Note characteristics of wound drainage. Perform and assist with range of motion exercises to unaffected joints. Maintain reverse or protective isolation, if appropriate. Instruct patient not to touch or scratch incision. Note: Not necessary for patients receiving enoxaparin (Lovenox); however, stool occult blood tests may be indicated. Maintain affected joint in prescribed position and body in alignment when in bed. Maintains fluid and nutritional balance to support. Administer medications as indicated: warfarin sodium (Coumadin), heparin, aspirin, low-molecular-weight heparin, e.g., enoxaparin (Lovenox). On the first day of admission, the 5 most frequent nursing interventions were intravascular administration, care plan, orthotics management, teaching/emotional support, and elimination care. The significant relationships among nursing interventions, comorbidities, and complications found in this study suggest that nurses should consider comorbidities in their care planning, monitoring, and documenting of nursing interventions and outcomes along with the onset of complications. This is used when extensive blood loss is anticipated following total hip replacement surgery. 2014 Oct;22(7):825-36. doi: 10.1111/jonm.12022. Rationale: Patient with degenerative joint disease can quickly lose joint function during periods of restricted activity. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Discuss need for safe environment in home (removing scatter rugs and unnecessary furniture) and use of assistive devices (handrails in tub or toilet, raised toilet seat, cane for long walks). Demonstrate and assist with transfer techniques and use of mobility aids, e.g., trapeze, walker. Administer narcotics, analgesics, and muscle relaxants as needed. Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently working as a full-time writer and editor for Nurseslabs. Please enable it to take advantage of the complete set of features! Total Hip Replacement surgery is indicated in the following conditions: Arthritis such as rheumatoid arthritis and degenerative joint diseases; Fractures of the femoral neck; Failure of previous reconstructive surgeries such as failed prostheses, osteotomy and femoral head replacement; Problems that results from congenital hip disease; Nursing Interventions Rationale: May indicate excessive bleeding and hematoma formation, which can potentiate neurovascular compromise. During his time as a student, he knows how frustrating it is to cram on difficult nursing topics. Patient must be cautioned not to sit too low or cross the legs. Rationale: Reduces risk of pressure on underlying nerves or compromised circulation to extremities. Note characteristics of wound drainage. Rationale: Promotes independence in self-care, reducing risk of complications. Encourage fluid intake, high-protein diet with roughage. Notify of bleeding precautions. As a nurse educator since 2010, his goal in Nurseslabs is to simplify the learning process, break down complicated topics, help motivate learners, and look for unique ways of assisting students in mastering core nursing concepts effectively. Rationale: Promotes vasoconstriction to reduce bleeding or tissue edema in surgical area and lessens perception of discomfort. | Orthopedic surgery is consulted who orders for the patient to have surgery is the am. USA.gov. In cases where a severely damaged hip is present, an artificial joint is used to replace the non-functional area. He was 80 and had no additional health concerns over than high BP.His Hgb, Hct, WBC were low, and his BP was running 90/52 (normally takes hypertensive meds/BP dropped post surgery). When using the fracture bedpan, the patient is instructed to flex the unoperated hip and use the trapeze to lift the pelvis onto the pan. Rationale: Reduces muscle spasm and undue tension on new prosthesis and surrounding tissues. Investigate sudden increase in pain and shortening of limb, as well as changes in skin color, temperature, and sensation. Rationale: Strengthens muscle groups, increasing muscle tone and mass; stimulates circulation; prevents decubitus. A semi-reclining wheelchair and toilet seat extenders may be used to minimize hip joint flexion. 2007 Jan-Feb;55(1):5-14. doi: 10.1016/j.outlook.2006.06.006. Protect operative heel, elevating whole length of leg with pillow and placing heel on water glove if burning sensation reported. Monitor temperature. Note: CPM therapy is used in only about 50% of patients at this time. Rationale: Provides knowledge base from which patient can make informed choices. Inadequate secondary defenses/immunosuppression (long-term corticosteroid use, Invasive procedures; surgical manipulation; implantation of a foreign body. Here are 13 nursing diagnosis for a client undergoing surgery or perioperative nursing care plans (NCP): Deficient Knowledge (Pre-op) Fear/Anxiety; Risk for Injury; Risk for Injury (Pre-op) Total Joint Replacement can be performed on any joint except the spine. Inspect skin, observe for reddened areas. Purulent, nonserous, odorous drainage is indicative of infection, and continuous drainage from incision may reflect developing skin tract, which can potentiate infectious process. Note presence of chills. Note: Monitoring of CBC or repeated count