1.

PROCESS OF HEALTHCARE FOR HIP-SURGERY PATIENTS

1.1. Preoperative care for hip-surgery patients

Psychological preparation of patients for surgery begins with a doctor in the

clinic when the decision of the surgery is made. The pacient is admitted to the Department of
Orthopaedics the day before the surgery with necessary medical documentation ( blod tests:
CBC, ESR, coagulogram, blood type, Rh factor, RTG, the opinion of cardiologist and
anesthesiologist). Upon receipt of the patient, nurse observes the appearance of patients,
measures vital signs, controls the bodily fluids, applies the administered treatment and cares
for the patient's nutrition. The day before surgery and the morning of the surgery the patient
takes a shower with a foaming antibacterial soap ( Plivasept ). The night before the surgery,
the patient receives a subcutaneous injection of low-molecular-weight heparin, a drug which
prevents possible venous thrombosis and sedative (Normabel 5 mg). The patient gets lunch
and he can drink liquid until midnight. No special preparation is needed for the digestive tract.
On the day of the surgery the patient is fasting (he can drink therapy for blood pressure with
one sip of water). Shortly before being taken to the operating tract pacient's surgical area is
being shaved. The patient is taken to the room with a bed accompanied by a nurse, with a
complete necessary medical documentation.

1.2. Postperative care for hip-surgery patients

Postperative care for hip-surgery patients is directed towards removing body aches
(pain), complication recognition (shock, bleeding, pressure on blood vessels and nerves, fat
embolism, infection or dislocation), preventing complications and providing psychological
support.
The nurse adjusts the patient in bed (slightly elevated headboard, it is recommended
regardless of surgical approach, that the treated limb should be in the light abduction and
neutral rotation when the patient is lying in bed using abduction pillow), nurse also measures
vital functions: heart rate, RR, respiration every 15 minutes during the first 3 hours, then
every 30 minutes and then every 3 h for 24 h. Nurse applies the treatment and provides
nutritional care for the patient, controlles the drainage of the operating field, the environment
of operative wound, urination and stool, helps the patient change his position, and in
collaboration with the physiotherapist helps patient getting up for the first time. Nurse also
plans and implements nursing interventions.
 1.3. Possible nursing diagnoses in the care of hip-surgery patients

1. Reduce the risk through self-care: feeding, personal hygiene, dressing, toilet facilities
related to the reduced mobility.
2. A high risk of bleeding related to the surgical wound.
3. A high risk for infection related to the surgical wound.
4. A high risk for constipation related to the reduced mobility.
5. A high risk for bedsore related to the reduced mobility.
6. Pain related to the surgical wound.
7. High risk of falling related to the use of aids (forearm crutches).

2. CASE

2.1. Nursing anamnesis and status

 Pacient M.K., born in 1975., from Koka. He is married, he has five children and
he is unemployed. He was admitted to the Department of Orthopaedics on December 3rd,
2015 with the medical diagnosis Coxarthrosis lat. dex for surgery.

The patient is supposed to come to the Department of Orthopedics to the agreed surgery. This
should be his first hospitalization to this Department. He is suffering from hypertension,
taking regular therapy and is regularly examined by a cardiologist (last examination was a
month ago). He does not smoke or consume alcohol. Patient denies allergies.

Patient had three meals a day at home, at least one cooked meal. Barbecue is his favourite
meal, but he avoids spicy food. He does not take dietary supplements. He states that he daily
drinks about 2.5 liters of fluid, especially water or tea. During hospitalization he has three
meals a day. He states that he is satisfied with the hospital food. He drinks about 2.5 liters of
fluid a day. Patient denies problems with swallowing.

At home, the patient had a stool per day. He stated that he did not have a problem with the
stool. He has urinated 6-7 times a day without dysuric complaints. In the hospital he had a
stool per day. He has urinated 6-7 times a day without dysuric complaints. Patient has no
problems with sweating.

At home, the patient has done all self-care activities by himself. He likes to take recreational
walks. During hospitalization, the patient did all the activities with a use of aids (forearm
crutches). He needed assistance for dressing, with his underwear, pajama pants and socks. For
the activity of personal hygiene he needed assistance during washing his back and lower
extremities. He likes to take a shower in the morning, use Axe shower gel and he has all the
necessary accessories.

