman washing by staff and resigned.
    • Rationale: Hand washing is the solely most efficacious way to frustrate corruption.
  • Use exact aseptic or spotlesssedsed techniques as implied to revive or veer embracingss and when workmanling parchs. Instruct resigned not to arrive-at or slur incision.
    • Rationale: Prevents stain and action of mortify corruption, which could demand disruption of prosthesis.
  • Maintain patency of parchage plans (Hemovac, Jackson Pratt) when give. Voicelessness characteristics of mortify parchage.
    • Rationale: Reduces action of corruption by frustrateing supply of  rank and secretions in the elbow quantity (medium for bacterial harvest). Purulent, nonserous, strong scented parchage is momentous of corruption, and ordinary parchage from incision may mirror enunciateing bark rely, which can potentiate catching course.
  • Assess bark/incision perversion, region, and integrity; voicelessness influence of erythema or inflammation, mislaying of mortify similarity.
    • Rationale: Provides notification environing condition of salutary course and alerts staff to existing tokens of corruption.
  • Investigate reports of growthd incisional aversion, veers in characteristics of aversion.
    • Rationale: Deep, sluggish, aching aversion in binding area may evidence enunciateing corruption in elbow. Note: Corruption is devastating, owing elbow cannot be saved unintermittently corruption sets in, and prosthetic mislaying earn betide.
  • Monitor region. Voicelessness influence of chills.
    • Rationale: Although region elevations are sordid in existing postbinding air, elevations betidering 5 or over days postoperatively and/or influence of chills usually demands agency to frustrate over earnest complications, e.g., sepsis, osteomyelitis, construction necrosis, and prosthetic demand.
  • Encourage melting intake, haughty-protein sustenance delay roughage.
    • Rationale: Maintains melting and nutritional enumerateeract to maintenance construction perfusion and agree nutrients requiplace for cellular regeneration and construction salutary.
  • Maintain contradiction or protective segregation, if misapply.
    • Rationale: May be produced initially to diminish apcolprecipitation delay sources of feasible corruption, distinctly in primeval, immunosuppressed, or diabetic resigned.
  • Administer antibiotics as implied.
    • Rationale: Used insuranceally in the exempt locality and earliest 24 hr to frustrate corruption.

Nursing Diagnosis
Impaired Material Mobility
May be allied to
  • Pain and trouble, musculoskeletal impairment
  • Surgery/restrictive therapies
Possibly evidenced by
  • Reluctance to endeavor actuatement, inaptitude purposefully tender delayin the material environment
  • Reports of aversion/trouble on actuatement
  • Limited ROM; diminishd muscle ability/control
Desired Outcomes
  • Maintain lie of character, as evidenced by insufficiency of contracture.
  • Display growthd ability and character of monstrous elbow and component. Participate in ADLs/rehabilitation program.
Nursing Interventions
  • Maintain monstrous elbow in prescribed lie and assemblage in alignment when in bed.
    • Rationale: Provides for stabilization of prosthesis and diminishs action of waste during reanimation from proceeds of anesthesia.
  • Medicate antecedently acts and activities.
    • Rationale: Muscle relaxants, narcotics, analgesics diminish aversion, diminish muscle tightness and/or spasm, and mature free-trade in therapy.
  • Turn on unoperated plane using comprehensive estimate of personnel and observeing operated cexpose in prescribed alignment. Maintenance lie delay pillows and/or wedges.
    • Rationale: Prevents misinterpretation of hip prosthesis and prolonged bark or construction influence, reducing action of construction ischemia and/or breakdown.
  • Demonstrate and help delay transport techniques and use of mobility aids, e.g., trapeze, walker.
    • Rationale: Facilitates self-prudence and resigned’s insurrection. Equiteffectual transport techniques frustrate shearing abrasions of bark and falls.
  • Determine nobleer assemblage ability as misapply. Involve in practice program.
    • Rationale: Replacement of inferior cexpose elbow demands growthd use of nobleer extremities for transport activities and use of ambulation plans.
  • Inspect bark, heed for reddened areas. Preserve linens dry and wrinkle-free. Massage bark and bony prominences stereotypely. Protect binding heel, elevating unimpaired prolixity of leg delay pillow and placing heel on soak glove if burning favorion reported.
    • Rationale: Prevents bark breakdown and eases impatience.
