Question

Ramona Heart is a 75 y. o. female with a history of osteoarthritis and degenerative joint disease. She lives with her husband in a single family home. She has been active until recent changes related to pain and stiffness in her right hip. After consulting her primary care giver, she has agreed to have a right total hip replacement. She is admitted to the hospital for surgery the next morning at 7:30A. Her husband and daughter are at her bedside.

Post Hip Replacement Assessment:

Vital signs: R 16 HR 88 BP 136/72 T 97.8; skin cool to touch, Ramona is drowsy, but alert. Ramona states pain of 2 out of 10, but stiff. Client is NPO since surgery and has IV fluids infusing: D5W at 100 mL/hr. Wound assessment: large gauze dressing over site, no redness or bleeding noted. A wound drain is draining to suction, 50 mL dark red drainage noted. Foley catheter in place and draining to gravity, 350 mL light yellow urine in bag. Lower extremities are cool to touch, with dorsalis pedis and posterior tibial pulses noted bilaterally, brisk capillary refill < 3 seconds. Ramona states positive sensation, no tingling.

Assignment:

1. Construct in approved NANDA format 3 nursing diagnosis related to care of client having surgery (hip replacement surgery)
2. Determine 5 expected outcomes related to care of client having surgery (hip replacement surgery)
3. Develop a plan of care for Ramona Heart

Answer 1

Osteoarthritis:

A form of arthritis ( inflammation of joints), mainly affecting older people, caused by chronic degeneration of the cartilage and synovial membrane of the joints leading to pain and stiffness . It is also called as degenerative arthritis.

Hip replacement surgery: It is a surgical procedure, by which a painful hip joint is replaced by an artificial or prosthetic implant.

NANDA Nursing Diagnosis for Hip Replacement Surgery:

1. Impaired physical mobility related to pain and discomfort as evidenced by reports of pain and discomfort on movement .

Expected outcome:

Client will display increased functioning of affected joint  and participate in Activities of Daily Living .

Interventions:

* Maintain correct body alignment in bed and prescribed position for the affected joint .

: for stabilization of prosthesis

* Assist with transfer techniques and demonstrate the use of mobility aids such as walker, trapeze.

* Assist with range of motion exercises with unaffected limb and passive exercises with affected limb.

: Periods of restricted activity ,can affect other joints negatively in patients with degenerative disorders.

* Encourage the participation of Activities of Daily Living and promote independence.

* Administer analgesics before activities and procedures as per physician's order.

2. Acute pain related to surgical procedure as evidenced by reports of pain and stiffness.

Expected outcome:

Client will report relief from pain and stiffness

Nursing interventions:

* Assess reports of pain on pain scale.

* Maintain a proper position of operated extrimity.

* Ensure adequate rest and sleep by providing comfortable bed with wrinkle free, and proper body alignment.

* Administer analgesics as per physician's order.

3. Risk for infection related to surgical manipulation and implantation of a foreign body.

Expected outcome:

Client will be free of erythema or purulent drainage and will achieve timely wound healing.

Nursing interventions :

* Assess sugical site for any signs of infection such as erythema, swelling, loss of wound approximation etc.

* Maintain strict aseptic environment and techniques for changing the surgical dressing and while handling the drains.

: to prevent infection

* Maintain hand hygiene by patient and the staffs by proper hand washing.

: to prevent the spread of infection.

* Administer antibiotics as per physician's order.