Hip Replacement: Pre- and Postoperative Management

The procedures used in both preoperative and postoperative care are important aspects of any surgical interventions. The thorough preparation of patients for a certain operation and subsequent monitoring of the progress of recovery are the practices that are utilized in most medical institutions. The benefits of this work are significant since any risks are minimized at the initial stage, and the threat of complications is reduced. As an example, the preoperative and postoperative management of a nursing home patient will be considered. The case is complex: a fractured neck of the femur after a fall, and a total hip replacement is planned. To analyze all the necessary procedures that need to be conducted, relevant nursing and medical practices will be considered. Fractures in old age pose severe problems for people, and the proposed intervention demonstrates how the patient should interact with medical personnel before and after a serious surgical intervention.

Preoperative Management: Basic Procedures

Since older people are more prone to fractures due to decreased bone strength, femoral neck injury may be critical. Moreover, the situation is complicated by the fact that the mental health of some patients is unstable. According to Unneby, Svensson, Gustafson, and Olofsson (2017), “the proportion of patients with hip fracture and dementia is about 30–45%” (p. 1542). This means that in addition to standard procedures involving preparation for surgery and subsequent care, additional attention should be paid to the moral state of patients. In general, preoperative activities for such an intervention imply observing a certain diet and therapeutic procedures. Therefore, further stages of care include appropriate nutritional principles, educational assistance for patients, as well as drug treatment.

Nutrition Principles

A proper diet for elderly patients with hip fractures is an essential component of preoperative care. As Kramer, Blokhuis, Verdijk, van Loon, and Poeze (2019) argue, poor nutrition leads to negative results inevitably because the body does not receive appropriate support, and the musculoskeletal structure is in a low tone. Malnutrition or a deficiency in nutrients that come with food can aggravate sarcopenia, or the loss of muscle tissue, which is found in old age (Kramer et al., 2019). This outcome, in turn, will create additional difficulties before the hip replacement surgery. Therefore, one of the tasks of the medical staff caring for the patient of a nursing home is to maintain an appropriate balance of nutrients and vitamins a day or two before the operation.

Assessing the severity of the patient’s condition will help determine which diet needs to be prescribed. Sethi (2015) notes that in case of serious injuries when joint replacement is required, the supply of nutrients is carried out intravenously. This procedure is usually performed if patients are in a severe or unconscious state. The ingestion of harmful food can aggravate infectious processes, which is unacceptable during surgical interventions (Sethi, 2015). Therefore, the personnel of the department should make sure that the patient receives the necessary amount of protein and other valuable substances that support a musculoskeletal tone.

Educational Methods

Another significant stage of preoperative care in the considered case is conducting the necessary educational work to help the patient adapt to the upcoming intervention and understand further prospects. Wang, Wei, Yu, Chen, and Long (2017) state that the preliminary interaction of medical staff with those patients who prepare for surgery interventions contributes to increasing mood, which affects the course of training positively. Patients should be aware that preparation for hip replacement is different from that in other parts of the body, which, in turn, requires special preparation. The load on the legs is unacceptable, and mobility should be minimal so as not to strain the muscles and, thus, not to create pressure on the affected area.

Through oral interaction, the nursing personnel will demonstrate some of the practical nuances of being in a temporarily incapacitated state. There is a set of actions that includes conversation, acquaintance with the staff, studying the list of medications, and some other steps (“So, you have broken your hip,” 2019). During the preoperative stage, patients with injuries tend to experience severe stress. Therefore, the task of medical employees is to not only prepare a person for surgical intervention but also provide proper assistance to help the patient avoid making mistakes in the postoperative period.

Medical Procedures

A fracture of the femoral neck in old age can lead to dangerous consequences not only due to the fragility and poor recovery of bone tissue but also problems with blood flow. In this regard, Moores, Beaven, Cattell, Baker, and Roberts (2015) suggest paying attention to the warfarin reversal method since blood thinning is unacceptable before a planned surgical intervention. Also, appropriate sedatives should be prescribed to the patient who is in severe condition and experiences stress. To avoid allergic reactions and anaphylactic shock, Baxter (2016) notes that a preliminary patient survey should include questions about the immunity of specific drugs. In addition, a complex of stimulating medications is to be introduced to support the dynamics of the heart rhythm. Also, as a necessary step, preoperative investigations may be crucial. In some cases, before surgery, a healthcare provider can prescribe such tests as an MRI study, X-rays, electrocardiogram, urinalysis, blood tests, or a CT scanning (“Hip pinning,” 2019).

Postoperative Management: Basic Procedures

The postoperative period for the patient with a replaced hip will be difficult. Therefore, the comprehensive assistance of medical personnel should be mandatory so that the person could adapt to temporary conditions and recover faster. According to Wainwright, Immins, and Middleton (2016), the time that patients in hospitals spend after such an operation is a significant problem due to the high costs that come from the budget. However, this aspect should not be related to care quality because regardless of the complexity of the intervention and the length of the rehabilitation course, medical employees’ duties include assisting patients and their needs. As a result, postoperative management is characterized by some specific nuances, in particular, special care during the first day, potential complications, and follow-up patient control.

Immediate Postoperative Period

Since the first day after surgery is the most difficult, it is essential to provide comprehensive care for the patient. Choi et al. (2017) note that during the next twenty-four hours after the intervention, a person may experience various conditions, including not only pain but also delirium. For this purpose, constant monitoring of the patient’s condition is necessary because if case-specific symptoms are ignored, there is a risk of death. As Choi et al. (2017) argue, the early recognition of the signs of delirium minimizes its impact on the human psyche and prevents complications.