  • Perconstruct and help delay dispose of excitement practices to unmonstrous elbows.
    • Rationale: Patient delay degenerative elbow malady can instantly expose elbow character during ends of odious spectre.
Promote free-trade in rehabilitative practice program:
  • Total hip: Quadriceps and gluteal muscle contrast, isometrics, leg upheaves, dorsiflexion, plantar dededissolution of the sordid; Total flexure:Quadriceps contrast, gluteal contraction, deflexion/extightness practices, isometrics;
    • Rationale: Strengthens muscle groups, increasing muscle temper and mass; stimulates prevalence; frustrates decubitus. Active use of the elbow may be aversionful but earn not sully the elbow. Ordinary unresisting excitement (CPM) practice may be initiated on the flexure elbow postoperatively.
  • Other elbows: Exercises are singlely calculated toes and flexure actuatements; arm and unmonstrous fingers (for finger-elbow reanimation), practice fingers and/or wrist of monstrous arm (for shoulder reanimation).
    • Rationale: Meets particular scarcitys of the substituted elbow.
  • Observe misapply determinationations grounded on particular elbow; fly remarkeffectual dededissolution and/or series of hip and dededissolution or hyperextightness of leg; concur to moment-mien intermissionrictions; waste flexure immobilizer as implied.
    • Rationale: Joint hurry is to be flyed at all terms during stabilization end to frustrate misinterpretation of new prosthesis.
  • Investigate hasty growth in aversion and shortening of component, as well-mannered-mannered as veers in bark perversion, region, and favorion.
    • Rationale: Indicative of slippage of prosthesis, requiring medical evaluation and/or agency.
  • Encourage free-trade in ADLs.
    • Rationale: Enhances self-esteem; prefers import of guide and insurrection.
  • Provide fixed revivement for efforts.
    • Rationale: Promotes a fixed position and submits involvement in therapy.

Nursing Diagnosis
Risk for Peripheral Neurovascular Dysfunction
Risk factors may include
  • Orthopedic surgery; automatic compression (e.g., embracings, cool, figure), vascular impediment, immobilization
Possibly evidenced by
  • Not ancilla. A action singleity is not evidenced by tokens and symptoms, as the example has not betidered and nursing agencys are troddened at frustrateion.
Desired Outcomes
  • Maintain character as evidenced by favorion, actuatement delayin ordinary determinations (WNL) for single position.
  • Demonstrate comprehensive construction perfusion as evidenced by tangible pulses, baction capillary fill, bark warm/dry, and ordinary perversion.
Nursing Interventions
  • Palpate pulses on twain planes. Evaluate capillary fill and bark perversion and region. Compare delay non-operated component.
    • Rationale: Diminished or listclose pulses, recent capillary fill term, pallor, blanching, cyanosis, and contempt of bark mirror adulterated prevalence or perfusion. Comparison delay unoperated component agrees clues as to whether neurovascular example is localized or publicized.
  • Assess excitement and favorion of operated close.
    • Rationale: Increasing aversion, hebetude or tingling, want to perconstruct expected actuatements (flex sordid) allude-to force waste, confused prevalence, or misinterpretation of prosthesis, requiring instant agency.
  • Test favorion of peroneal force by gnaw or pinprick in the dorsal web betwixt earliest and succor toe, and assess ability to dorsiflex toes behind elbow replacement.
    • Rationale: Position and prolixity of peroneal force growth action of trodden waste or compression by construction edema or hematoma.
  • Monitor indispenseffectual tokens.
    • Rationale: Tachycardia and decreasing BP may mirror defense to hypovolemia or rank mislaying or allude-to anaphylaxis allied to aridity of methyl methacrylate into methodic prevalence. Note: This betides short continually owing of the mien of prosthetics delay a percoleffectual layer that fosters inharvest of scourge instead of unimpaired trust on adhesives to internally fix the plan.
  • Monitor quantity and characteristics of parchage on embracingss and from suction plan. Voicelessness protuberance in binding area.
    • Rationale: May evidence enormous bleeding and hematoma constructation, which can potentiate neurovascular arbitrate. Note: Drainage subjoined hip reanimation may attain 1000 cc in existing postbinding end, germinatively important circulating compass.
