Gerontological Aged Care Rehabilitation Nursing for Elderly Patients with Hip Replacement Surgery

Running head: AGED CARE
AGED CARE
Name of the Student
Name of University
Author’s note

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Introduction
Falls in the elderly people are a current health care problem. Falls increases the risk of
hospitalization. Hip fracture due to falls is a serious complication for the elderly patients. Falls
might occur at home and also in hospitals. It is a serious event with a 30 day mortality of 11.8 %
and a 1 year mortality of about 40 %. In most of the cases a hip fracture might require a hip
replacement surgery (Radosavljevic et al., 2013). Hip replacement surgery might require
rehabilitation in order to train or prepare the patient to cope up with the normal pace of life such
as self-care activities, to rule out the chance of any post-operative infections, as the patient will
be always under the supervision of the registered caregivers.
The written assignment will provide insight to gerontological aged care rehabilitation
nursing of the geriatric patients who had suffered from a fall and had undergone a hip
replacement surgery. The paper would initially give an account of the pathophysiology of the
health issue supported by current evidences followed by a comprehensive management plan and
the evaluation of the management plans.
Pathophysiology
Hip fractures can be due to a large number of reasons. According to Guerado et al.,
(2016) osteoporosis causes the bones to become weaker making them more vulnerable to
fractures. In New Zealand , as estimated 10 million people suffers from osteoporosis and hip
fracture can occur due to simple weight bearing activities. Elderly women lose bone density
faster than that of men due to the decrease in the estrogen levels. According to Guerado et al.,

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(2016), mineralization deficit is a cause of the “bone weakness’ making the elderly people
susceptible to osteoporotic hip fractures. But as per the recent studies, the problem of
mineralization is that mainly the irregular distribution of the mineralization. The mineral density
of the tissues are significantly higher in the periosteal and decreases from there to the endostium
(Laurent et al., 2013). The alteration in the bone elasticity is due to the tissue variation in the
axial direction of the femoral neck. Again an increased mineral content of the bone tissue with
high porosity has been determined to have a deleterious effect on the bone strength and the risk
of fracture. Poor nutrition at the child hood might also lead to osteoporosis. Taking more
psychoactive medications at the time falls might cause problems in the maintenance of gait in
elderly patients. There are two main types of hip fractures – the femoral neck fracture and the
intertrochanteric region fracture (Rogmark&Leonardsson, 2016).
In a total hip replacement surgery, the damaged bone or the painful joint is removed and
is replaced with the prosthetic parts. The damaged head of the femur is removed and is replaced
with a metal stem that is being placed in the hollow femoral center. The femoral center is then
cemented in to the bone. The metallic ball is then placed on the upper part of the stem and the
ball replaces the removed femoral head (Laurent et al., 2013). The success of the surgery
depends on how the rehabilitation of the patient takes place. The patient might have stitches and
staples running around the wound. It is necessary to avoid getting the wound infected. Again a
good diet promotes proper healing of the tissues with a restoration of the muscle strength. A
graduated walking program should be established in order to increase the mobility slowly
(Rogmark&Leonardsson, 2016). Furthermore there are some complications such as infections,
blood clots, leg length inequality, dislocation, loosening of the implant. These are conditions
which cannot be taken care of properly at home hence a rehabilitation care is necessary for the

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elderly people. It is the rehabilitation that is necessary to avoid a persistent impairment and to
optimize the functional recovery. Han et al., (2014) have shown that rehabilitation improved
outcomes at the levels of both the hospital and home based rehabilitation.
Management plans for elderly patient requiring rehabilitation services
Total hip replacement surgery is among the most widely performed procedure in the
ageing population. Long term studies have indicated towards the persistent impairment and
limitations in the functional ability after a total hip replacement even in the absence of any pain.
Some of the long lasting impairment that can occur after the total hip replacement surgery is
reduction in the muscle strength, reduction in the postural stability and limited flexibility
(Radosavljevic et al., 2014). The functional restrictions might include reduced walking speed,
low ratings in the various assessment tolls for measuring the functional ability.
Rehabilitation after a hip arthoplasty aims to improve the functional capacity of the
elderly patients and the quality of life. Hence the main goal is to reduce the severity and the
onset of pain, prevention of the muscular atrophy, vascular and the cardiopulmonary
complications and depression (Radosavljevic et al., 2014). A rehabilitation program also
emphasize on the maximal movement of the hip joints. It also increases the muscular strength in
the extremity and restoration of the movement coordination.
A care planning by the rehabilitation team is necessary for a successful implementation
of the plans. The rehabilitating team should consist of licensed physicians, occupational
therapists and physical therapists and in some cases social worker and psychologists (Saxon,
Gray &Oprescu, 2014). This professional team synchronizes their treatment planning with the
medical experts of the cardiology, neurology and endocrinology department(Riemen&