Question

Seventy-five-year-old Jo Allen fell down her steps at home on Saturday and broke her hip. She called 911 and was taken to the hospital. Surgery is scheduled for Monday morning. She does not have a significant health history and has always lived at home.

1. Jo is concerned with having surgery. What things can you review with her to make sure she is fully prepared for her surgery?

2. Jo’s physician orders preoperative screening. What precaution is the physician taking in ordering these tests?

3. The nurse is concerned with Jo recovering quickly from the surgery. What things will the postoperative nurse assess?

4. Ms. Allen’s family has expressed concern about what measures can be taken to minimize the risks she faces to her future functional independence. What information will you re-enforce for the family to assure them that such risks will be considered when planning her care?

Answer 1

What things can you review with her to make sure she is fully prepared for her surgery?

You will change from your clothes into a hospital gown and maybe a cap.

Steps may be taken to help prevent deep vein thrombosis. You may be given special stockings to wear, or inflatable devices may be put on your legs. You may be given drugs to reduce the risk of deep vein thrombosis.

You will be taken to an area to wait until the surgical team is ready for you. Your health care provider or team will confirm your name, birth date, and type of surgery before you go to the operating room.

If the operation is to be done on one side of your body, the site may be marked with a special pen. An anesthesiologist will discuss which type of anesthesia you will receive during the operation.

A tube called an intravenous (IV) line may be placed into a vein in your arm or wrist. It is used for supplying your body with fluids, medication, or blood during and after the surgery. You may be given medication to help you relax.

You also may be given other medications that your doctor has ordered, such as antibiotics to reduce the risk of infection.

physician orders preoperative screening. What precaution is the physician taking in ordering these tests?

A history and physical examination, focusing on risk factors for cardiac, pulmonary and infectious complications, and a determination of a patient's functional capacity, are essential to any preoperative evaluation.

1. Blood tests such as a complete blood count (CBC) and kidney, liver, and blood sugar tests.

2. Chest x-ray to check your lungs.

3. ECG (electrocardiogram) to check your heart.

Surgeons who require lab work as part of a pre-op evaluation will likely ask for a full panel of blood work, a urinalysis, and an ECG or EKG. If the surgery requires the use of a general anesthetic, a chest x-ray may be taken

1. If they order any tests, ask why.

2. Ask your health care provider to check your test records for the past four to six months. ...

4. Bring a list of the names and doses for all your supplements, medicines, and vitamins.

5. Report any new symptoms—even if they occur after your exam.

There are three main criticisms against the universal screening strategy.

First, it may be suggested that many of the concerns with regard to infection transmission can be addressed through the practice of universal precautions rather than through universal screening.

Second, in the emphasis on universal screening, the focus appears to be more on prevention of infection transmission from patient to staff (which is none-the-less very important) rather than case detection for HIV/HBV/HCV and subsequent care of the infected patients.

Third, universal screening does not seem to give due attention to sensitivity and specificity issues in relation to screening tests and the concept of 'window period negativity', which does occur in some infections (especially in case of HCV). There is often disproportionate degree of importance given to a single test result, losing sight of the clinical context in which it may have been done

nurse is concerned with Jo recovering quickly from the surgery. What things will the postoperative nurse assess?

While you're in the recovery room, staff will monitor your blood pressure, breathing, temperature, and pulse. They may ask you to take deep breaths to assess your lung function. They may check your surgical site for signs of bleeding or infection. They will also watch for signs of an allergic reaction.

1. Rate, rhythm and volume of pulse;

2. Blood pressure;

3. Capillary refill time to assess circulatory status, along with the colour and temperature of limbs, also identifying reduced peripheral perfusion.

other important assessment include

1. Surgical site – dressing dry and intact.

2. Proper draining of drainage tubes.

3. Rate & patency of IV fluids.

4. Level of sensation after regional anesthesia.

5. Circulation/sensation in extremities after orthopedic or vascular surgery.

6. Patient safety.

What information will you re-enforce for the family to assure them that such risks will be considered when planning her care?

complication of hip surgery in future

Risks associated with hip replacement surgery can include: Blood clots. Clots can form in your leg veins after surgery. This can be dangerous because a piece of a clot can break off and travel to your lung, heart or, rarely, your brain

On average, hip replacement recovery can take around two to four weeks, but everyone is different,” says Thakkar. It depends on a few factors, including how active you were before your surgery, your age, nutrition, preexisting conditions, and other health and lifestyle factors

care of patient

Get in and out of bed and walk short distances (typically 150 to 300 feet) with the aid of assistive devices, such as a walker or crutches. Eat meals sitting up. Perform simple exercises. Follow precautions to avoid dislocating the new hip.

You are under total hip precautions for 6 to 12 weeks (you must not bend your hip more than 60-90 degrees; do not turn toes in or out; do not cross your ankles or legs).

The home health team will teach your family member how to care for themselves after the service ends, making sure they are safe and that their new joint is healing properly. They can also teach any family members or caregivers how to help with daily tasks. They will report the progress being made, and any setbacks, to your family member’s doctor, allowing for a smooth and successful recovery.

Additionally, the home health team will make sure all the needed equipment arrives at your family member’s home and that it is in good working condition. A social worker from the team will work with you and your family member to make sure you have all the appropriate equipment.

Hip exercises – before surgery

1. Ankle pumps

2. Thigh squeezes (quadriceps sets)

3. Buttocks squeezes (gluteal sets)

4. Heel slides (hip and knee flexion)

5. Leg slides (abduction/adduction)

6. Lying kicks (short arc quadriceps)

7. Straight leg raises.

8. Bed mobility exercise