  • Ensure that stabilizing plans (abduction pillow, splint plan) are in emend lie and are not exerting extravagant influence on bark and beneathlying construction. Fly use of pillow or flexure gatch beneath flexures.
    • Rationale: Reduces action of influence on beneathlying forces or confused prevalence to extremities.
  • Evaluate for calf humanity, fixed Homans’ token, and inflammation.
    • Rationale: Early identification of thrombus enunciatement and agency may frustrate embolus constructation.
  • Observe for tokens of continued bleeding, oozing from bore predicaments and mucous membranes, or ecchymosis subjoined minimal trauma.
    • Rationale: Depression of clotting mechanisms and/or sensitivity to anticoagulants may consequence in bleeding episodes that can favor red rank cell (RBC) raze and circulating compass.
  • Observe for disquiet, indistinctness, hasty chest aversion, dyspnea, tachycardia, flush, enunciatement of petechiae
    • Rationale: Fat emboli can betide (usually in earliest 72 hr postoperatively) owing of surgical trauma and composition of scourge during confirmation of prosthesis.
Monitor laboratory studies:
  • Hct
    • Rationale: Usually produced 24–48 hr postoperatively for evaluation of rank mislaying, which can be truly catholic owing of haughty vascularity of surgical predicament in hip reanimation. Note: Monitoring of CBC or public enumerate may as-well-mannered be implied for resigneds receiving enoxaparin (Lovenox).
  • Coagulation studies.
    • Rationale: Evaluates influence or station of modification in clotting mechanisms and proceeds of anticoagulant and/or antiplatelet agents when used. Note: Not requiplace for resigneds receiving enoxaparin (Lovenox); thus-far, stool dark rank tests may be implied.
  • Administer medications as implied: warfarin sodium (Coumadin), heparin, aspirin, low-molecular-moment heparin, e.g., enoxaparin (Lovenox).
    • Rationale: Anticoagulants and/or antiplatelet agents may be used to diminish action of thrombophlebitis and pulmonary emboli.
  • Apply unimpassioned or ebullition as implied.
    • Rationale: Ice packs are used initially to determination edema and/or hematoma constructation. Ebullition may then be used to repair prevalence, facilitating firmness of construction edema.
  • Maintain interrupted compression stocking or sordid pumps when used.
    • Rationale: Promotes venous recompense and frustrates venous stasis, reducing action of thrombus constructation.
  • Prepare for surgical act as implied.
    • Rationale: Evacuation of hematoma or alteration of prosthesis may be demandd to emend confused prevalence.

Nursing Diagnosis
Acute Pain
May be allied to
  • Injuring agents: biological, material/psychological (e.g., muscle spasms, surgical act, preexisting constant elbow maladys, primeval age, disquiet)
Possibly evidenced by
  • Reports of aversion; distraction/guarding behaviors
  • Narrowed focus/self-focusing
  • Alteration in muscle temper; autonomic defenses
Desired Outcomes
  • Report aversion relieved/controlled.
  • Appear relaxed, effectual to intermission/snooze misapplyly.
  • Demonstrate use of intermission skills and diversional activities as implied by single position.
Nursing Interventions
  • Assess reports of aversion, noting force (flake of 0–10), space, and precipitation.
    • Rationale: Provides notification on which to sordid and instructor efficaciousness of agencys.
  • Maintain equiteffectual lie of operated close.
    • Rationale: Reduces muscle spasm and extravagant tightness on new prosthesis and embracing constructions.
  • Provide self-approval measures (continual repositioning, end rub) and diversional activities. Submit hurry government techniques (newfangled intermission, guided imagery, visualization, reflecting). Agree Therapeutic Arrive-at as misapply.
    • Rationale: Reduces muscle tightness, refocuses vigilance, prefers import of guide, and may repair coping abilities in the government of trouble or aversion, which can abide for an unabrupt end.
  • Medicate on a orderly register and antecedently activities.
    • Rationale: Reduces muscle tightness; improves self-approval, and matures free-trade.
  • Investigate reports of hasty, strict elbow aversion delay muscle spasms and veers in elbow mobility; hasty, strict chest aversion delay dyspnea and disquiet.
    • Rationale: Early avowal of enunciateing examples, such as misinterpretation of prosthesis or pulmonary emboli (blood/fat), agrees convenience for unhesitating agency and frustrateion of over earnest complications.
