BSN-3B1 Critical Thinking Exercise Nursing Management of the Client with Total Hip Replacement Situation: A 72-year-old male client is being discharged home from the hospital following hip replacement surgery. In addition to the prevention of other complications, the staff has made every effort to prevent deep vein thrombosis and pulmonary embolism: the two most common causes of postoperative mortality in older clients. Prior to discharge, the nurse gives the client a list of instructions for positioning, sitting, and ambulating at home.
The client is also instructed to use a walker or crutches until weight bearing is safe, and to employ adaptive devices for everyday activities. Finally, the client is advised to watch for any signs of hip prosthesis loosening or dislocation, and to call the surgeon immediately if such signs occur. 1. What are the signs and symptoms of deep vein thrombosis and pulmonary embolism? Deep Vein Thrombosis * Swelling of the leg or along a vein in the leg * Pain or tenderness in the leg, which you may feel only when standing or walking * Increased warmth in the area of the leg that’s swollen or painful * Red or discolored skin on the leg
Pulmonary Embolism * Unexplained sudden onset of shortness of breath * Chest pain or discomfort that worsens when you take a deep breath or when you cough * Feeling lightheaded or dizzy, or fainting * Rapid pulse * Sweating * Coughing up blood * A sense of anxiety or nervousness 2. What types of adaptive equipment is available for clients who have undergone hip replacement surgery? Adaptive equipment to help in daily activities: * Reaching – use a reacher in getting items from cabinets or off the floor. Do not bend over to pick up something from the floor. Dressing – since you are not to bend past 90 degrees, use adaptive devices to be as independent as you can when dressing. -Wear slip-on shoes or use elastic shoelaces so you will not have to bend over to tie your shoes. -A long-handled shoe horn will help you put shoes on or take stockings and socks off. -A dressing stick may be used to put on pants. * Use the hook to catch the waist of underwear or pants. * Place your operative leg first in the pants when dressing, and take it outlast when undressing. * Pull the slacks up over your knees. * Stand with the walker in front of you and pull your slacks up. Socks and Stockings – a stocking aid will make it easier to put on socks or stockings. Elastic stockings may be ordered for you. * Slide the sock or stocking onto the stocking aid. Be sure the heel is at the back of the plastic and the toe is tight against the end. * Secure the sock in place with the notches on the plastic piece. Do not pull the top of the sock over the top of the plastic piece. * Holding onto the cords, drop the stocking aid out in front of the operated foot. * Slip your foot into the sock and pull it on. * Release the sock from the notches on the plastic piece using your dressing stick or reacher. To take the stocking or sock off, use the hook on the dressing stick or reacher to hook the back of the heel and push the sock off your foot. * Using the Bathroom * A raised toilet seat may be helpful to you at home. It will keep you from bending too far when sitting or standing. The higher seat also makes it easier to stand up from the toilet. * Clean yourself after toileting as you are used to, just be careful not to bend too far forward or twist too much at the hip. * Bathing – unless you have a walk-in shower, you will have to learn a new method for getting in and out of the bathtub.
Do not sit down into the tub for 6 to 12 weeks. * If possible, have someone help you the first time you bathe at home. * You may sponge bathe until you are comfortable or have help to shower. * If you have a walk-in shower, you may stand and shower as long as you feel steady and balanced. * If you have a tub shower and need to sit to bathe, you will need a shower bench. Make sure the shower bench is placed firmly in the tub. Have someone adjust the height of the shower bench so it is as tall as it can be to allow you to rest your feet comfortably on the floor of the tub when you are sitting. Have someone put non-skid strips or pads in your bathtub for safety. * Have a secure place to put your soap to avoid dropping it. Try soap on a rope or a deep soap dish. These items are sold at many department stores. * Use a long-handled sponge or bath brush to reach your lower legs and feet without bending more than 90 degrees at your hips. * A portable shower hose may be helpful. * Turn on cold water first to avoid burning yourself. * Getting In and Out of Bed * You will get in and out of bed on the same side as you had surgery. A hospital bed may be needed at home. Your physical therapist, nurse and case manager will talk withyou about this if needed. * Some people find it helpful to wear pajamas made of silky materials to help them slide more easily on the sheets. * You will need someone to carry youroperative leg as you use your arms and non-operative leg to scoot yourself in and out of bed. * Sitting – use a hip cushion to help you sit safely and not break your hip precautions. The cushion adds height to help keep your knees lower than your operative hip when you are sitting.
It also may make it easier for you to stand up. If you are not sure about the height of a chair, put your cushion on it to be safe. * Getting Into a Car – it is important to know how to get into the car in a safe manner. It is better for you to ride in a mid-size or large car with regular bench seats rather than bucket seats. Use a thick pillow or cushion. On a long trip, be sure to make frequent rest stops, about every 30 minutes. Get out and shift your weight from one leg to the other or walk around. The best choice after a total hip replacement is to ride in the back seat . What are the signs of prosthetic hip dislocation and how can this problem be prevented? * Hip Pain * Uneven Leg Lengths * Numbness Acute phase complications -sciatic nerve damage -inability to perform closed reduction – recurring dislocation Recovery phase complications -avascular necrosis -arthritis, chondrolysis -myositis ossificans Precautions: -Do not cross your legs at the knees. -Do not twist at the hip. -Do not bend your hip past 90 degrees. (This means you are not to bend over at your waist or lift your knee higher than your hip if you are sitting)
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