Total Hip Replacement Assignment

Promoting Safety, Independence, and Least Restrictive Environments

According to Karachalios et al. (2018), total hip replacements are surgical procedures where painful hip joints with arthritis are removed and replaced with artificial joints, usually made from metal. Notably, the procedure is only performed after other alternatives for pain relief fail. Several safety concerns exist for Max, a 70-year-old patient who is one-hour post-op, following a total hip replacement. Geriatric post-operative patients are highly vulnerable to pulmonary complications, post-operative pneumonia, falls, pressure ulcers, urinary tract infections, and postoperative delirium characterized by functional decline. Patient safety along these lines should, therefore, be considered. The primary safety concerns for Max are pain and patient falls.Total Hip Replacement Assignment

Various interventions would be taken to ensure Max’s safety. First, controlling post-operative pain in patients should be prioritized as it allows them to stick to their physical therapy regimen while enhancing their quality of life (Wirtz & Kohlhof, 2019).  In light of this, we should constantly evaluate Max for pain around the joints and monitor difficulty in movements. In case of any signs of discomfort, we should re-assess the effectiveness of pain medications or physical therapy. Second, the facility should assess Max’s risks for falls. Seniors who have undergone hip replacements are at a high risk of falls. Poor bone health greatly contributes to these falls. Therefore, we should provide the patient with vitamin D and calcium supplements to minimize hip fracture risk. Max’s diet should comprise high vitamin D and calcium-rich foods to maintain his bone health. Another intervention is improving Max’s mobility to reduce immobility and consequent infections such as pressure ulcers and urinary tract infections.Total Hip Replacement Assignment

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Demerol/ Meperidine is not a good choice of drug for 70-year old Max. The drug is ineffective for pain control among geriatric patients and is associated with delirium and seizures. Max, who usually is up and lib, alert and oriented, appeared sleepy and confused after Demerol administration. Demerol’s use by patients over the age of 65 is considered an indicator of poor quality patient care. Friesen et al. (2016) assert that as an opioid analgesic, meperidine has little advantages than other opioids and numerous drawbacks, among them short action duration, the release of a neurotoxic metabolite known as normeperidine, and limited potency.  Seniors are highly sensitive to Demerol’s adverse effects and may experience reduced renal functioning, which leads to the accumulation of normeperidine in the body.

Effective discharge planning for post-operative patients is a crucial aspect of care transitions. Effective care transitions from hospital to home settings reduce the likelihood of readmissions and minimize healthcare costs (Changsuphan et al., 2018). Among the services that would facilitate, Max’s successful discharge is patient education. As a post-operative care component, the healthcare provider should educate Max and his wife on the potential side effects and complications of total hip replacement. Patient education should encompass home and incision care, sleeping, and sitting positions, moving safely, emergency options, and follow-up care. Informing Max’s family on his condition and how helpful they can improve Max’s health is paramount.  The discharge team, together with Max’s wife, should plan on transport services for Max. Ideally, Max is not allowed to drive for up to six weeks post-operation. If Max needs to wait for transport, he should be moved to the lounge area. Occupational therapy services would be provided to ensure that Max manages essential daily tasks, such as sitting. Other services include physiotherapy to ensure the patient can perform moderate exercises independently and walk safely without crutches. The ward staff should discuss Max’s discharge arrangements with the patient and family to ensure a safe transition.Total Hip Replacement Assignment

References

Changsuphan, S., Kongvattananon, P., & Somprasert, C. (2018). Patient readiness for discharge after total hip replacement: an integrative review. Journal Of Health Research, 32(2), 164-171. https://doi.org/10.1108/jhr-01-2018-016

Friesen, K., Falk, J., & Bugden, S. (2016). The safety of meperidine prescribing in older adults: A longitudinal population-based study. BMC Geriatrics, 16(1). https://doi.org/10.1186/s12877-016-0275-5

Karachalios, T., Komnos, G., & Koutalos, A. (2018). Total hip arthroplasty. EFORT Open Reviews, 3(5), 232-239. https://doi.org/10.1302/2058-5241.3.170068

Wirtz, D., & Kohlhof, H. (2019). The geriatric patient: special aspects of peri-operative management. EFORT Open Reviews, 4(6), 240-247. https://doi.org/10.1302/2058-5241.4.180087

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Total Hip Replacement Assignment