Upload
lesley-whitehead
View
219
Download
0
Tags:
Embed Size (px)
Citation preview
Get Hip to Hip Replacement
By Anne Eby, RNNursing made Incredibly Easy! May/June 20082.0 ANCC/AACN contact hoursOnline: www.nursingcenter.com
© 2008 by Lippincott Williams & Wilkins. All world rights reserved.
The Hip
The Joint
One of the body’s largest weight–bearing joints
Consists of two main parts: The ball or femoral head Acetabulum (a rounded socket)
Ligaments connect the ball to the socket, providing joint stability
Articular cartilage covers the bone surfaces of the ball and socket joint, cushions the bones, and allows for freedom of movement
The synovial membrane lubricates and eliminates friction in the hip joint
Causes of Hip Pain & Disability
Most common cause is osteoarthritis
Rheumatoid arthritis
Femoral neck fracture
Failed previous reconstruction surgeries
Congenital hip disease
Types of Hip Fractures
Classified as intracapsular or extracapsular:
Intracapsular involves the femoral neck; 45% of hip fractures
Extracapsular involves the intertrochanteric (45%) and subtrochanteric (10%) regions
Regions of the Proximal Femur
Classification of Hip Fractures
Severity and degree of stability:
Stable—nondisplaced and nondeformed; may not be detectable on X-ray and MRI may be needed
Unstable—when femoral neck is displaced; detectable on X-ray
Examples of Unstable Pelvic Fractures
Risks for Hip Fracture
Increasing age
Chronic medical conditions, such as osteoarthritis, osteoporosis, and cancer
Female gender
Decrease bone density
Family history of osteoporosis
Small, slim build
Decreased bone mass density
Asian or Caucasian ethnicity
Nutritional deficiencies, such as Vitamin D or calcium, or those caused by eating disorders
Tobacco or alcohol use
Certain medications, such as steroids and proton pump inhibitors
Environmental hazards, such as loose rugs, poor lighting, and cluttered floors
Signs of Hip Fracture
Pain in the affected hip
Vague complaints of pain in the surrounding area: buttocks, thighs, knees, back, or groin
Shortening and/or external rotation of the affected leg
Swelling or bruising of the hip
Treatment for Hip Fracture
Depends on several factors:
Patient’s general health Expected quality of life after surgery Stability of the fracture
Treatment for Hip Fracture
Surgical stabilization with percutaneous hip pinning is the treatment of choice for stable, or nondisplaced, hip fractures
Hemiarthroplasty and total hip replacement are treatment options for unstable, or displaced, hip fractures
Internal Fixation Devices for Stable Hip Fracture
Hemiarthroplasty
A bipolar or unipolar implant is secured into the femoral head with the injection of bone cement around the prosthesis or by bony ingrowth into the prosthesis
Associated with a smaller risk of dislocation
Picturing Hemiarthroplasty
Total Hip Replacement
The acetabulum is resurfaced and fitted with a metal cup
Articulation takes place between the metal cup and the head of the femoral implant
May also be considered in patients without fracture if current treatment modalities aren’t working
Picturing Total Hip Replacement
Postoperative Nursing Care
Monitor vital signs closely
Monitor level of sedation
If the patient has a drain: Expect 200 to 500 mL of drainage during first 24 hours post-op, decreasing to 30 mL after 48 hours
Change the dressing daily and assess the wound
Assess pain level and administer pain medications to achieve pain relief
Help with deep breathing and coughing to decrease lung congestion
Make sure hip precautions are in place
Assist with ambulation and activities of daily living
Preventing Complications
DVT prophylaxis with anticoagulant therapy lasting up to 6 weeks post-op and/or compression stockings
Infection prevention with prophylactic antibiotics
Postoperative pneumonia prevention with early ambulation and coughing and deep breathing exercises
Physical Therapy
Consists of gait training and mobility
First the patient learns correct weight-bearing practices
Then skills such as going up and down stairs
The patient is sent home with a list of exercises to perform after discharge
Patient Teaching
Teach the patient about:
DVT prevention Pain management Hip precautions Prevention of future fractures Activities of daily living
Avoiding Hip Dislocation After Replacement Surgery