Assessment Basic of the Hip Replacement Patient PNCI - Learner
Rosa De Luca
Age: 83 Weight: 55 kg Base: Standard Adult
Patient History
Past Medical History: Patient is alert, but very teary-eyed. She is very emotional as she talks about her dog, saying "I really miss my Renny." She has a history of severe arthritis and experienced unrelieved pain in her right hip during the six months before her surgery. A total hip arthroplasty was performed two days ago for her degenerative hip disease. The patient has a history of hypertension, cataracts and hearing loss. The result of the INR drawn this morning was 2.5. Allergies: None Medications: Benazepril 10 mg by mouth twice a day Code Status: Full code Social History: Patient is widowed and lives alone with her dog Renny, in a two-story house.
Handoff Report
The report should follow the SBAR format and include: Situation: Rosa de Luca is an 83-year-old female who had a total right hip replacement performed 48 hours ago for her genenerative hip disease. Background: The patient has had a history of severe arthritis and unrelieved pain in her right hip for six months. Assessment: Vital signs: HR 78, BP 183/112, RR 14, SpO2 97% on room air and temperature 38.0oC General Appearance: Teary-eyed Cardiovascular: Normal sinus rhythm with pan systolic murmur Respiratory: Breath sounds with coarse crackles bilaterally GI: Normoactive bowel sounds GU: Voiding without difficulty Extremities: Pink and warm; pedal pulse to right foot is absent Skin: Pink, warm and dry; skin turgor good Neurological: Alert and oriented to person, place and time; pupils equal and reactive to light and accommodation; no neurological deficits noted IVs: Saline lock in right forearm Labs: Morning INR/PT drawn; results pending Program for Nursing Curriculum Integration (PNCI) Basic Assessment of the Hip Replacement Patient
2010 METI, Sarasota, FL ECS Version
1
Basic Assessment of the Hip Replacement Patient PNCI - Learner
Fall Risk: High risk for falls Pain: No complaints of pain Recommendations: Monitor intake and output, perform incentive spirometer every four hours while awake, obtain results of morning labwork, use abduction pillow when in bed
Orders
Initial Healthcare Provider's Orders: Vital Signs every four hours Neurovascular checks every four hours Apply sequential compression devices bilaterally Low sodium diet as tolerated Up with assist Physical therapy for hip rehabilitation Abduction pillow Check SpO2 every shift Intake and output every shift Incentive spirometer every four hours while awake INR/PT daily and call healthcare provider with results Benazepril 10 mg PO twice a day Enoxaparin 40 mg SQ every day Warfarin 2 mg PO every night Hydrocodone 5 mg/Acetaminophen 500 mg 1-2 tabs PO every four to six hours prn pain Promethazine 25 mg IM every four to six hours prn nausea
Learning Objectives
Performs basic physical assessment of the patient (APPLICATION). Identifies and documents normal and abnormal assessment findings (APPLICATION). Performs a functional assessment the of patient (APPLICATION). Identifies appropriate nursing care of a patient post hip arthroplasty (APPLICATION).
Program for Nursing Curriculum Integration (PNCI) Basic Assessment of the Hip Replacement Patient
2010 METI, Sarasota, FL ECS Version
2
Basic Assessment of the Hip Replacement Patient PNCI - Learner Preparation Questions
What are the steps to complete a physical assessment? What assessments are highest priority for a patient who has had a hip replacement two days ago? Describe normal and abnormal lung sounds.
a.) What are common causes for each abnormal sound? b.) What is the pathophysiology causing each of these abnormal sounds? Describe normal and abnormal heart sounds. a.) What are common causes for each abnormal sound? b.) What is the pathophysiology causing each of these abnormal sounds? Prioritize five assessments you believe would be most important for this patient. Why did you choose these and prioritize them in this way? What is the difference between abnormal and significant findings? What supportive emotional measures can the nurse provide a hospitalized patient? What are the components of a functional assessment? Why is this important for this patient? Do you think this patient will be able to return home and care for herself? Why or why not? Describe the nursing care of a patient with a total hip arthroplasty.
References
Chilov, M.N., Cameron, I.D. & March, L.M. (2003). Evidence-based guidelines for fixing broken hips: An update. The Medical Journal of Australia, 9, 489-493. Crimlisk, J.T. & Grande, M.M. (2004). Neurologic assessment skills for the acute medical surgical nurse. Orthopaedic Nursing, 23(4), 3-9. Howell, B. (2007) Joint surgery: Paving the way to a smooth recovery. RN, 70(1), 32-38. Jarvis, C. (2008). Physical examination & health assessment (5th ed.). Philadelphia: Saunders. LeMone, P. & Burke, K. (2008) Medical-surgical nursing: Critical thinking in client care (4th ed.). Upper Saddle River, NJ: Pearson/Prentice Hall. Lockwood, C., Conroy-Hiller, T., & Page, T. (2004). Vital signs. International Journal of Evidence Based Healthcare 2(6), 207-230. McGee, S. (2007). Evidence-based physical diagnosis (2nd ed.). Philadelphia: Saunders. Taylor, C., Lillis, C., LeMone, P. & Lynn, P. (2008). Fundamentals of nursing: The art & science of nursing (6th ed.). Philadelphia: WoltersKluwer/Lippincott. Weber, J. & Kelley, J. (2007). Health Assessment in Nursing (3rd ed.). Philadelphia: Lippincott.
Program for Nursing Curriculum Integration (PNCI) Basic Assessment of the Hip Replacement Patient
2010 METI, Sarasota, FL ECS Version
3
Basic Assessment of the Hip Replacement Patient PNCI - Learner Author
Nancy McMenamy, Texas Woman's University - Dallas, TX Reviewed by: Nancy McMenamy, Texas Woman's University - Dallas, TX, 2008 and Wendy Jo Wilkinson, METI - Sarasota, FL, 2009
Program for Nursing Curriculum Integration (PNCI) Basic Assessment of the Hip Replacement Patient
2010 METI, Sarasota, FL ECS Version
4