Patient stated that he did not have any problem with falling asleep or sleeping at home.

He usually goes to bed around 10 P.M. and wakes up around 6 A.M. After waking up he
would feel rested and ready for daily activities. In the hospital he said that he had no trouble
sleeping or falling asleep. Usually he goes to bed around 10 P.M. and wakes up around 6:30
A.M.
The patient has no vision problems. He denies problems with his hearing and his memory. He
sometimes feels the pain around his wound and because of that he is taking Analgin pills.

He describes himself as a communicative and cheerful person tending to make social contacts.
He likes to be in a company of large group of people.

Patient lives in the family house with his wife and five daughters. Patient stated that the
family relations are excellent. Every day they visit and bring him all the necessary things.
The patient states that he does not want to talk about sexuality.

He stated that he had higher stress when he lost his job. In that situation, thing that helped him
the most was that he could share his problems with his wife and children who understand and
support him. He stated that his stay in the hospital was not stressful.

The patient is Roman Catholic. He stated that he sometimes goes to the Holy Mass. He does
not consider that his faith is the most important thing in his life.

PHYSICAL EXAMINATION
The patients tubal measured temperature was 36.7 C. His pressure was measured on his left
hand, in the sitting position and it was 140/90 mmHg. Pulse rate was 85. Pulse is rhythmic
and well filled. Respiratory rate was 16. Patient's height is 183 cm and weight is 80 kg. BMI
is 23.9. Skin and turgor pressure are normal. The bony protuberance, edema and lesions are
not visible. The oral cavity is clean, he has his own denture. He is oriented in time and space.

2.2. Nursing diagnoses and nursing care plans

Nursing diagnosis:
High risk of falling related to the use of forearm crutches.

Goal:
During hospitalization the patient will not fall.
Nurse interventions:
1. Familiarize a patient with the environment.
2. Remove all obstacles from the environment.
3. Ensure a bell within reach.
4. Place the forearm crutches next to the bed.
5. Place the patient's slippers with rubber soles next to the bed.
6. Warn the patient that the department has no handrails in the hallways and by the open
window.
7. Warn the patient not to walk around when it's time to wash patient rooms and
hallways.

Evaluation:
During hospitalization the patient did not fall.

Nursing diagnosis:
Reduced ability of dressing is related to reduced agility 2 surgery on his right hip and that
manifests in inability to dress the pajama pants and socks.

Goal:
During hospitalization, the patient will be able to take off and put on his undershirt and the
pajama top by himself and with the help of nurse his pajama pants and socks.

Interventions:
1. Ensure privacy during dressing.
2. Encourage patient to be independent when taking off and putting on underclothes and
pajama top.
3. Provide plenty of time so that the patient can take off and put on the pajama top
4. Encourage using a trapeze for easier taking off and putting on pajama top.
5. Put on pajama pants and socks on the patient.
6. Commend for every progress.

Evaluation:
During hospitalization, the patient was able to take off and put on his undershirt and the
pajama top by himself and with the help of nurse his pajama pants and socks.

Nursing diagnosis:
Reduced ability to maintain personal hygiene is related to reduced agility 2 surgery on his
right hip which manifests in inability to wash and clean his back and legs.

Goal:
Patient will be able to wash his face by himself, wash and wipe his upper body to the waist
and genitals and glutes, and with the help of nurse he will be able to wash and wipe his back
and legs.

Interventions:
1. The nurse will arrange the time with the patient for his shower (in the morning).
2. Ensure privacy.
3. Bring necessary accessories on the cart for maintaining personal hygiene.
4. Provide plenty of time so that the patient can maintain personal hygiene.
5. Encourage the patient to wash his face and wash the upper body from the waist up,
and glutes and genitals by himself.
6. Wash the patient back and legs.
7. Encourage the patient to dry washed parts of the body with a towel.
8. Wipe the patient back and legs.
9. Help the patient with putting on his pajama pants and socks.
10. Push a cart out and clean up the utensils.

Evaluation:
Patient was able to wash his face by himself, wash and wipe his upper body to the waist and
genitals and glutes, and with the help of nurse he was able to wash and wipe his back and
legs.