Total Hip Arthroplasty: Nursing Interventions

• Total Hip Arthroplasty (THA) is a surgical procedure to replace a damaged hip joint with an artificial joint (prosthesis).
• Nursing interventions for patients undergoing THA are crucial for ensuring optimal outcomes and preventing complications.

Pre-operative Nursing Interventions

• Comprehensive patient education is given about the THA procedure, expected outcomes, and the rehabilitation process.
• Assessment of the patient's overall health status is performed, including cardiovascular, respiratory, and musculoskeletal systems.
• The patient's medication list is reviewed to identify drugs that may increase the risk of bleeding or interact with anesthesia.
• Patients are taught pre-operative exercises to strengthen upper body muscles, needed for mobility after surgery
• Post-operative pain management strategies are agreed.
• Education regarding hip precautions to prevent dislocation is important after surgery.
• Instructions on the use of assistive devices for mobility will be given, such as walkers or crutches.
• Provide psychosocial support to address any anxiety and concerns related to the surgery.
• Confirm the patient understands and signs the informed consent form.

Post-operative Nursing Interventions

• Vital signs are monitored, and the patient's overall condition is assessed.
• Pain is managed through prescribed medications and non-pharmacological methods, such as ice packs and relaxation techniques.
• Complications such as deep vein thrombosis (DVT) and pulmonary embolism (PE) are prevented via prophylactic anticoagulation, anti-embolism stockings, and sequential compression devices.
• Early ambulation is encouraged with the assistance of physical therapy.
• Hip precautions are reinforced to prevent dislocation.
  • Avoid hip flexion beyond 90 degrees.
  • Avoid adduction of the operated leg (crossing the midline).
  • Avoid internal rotation of the operated leg.
• Correct patient positioning in bed is important to maintain hip alignment.
• Monitor the surgical incision for signs of infection, such as redness, swelling, and drainage.
• Wound care and dressing changes are provided as needed.
• Encourage deep breathing and coughing exercises to prevent pneumonia.
• Intake and output is monitored, and adequate hydration is encouraged to prevent constipation.
• Assistance is provided with activities of daily living (ADLs), such as bathing, dressing, and toileting.
• Emotional support is provided, and any concerns or anxieties are addressed.
• Patients and their family members are educated about medication management, wound care, and hip precautions.
• Coordination with physical therapy and occupational therapy helps ensure a smooth transition to rehabilitation.
• The patient's home environment is assessed, and recommendations are made for modifications to ensure safety and accessibility upon discharge.

Potential Post-operative Complications

• Hip Dislocation:
  • Signs include increased pain, audible pop sound, and limited movement.
  • Maintain hip precautions.
  • Keep a abduction pillow between legs.
• Deep Vein Thrombosis (DVT):
  • Prevention includes anticoagulants, compression stockings, and early ambulation.
  • Asses for pain, swelling, redness, especially focusing on the calf area.
• Infection:
  • Monitor for signs of infection, including fever, chills, and increased pain, swelling, redness, or drainage at the surgical site.
  • Maintain sterile technique for wound care.
• Pneumonia:
  • Encourage deep breathing and coughing exercises.
  • Monitor respiratory status.
• Delayed Wound Healing:
  • Ensure adequate nutrition and hydration.
  • Manage underlying conditions such as diabetes.
• Neurovascular Injury:
  • Assess for changes in sensation, motor function, and circulation in the affected extremity.
  • Report any new findings to the surgeon.
• Leg Length Discrepancy:
  • Assess leg length and address concerns with appropriate shoe lifts or other interventions.

Discharge Planning

• Coordinate follow-up appointments with the surgeon, physical therapist, and other healthcare providers.
• Ensure the patient has a clear understanding of medication management, wound care, and hip precautions.
• Give information about community resources and support groups.
• Assess the patient's ability to perform ADLs and make recommendations for home healthcare services if needed.
• Educate patients and family members about signs and symptoms of complications, and when to seek medical attention.
• Review the patient's rehabilitation plan and goals.
• Ensure the patient has a safe and accessible home environment.
• Address any remaining questions or concerns.