may also be indicated for patients receiving enoxaparin (Lovenox). Client will achieve timely wound healing, be free of purulent drainage or erythema, and be afebrile. Deep infection may require removal of the implant. Continuous passive motion (CPM) exercise may be initiated on the knee joint postoperatively. To decrease the homologus blood transfusions, autotransfusion drainage system may be used. I am in my 1st semester of nursing and on my 1st week of clinicals I had a post-op pt with an elective total hip replacement the prior day. Clipboard, Search History, and several other advanced features are temporarily unavailable. Nurseslabs – NCLEX Practice Questions, Nursing Study Guides, and Care Plans, 5 Total Joint (Knee, Hip) Replacement Nursing Care Plans. Note presence of chills. Encourage fluid intake, high-protein diet with roughage. Risk for peripheral neurovascular dysfunction related to swelling, constricting devices, or impaired circulation Nursing Diagnosis. Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Rationale: Meets specific needs of the replaced joint. Instruct patient not to. In cases where the patient needs to be turned, the operative hip must be kept in abduction and the entire length of the leg supported by pillows. Hip replacement surgery can be a life altering event for the patient with advanced painful hip disease. Muscle aching indicates too much weight bearing or activity, signaling a need to cut back. Test sensation of peroneal nerve by pinch or pinprick in the dorsal web between first and second toe, and assess ability to dorsiflex toes after joint replacement. Maintain proper position of operated extremity. Investigate reports of sudden, severe joint pain with muscle spasms and changes in joint mobility; sudden, severe chest pain with dyspnea and restlessness. In this procedure, the acetabulum and the head of the femur is replaced with prostheses. Rationale: Ice packs are used initially to limit edema and/or hematoma formation. Risk for Peripheral Neurovascular Dysfunction, Nursing Care Plan: The Ultimate Guide and Database, Arterial Blood Gas Interpretation for NCLEX (40 Questions), Arterial Blood Gas Analysis Made Easy with Tic-Tac-Toe Method, Select All That Apply NCLEX Practice Questions and Tips (100 Items), IV Flow Rate Calculation NCLEX Reviewer & Practice Questions (60 Items), EKG Interpretation & Heart Arrhythmias Cheat Sheet. Rationale: Bacterial infections require prompt treatment to prevent progression to osteomyelitis in the operative area and prosthesis failure, which could occur at any time, even years later. Used prophylactically in the operating room and first 24 hr to prevent infection. Note swelling in operative area. It is very crucial that the femoral head component of the acetabular cap is maintained in the correct position. Demonstrate use of relaxation skills and diversional activities as indicated by individual situation. Remind patient not to sleep on the operated side until this position is cleared with the surgeon. Identify patients who are at high risk for infection such as those who have diabetes, elderly, obese and poorly nourished. Note: This occurs less often because of the advent of prosthetics with a porous layer that fosters ingrowth of bone instead of total reliance on adhesives to internally fix the device. Rationale: Replacement of lower extremity joint requires increased use of upper extremities for transfer activities and use of ambulation devices. Rationale: Maintains fluid and nutritional balance to support tissue perfusion and provide nutrients necessary for cellular regeneration and tissue healing. Narcotic infusion (including epidural) may be given during first 24–48 hr, with oral analgesics added to pain management program as patient progresses. Let us know if you have found this post helpful. Review drug regimen: anticoagulants or antibiotics for invasive procedures. Use strict aseptic or clean techniques as indicated to reinforce or change dressings and when handling drains. Rationale: Provides information about status of healing process and alerts staff to early signs of infection. Rationale: Evacuation of hematoma or revision of prosthesis may be required to correct compromised circulation. Reduces the risk of infection by preventing the accumulation of. Review disease process, surgical procedure, and future expectations. Instruct in home use of CPM exercise program. Limited flexion is maintained during transfers and when sitting. Long-term restrictions depend on individual situation or physician’s protocol. Instruct the patient not to flex the operated hip. Avoid use of pillow or knee gatch under knees. Observe appropriate limitations based on specific joint; avoid marked flexion and/or rotation of hip and flexion or hyperextension of leg; adhere to weight-bearing restrictions; wear knee immobilizer as indicated. May be done initially to reduce contact with sources of possible infection, especially in. Investigate reports of increased incisional pain, changes in characteristics of pain. Minimizes joint stiffness; relieves muscle spasms related to disuse. Maintain patency of drainage devices (Hemovac, Jackson Pratt) when present. Rationale: Reduces muscle tension; improves comfort, and facilitates participation.