The mental state of the patient requires no less thorough assessment than the physical one. According to available data, many older adults who undergo hip replacement have cognitive impairment that worsens after surgery (“Hip fracture,” 2019). According to Keehan et al. (2014), standard practices today include taking strong opioids and using anesthesia (general or spinal). In addition, as the author’s remark, unlike other fractures, hip damage requires complete immobility due to the need to fix the body (Keehan et al., 2014). This will eliminate the manifestations of postoperative delirium and become an additional incentive for faster recovery.

Potential Complications

Further postoperative management is less stressful, but potential challenges may arise. According to Chammout et al. (2017), some patients who have undergone hip replacement have relapses called periprosthetic fractures when bone tissue breaks in places near the prosthesis. As a possible preventive measure, the authors recommend using high-quality and modern materials in prosthetics to exclude damage to muscle and bone tissues near the place of intervention (Chammout et al., 2017). Therefore, it is essential to monitor the state of the implant and the patient’s condition.

Analysis of not only the state of the operated hip but also other body systems is necessary. As Liodakis et al. (2016) argue, experts distinguish two groups of problems – major that can lead to death, for instance, myocardial infarction or sepsis, and minor (urethra infections, pneumonia, and some other problems). To avoid these complications, medical personnel should conduct clinical tests regularly and monitor the patient’s body condition. If any indicators change in the negative direction, the immediate elimination of symptoms should be performed. Keehan et al. (2014) state that recovery after hip replacement should be accompanied by a course of physiotherapeutic procedures. Despite periodic pain, minor physical exertion is a crucial component of rehabilitation.

Follow-up Care Principles

Later postoperative management is characterized by monitoring and evaluating key health indicators, as well as the condition of the hip area. Hailer, Garland, Rogmark, Garellick, and Kärrholm (2016) provide statistics and note that during the first year after such an intervention, about 20% of patients die (p. 560). To avoid this outcome, the authors offer to maintain supporting follow-up care after patients’ discharge from hospital and help people to adapt to life with an implant (Hailer et al., 2016). An educational method based on older adults’ mutual interaction may be an effective principle of care.

Control over the object of analysis should be regular so that no complications could cause death. Experts note that any non-standard cases, such as suppuration, inflammation, or other problems, require immediate intervention even two months after surgery (“Hip pinning,” 2019). The patient has the right to help during the postoperative period, and because there are a large number of employees in the nursing home, significant problems are unlikely to arise.

Conclusion

The proposed pre-and postoperative principles of caring for the patient with a femoral neck fracture and subsequent hip replacement make it possible to describe the interaction of the person with medical personnel. Examples from literature prove that thorough care and observation are indispensable to prevent death and support the patient morally. Being in a nursing home will contribute to the speedy recovery of the older adult due to monitoring by the staff and sharing experience with other people.

References

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Chammout, G., Muren, O., Laurencikas, E., Bodén, H., Kelly-Pettersson, P., Sjöö, H.,… Sköldenberg, O. (2017). More complications with uncemented than cemented femoral stems in total hip replacement for displaced femoral neck fractures in the elderly: A single-blinded, randomized controlled trial with 69 patients. Acta Orthopaedica, 88(2), 145-151. Web.

Choi, Y. H., Kim, D. H., Kim, T. Y., Lim, T. W., Kim, S. W., & Yoo, J. H. (2017). Early postoperative delirium after hemiarthroplasty in elderly patients aged over 70 years with a displaced femoral neck fracture. Clinical Interventions in Aging, 12, 1835-1842. Web.

Hailer, N. P., Garland, A., Rogmark, C., Garellick, G., & Kärrholm, J. (2016). Early mortality and morbidity after total hip arthroplasty in patients with femoral neck fracture: A nationwide study of 24,699 cases and 118,518 matched controls. Acta Orthopaedica, 87(6), 560-566. Web.

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Kramer, I. F., Blokhuis, T. J., Verdijk, L. B., van Loon, L. J., & Poeze, M. (2019). Perioperative nutritional supplementation and skeletal muscle mass in older hip-fracture patients. Nutrition Reviews, 77(4), 254-266. Web.

Liodakis, E., Antoniou, J., Zukor, D. J., Huk, O. L., Epure, L. M., & Bergeron, S. G. (2016). Major complications and transfusion rates after hemiarthroplasty and total hip arthroplasty for femoral neck fractures. The Journal of Arthroplasty, 31(9), 2008-2012. Web.

Moores, T. S., Beaven, A., Cattell, A. E., Baker, C., & Roberts, P. J. (2015). Preoperative warfarin reversal for early hip fracture surgery. Journal of Orthopaedic Surgery, 23(1), 33-36. Web.

Sethi, M. K. (2015). Orthopaedic surgery examination and board review. New York, NY: McGraw Hill.

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Unneby, A., Svensson, O., Gustafson, Y., & Olofsson, B. (2017). Femoral nerve block in a representative sample of elderly people with hip fracture: A randomised controlled trial. Injury, 48(7), 1542-1549. Web.

Wainwright, T. W., Immins, T., & Middleton, R. G. (2016). Enhanced recovery after surgery: An opportunity to improve fractured neck of femur management. The Annals of the Royal College of Surgeons of England, 98(7), 500-506. Web.

Wang, J., Wei, P., Yu, M., Chen, L., & Long, L. (2017). Comprehensive effect of nursing intervention in perioperative elderly patients with femoral neck fracture: Role of serum inflammatory mediators. Biomedical Research, 28(21), 9515-9518.