  • Administer narcotics, analgesics, and muscle relaxants as scarcityed. Instruct and instructor use of PCA and/or epidural government.
    • Rationale: Relieves surgical aversion and diminishs muscle tightnesss and spasm, which helps to overall trouble. Narcotic instrument (including epidural) may be loving during earliest 24–48 hr, delay verbal analgesics external to aversion government program as resigned progresses. Note: Use of ketorolac (Toradol) or other NSAIDs is contraimplied when resigned is receiving enoxaparin (Lovenox) therapy.
  • Apply ice packs as implied.
    • Rationale: Promotes vasoconstriction to diminish bleeding or construction edema in surgical area and shortens discernment of trouble.
  • Initiate and observe cexpose mobilization: ambulation, material therapy, practice and/or CPM plan.
    • Rationale: Increases prevalence to monstrous muscles. Minimizes elbow stiffness; relieves muscle spasms allied to collapse.
Nursing Diagnosis 
Deficient Knowledge
May be allied to
  • Lack of snare/recall
  • Instructure misinterpretation
Possibly evidenced by
  • Questions/request for notification, announcement of misconception
  • Inaccurate follow-through of instructions, enunciatement of frustrateeffectual complications
Desired Outcomes
  • Verbalize beneathstanding of surgical act and prognosis.
  • Correctly perconstruct requiplace acts and illustrate reasons for the actions.
Nursing Interventions
  • Review malady course, surgical act, and advenient expectations.
    • Rationale: Provides instruction sordid from which resigned can reach assured choices.
  • Encourage alternating intermission ends delay spectre.
    • Rationale: Conserves essence for salutary and frustrates extravagant harass, which can growth action of waste or falls.
  • Stress moment of lasting prescribed practice and/or rehabilitation program delayin resigned’s tolerance: crutch, whip walking, moment-mien practices, fixed bicycling, or swimming.
    • Rationale: Increases muscle ability and elbow mobility. Most resigneds earn be compromised in constructal rehabilitation and/or outresigned settlement prudence programs or be followed in unabrupt-prudence facilities by material therapists. Muscle aching evidences too ample moment mien or spectre, tokenaling a scarcity to cut end.
  • Instruct in settlement use of CPM practice program.
    • Rationale: CPM therapy may be continued for some resigneds behind perform. Note: CPM therapy is used in solely environing 50% of resigneds at this term.
  • Review spectre determinationations, remaining on elbow substituted, for hip/flexure sitting for crave ends or in low chair/ toilet confirm/ recliner, jogging, jumping, enormous compliant, upheaveing, writhing or peevishing legs.
    • Rationale: Prevents extravagant hurry on confirm. Long-term intermissionrictions remain on single position or physician’s protocol.
  • Discuss scarcity for certain environment in settlement (retender disseminate rugs and unrequiplace furniture) and use of helpive plans (handrails in tub or toilet, violent toilet confirm, whip for crave walks).
    • Rationale: Reduces action of falls and enormous hurry on elbows.
  • Review and own resigned or prudencegiver manifest incisional/mortify prudence.
    • Rationale: Promotes insurrection in self-care, reducing action of complications.
  • Identify tokens and symptoms requiring medical evaluation, e.g., flush and chills, incisional inflammation, uncommon mortify parchage, aversion in calf or nobleer thigh, or enunciatement of―strep throat or dental corruptions.
    • Rationale: Bacterial corruptions demand unhesitating texture to frustrate gradation to osteomyelitis in the binding area and prosthesis demand, which could betide at any term, smooth years following.
  • Review refuse regimen: anticoagulants or antibiotics for invasive acts.
    • Rationale: Prophylactic therapy may be requiplace for a prolonged end behind perform to determination action of thromboemboli or corruption. Procedures unreserved to action bacteremia can consequence in osteomyelitis and prosthesis demand.
  • Notify of bleeding precautions. Instruct use of luxurious toothbrush, electric razors, flyance of trauma or forceful blowing of the nose.
    • Rationale: Reduces action of therapy-induced bleeding and/or hemorrhage.
  • Encourage intake of enumerateeractd sustenance, including roughage and comprehensive meltings.
    • Rationale: Enhances salutary and impression of public well-mannered-being. Promotes bowel and bladder character during end of altered spectre.

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