Basic Assessment of the Hip Replacement Patient

Basic Assessment of the Hip Replacement Patient

Simulated Clinical Experience (SCETM) Overview

Learning Objectives

Location: Orthopedic Unit

1. Performs basic physical assessment of the patient (APPLICATION).

History/Information: An 83-year-old widowed female has a history of severe arthritis and unrelieved pain in her right hip for six months. A total right hip replacement (total hip arthroplasty) was performed two days ago for her degenerative hip disease. The patient lives alone in a two-story house with her dog, Renny, which she adores. She has a history of hypertension, has cataracts and is hard of hearing.

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 10mg PO twice a day Enoxaparin 40mg SQ every day Warfarin 2mg PO every night Hydrocodone 5mg/Acetaminophen 500mg 1-2 tabs PO every four to six hours prn pain Promethazine 25mg IM every four to six hours prn nausea

2. Identifies and documents normal and abnormal assessment findings (APPLICATION).

3. Performs a functional assessment of the patient (APPLICATION).

4. Identifies appropriate nursing care of a patient post hip arthroplasty (APPLICATION).

ECS? Program for Nursing Curriculum Integration (PNCI?)

Learner 1

ECS? Program for Nursing Curriculum Integration (PNCI?) Basic Assessment of the Hip Replacement Patient

? 2008 METI, Sarasota, FL; Original author: Nancy McMenamy, Texas Woman's University-Dallas. Reviewer: Nancy McMenamy, Texas Woman's University-Dallas. v.4 August 2008

Questions to Prepare for the Simulated Clinical Experience

References

1. What are the steps to complete a physical assessment?

2. What assessments are highest priority for a patient who has had a hip replacement two days ago?

3. 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?

4. 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?

5. Prioritize five assessments you believe would be most important for this patient. Why did you choose these and prioritize them in this way?

6. What is the difference between abnormal and significant findings?

7. What supportive emotional measures can the nurse provide a hospitalized patient?

8. What are the components of a functional assessment? Why is this important for this patient?

9. Do you think this patient will be able to return home and care for herself? Why or why not?

10. Describe the nursing care of a patient with a total hip arthroplasty.

Chilov, M. N., Cameron, I. D. and March, L. M. (2003). Evidence-based guidelines for fixing broken hips: An update. The Medical Journal of Australia, 9, 489-493.

Crimlisk, J. T. and 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 and health assessment (5th ed.). Philadelphia: Saunders.

Joanna Briggs Institute for Evidence Based Nursing and Midwifery. (1999). Best practice: Graduated compression stockings for the prevention of postoperative venous thromboembolism, 5(2). Retrieved March 25, 2008 from . joannabriggs.edu.au/pdf/BPISEng_5_2.pdf.

LeMone, P. and Burke, K. (2008) Medical-surgical nursing: Critical thinking in client care (4th ed.). Upper Saddle River, New Jersey: Pearson/Prentice Hall.

McGee, S. (2007). Evidence-based physical diagnosis (2nd ed.). Philadelphia: Saunders.

Taylor, C., Lillis, C., LeMone, P. and Lynn, P. (2008). Fundamentals of nursing: The art and science of nursing (6th ed.). Philadelphia: WoltersKluwer/Lippincott.

Weber, J. and Kelley, J. (2007). Health Assessment in Nursing (3rd ed.). Philadelphia: Lippincott.

Learner 2

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