Nursing Care Plan for Hip Fracture Surgery Essay

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Examining Potential Post-Operative Complications for Hemiarthroplasty

Hemiarthroplasty refers to the operation that is commonly used for the treatment of a fractured hip. This operation is similar to that of a total hip replacement, but it only involves the replacement of half the hip. In most cases, the operation only replaces the ball portion of the hip joint. As with any other orthopedic surgery, there are complications that are associated with this surgery. Some of the complications might be medical and others related directly to the surgical treatment itself (Smith, Aboelmagd, Hing, & Macgregor, 2016). It is estimated that medical complications affect approximately 20 percent of patients with hip fracture. The majority of these complications are mostly postoperative complications. This paper will analyze the post-operative complications of a 38-year-old male patient who underwent a left hip hemiarthroplasty. The complications that might affect the patient will be discussed and the etiology of the complications presented. A care plan will be provided showing how the complications could be addressed. The role of the physiotherapist will be discussed with an aim to show how they can promote recovery and prevent complications. Finally, education will be offered to the patient before discharge in order to support their recovery at home.

Post-Operative Complications Risk Factors

The likelihood of a patient having post-operative complications is usually influenced by the type of surgery, perioperative management, and the patient's pre-existing comorbid state. Anesthesia can cause many post-operative complications, but they are mostly centered around the airway, circulatory, or respiratory systems. There are also instances of patients reacting abnormally to anesthetic drugs. Hemorrhage is another risk factor associated with post-operative complications (Carpintero et al., 2014). Hemorrhage can be classified as primary, reactionary, or secondary. Primary hemorrhage would occur when a vessel is cut during the surgery, reactionary hemorrhage occurs when the blood pressure of the patient rises at the end of the operation causing vessels that were not bleeding before to start bleeding, and secondary hemorrhage occurs mainly due to an infection that causes damage to a vessel. Atelectasis refers to the collapse of the areas of the lungs, which might result in post-operative pulmonary complications like hypoxia (Breathnach, Karip, McCoy, Cleary, & Quinlan, 2016). Post-operative pain needs to be assessed and managed quickly. Pain is normally an indicator of something not being right and it is best to analyze and establish why the patient is feeling the pain. Before prescribing an analgesic, there are considerations to be made pertaining to the patient.

Infection is another risk factor for post-operative complications. Wounds should be checked constantly to ensure that they are not infected especially within the first week after surgery. The wound should also not have any redness or discharge. Wound sinus occurs after normal healing and it is considered to be a late infectious complication (Carpintero et al., 2014). The surgical injury could also lead to post-operative complications. There might be unavoidable tissue damage during the surgery. This damage could have far reaching implications, for example, a patient might become impotent after undergoing prostate surgery. A patient can also suffer from urinary problems after surgery.

Potential Post-Operative Complications for Mr. Wolfe

The major complication that might affect Mr. Wolfe after the hip surgery is heart failure. This is mainly because he currently has high blood pressure and his BP of 143/89 indicates that he is in hypertension stage 1. Mr. Wolfe is at risk of deep vein thrombosis (DVT) mainly because of his high blood pressure. DVT is the formation of blood clots within a deep vein mostly in the legs. DVT is a major risk that is associated with surgery in the lower extremities like a hip replacement. If the patient does not move for a long period of time they are likely to develop the condition this is because the calf muscles will not contract and this will prevent blood circulation resulting in the formation of blood clots within the veins. A decreased blood flow rate referred to as venous stasis can also lead to DVT (Whiting et al., 2015). Mr. Wolfe has a high blood pressure and this indicates that his blood is not flowing as expected.

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With a decreased blood flow, there is an increased risk of him developing blood clots anywhere within his body. In order to prevent this complication, there is need to ensure that the patient stays active and offer intermittent pneumatic compression when possible.

Post-operative pulmonary complications are defined as anomalies of the lung that result in an identifiable disease that has an adverse impact on the clinical course of the patient. Pulmonary embolism (PE) is one potential complication that is associated with the pulmonary. PE is a blockage of an artery in the lungs by something that has traveled from elsewhere within the body through the bloodstream. PE is mostly caused by DVT and it results in breathlessness that might come on gradually or suddenly, chest pain that might become worse when the patient breathes, or sudden collapse of the patient (Carpintero et al., 2014). In most cases, PE is caused by a blood clot that had formed in the leg and travels to the lungs. For Mr. Wolfe, there is potential for him developing PE because he is at risk of developing DVT. Prevention of DVT would also result in the prevention of PE. A patient who has undergone surgery is always at risk of developing PE because they are immobile for long periods. After hip surgery, the patient might find it hard to move and they would prefer to lie in bed and not exercise, which might increase their risk of developing the condition (Carpintero et al., 2014).

Urinary tract infections are the most common cause of nosocomial infection and they affect about 12 percent to 61 percent of all patient who undergo hip surgery or fractures (Lanting, Odum, Cope, Patterson, & Masonis, 2015). Urinary tract infections have been shown to prolong hospital stay by 2.5 days and they also result in a higher mortality rate. The single most important risk factor related to urinary tract infection is the urinary catheter. It is recommended that indwelling catheters be removed within 24 hours of insertion. This will reduce the risk factor of the patient. In the case of Mr. Wolfe, he still has his catheter and the nurse should ensure that it is removed as soon as possible to reduce the risk of infection.

Pressure scars occur when there is an imbalance between the extrinsic mechanical forces that are acting on the skin and the soft tissues and the intrinsic susceptibility to the tissue to collapse (Frisch et al., 2014). The most frequent cause of pressure scars is an acute hip fracture, and approximately 35 percent of decubitus ulcers occur at the end of the first week of hospitalization. A patient with a history of smoking is also at a high risk of developing pressure scars. Our patient is a heavy smoker and he is at risk of developing pressure scars. Therefore, it would be prudent to ensure that nursing care is focused on prevention, there is aggressive skin care, and good nutrition is offered in order to prevent the evolution of ulceration.

Gastrointestinal postoperative stress ulcer is one of the well documented medical complications that patients who have undergone hip surgery suffer (Carpintero et al., 2014). For patients with a history of gastroduodenal ulcers, this condition will most likely develop if they underwent any major surgery. In order to prevent gastrointestinal bleeding, one should use pump inhibitors, and antacids, which have both been shown to be effective in this clinical situation. These methods have been shown they minimize the mortality and morbidity associated with the condition.

Since the patient is a carpenter there is a likelihood of them developing musculoskeletal complications. The patient spends long hours standing and moving heavy materials, which might aggravate their left hip. The muscle tissues of the hip are likely to be strained especially if they have not fully healed and this might increase their wear and tear. The patient is a heavy smoker and smoking has been known to have an effect on the musculoskeletal system of the individual.

It is estimated that 10 percent of patients who undergo.....

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