Nursing- Preoperative and Postoperative Management Article 2022

Running Head: NURSING- PREOPERATIVE AND POSTOPERATIVE MANAGEMENT
Nursing- Preoperative and Postoperative Management
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Introduction
This article is about the preoperative and postoperative management of the patient
after a total hip replacement surgery due to fractured neck of the femur post a fall. A
fractured neck of the femur, also known as the hip bone is considered as a serious injury
especially in case of older adults (Larsson et al., 2016). The symptoms can be pan around hip
region of the patient especially at times of movement and also shortening of the leg. Joint
replacement surgery if recent has become extremely common. The important indication for
the hip replacement surgery is that the patient complaining of an ensuring pain, loss of
function of that region and impaired movement. Post the operation although not a normal hip
but the replaced hip provides relieve from the distress. Most of the patients have a significant
decrease in the pain and also promotes substantial function allowing the individual to remain
active and enjoy the activities that was a challenge for them due to the pain (Ibrahim et al.,
2013).
Discussion
Pre-operative management
The pre-operative management of a patient undergoing total hip replacement surgery
involves preparing the patient for the operation. The preparation involves physical,
psychological and social factors.
The physical preparation includes that the patient should be fit to be administered
anaesthesia, they should not have any infections prior to the operation and they should be at
their optimal level of physical function prior to the operation. The cardiovascular as well as
the respiratory assessments needs to be analysed (Larsson et al., 2016). The comorbidities
should also be assessed like the hypertension and cardiac arrhythmias, these conditions can
interfere and impact the surgery. It should be ensured that there is no infection in the blood

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of the patient even at distant source like urine infection or dental infection since it might
spread to the hip prosthesis. This is known as haematogenous seeding. The potential dental,
skin and urine infection should be checked and treated before the surgery. Methicillin
resistant Staphylococcus aureus (MRSA) screening should be carried out (Ibrahim et al.,
2013) (Larsson et al., 2016).
Based on the literature studies it is observed that the psychological state of the patient
plays an important role in on the recovery process post the joint replacement surgery. The
patients with low mental health before the surgery has a worse physical health outcomes after
the operation that may be characterised by elevated pain levels. The nursing intervention
should promote self efficacy in the patients and they should be educated about the acute
surgery phase and the recovery period so that they can come to terms with it and also prepare
themselves accordingly (Ibrahim et al., 2013). The patient should be able to believe that they
can cope with the surgery as well as the rehabilitation and that it will be of benefit for the
patients to be actively involved in their rehabilitation.
Social preparation considers the home circumstances of the patient and their ability to
manage the patient post the total hip replacement surgery. The home environment plays a
vital role as the patient will have minor mobility restrictions for atleast up to three months till
they recover completely. There is a potential risk of dislocation of prosthesis (Sibbern et al.,
2017). Patients can have different roles in life and some of these will be challenging to
execute during recovery from the surgery. It is important for them to be aware of these before
the surgery is that they can plan their works accordingly by asking aid from other family
members (Stowers et al., 2016).
An elevated care level of nursing is important in the entire patient pathway since the
total hip replacement surgery is taken into consideration till the patient enters the operation
theatre. The nurse practitioners ensures holistic assessment of the patient to analyse whether

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patients is fit to undergo the surgery and whether the patient is physically, psychologically
and socially ready. The nurses aid in ensuring that the patient is fit for operation (Sibbern et
al., 2017).
Postoperative management
After the surgery the patients are taken to the post anaesthesia care unit and closely
monitored. The patients are encouraged to stay for 3 to 7 days after the total hip replacement
surgery. Patients experiencing challenges in the urination should have a catheter that is placed
to drain the bladder. The patients should receive intravenous fluids. Patients should also be
encouraged to execute simple coughing and breathing exercises to prevent the risk of fluid
accumulation in the lungs (Louw et al., 2013).
It is crucial for the nurse to be aware of the complications that might cause harm to
the patient if they are no cared for or are unnoticed. The care plan of the nurse should aim at
prevention of the following complications like dislocation of the hip prosthesis, excessive
wound drainage, thromboembolism and infection (Klemetti et al., 2015).
The nurse practitioner should exploit a portable suction device for accumulation of the
blood and fluid at the surgical site. The fluid accumulation causes elevated distress in the
patient and should be avoided at highest priority. It could also lead to potent infection in that
site. The expected volume of drainage should be 200ml to maximum of 500 ml within the
first 24hours and then the drainage volume should gradually reduce post 48 hours of
operation with a drainage of 30ml in 8 hours (Louw et al., 2013). If the drainage volume is
higher than normal the nurse should inform the physician immediately. Auto-transfusion
systems should be exploited to decrease the homologous blood transfusions. This can also be
utilised when there is elevated rate of blood loss that is anticipated post the total hip
replacement surgery.

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Thrombus is defined as blood clot that can form post the total hip replacement surgery
in the veins of the thigh, leg or pelvis of the patient. The nurse practitioner should take
highest priority to promote circulation of the blood and prevent venous stasis post the hip
reconstruction. Based on the blood thinning medication that is prescribed by the physician
low dose of heparin or enoxaparin can be administered to prevent the formation of clot at
undesired places. In proper flexion and mobilization with ion limits can be promoted (Ramos
et al., 2014).
Some of the patients can develop an infection after the total hip replacement surgery.
This requires the removal of the components of the prosthesis and cleaning of the joint along
with antibiotics that can last for 6 to 8 weeks (Klemetti et al., 2015). The implants might be
required to be removed in case of deep infection. The patients at high risk of infection should
be identified and the potential risks of the infection should be avoided. The patients at high
risk includes elderly, obese, those who are affected with diabetes. Required prophylactic
antibiotics can be administered with aid of the general physician. The indwelling urinary
catheters as well as the portable wound suction should be removed as early as possible to
prevent the risks of infection (Keswani et al., 2016).
Nursing intervention for dislocation of the hip prosthesis is crucial post the total hip
replacement surgery. The patient must be cautioned about not sitting too low or by crossing
the legs. The legs should be positioned in abduction to prevent dislocation of the prosthesis. It
is very important that the femoral head component of the acetabular cap should be maintained
at the proper position. The hip is kept in abduction position by placing two to three pillows
between the legs of the patient or by placing abduction splints or wedge pillows. Even when
the patient needs to be turned the hip that is operated should be in abduction and the entire
legs should be supported with pillows. The hip of the patient should not be flexed at degrees
higher than 45 to 60 degrees (Ramos et al., 2014). The patient should be reminded that they

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should not sleep on the operated side of the hip unless it is cleared by the doctor. In case of
dislocation the nurse should recognize and look for the following symptoms that includes
shortening of breath, inability to move the leg and mal-alignment of the leg. The other
symptoms may include increased discomfort in the patient and abnormal rotation (Ramos et
al., 2014) (Keswani et al., 2016).
Conclusion
It can be concluded from this article that joint replacement is a major surgery that requires
preparation of the patient mentally, physically and socially. Nurse practitioners play an
integral part in their primary as well as the secondary care setting. Thus, it can be concluded
that preoperative interventions can aid patients in having a greater probability of benefitting
from the surgery. Post total hip replacement surgery also requires the intervention of the
nurses to prevent the complications related to the surgery and also aid in faster recovery of
the patient. Thus, a holistic management of the pre and post operation aids in faster recovery
of the patient and promotes the efficacy of the surgery.

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