| Patients undergoing these
procedures need skilled nursing care so that they can
recover from surgery and enjoy the benefits of their new
joint. However, as Adele Cambridge lives alone with no
primary care, the immediate recovery period (first 5–7
days) should be spent within the hospital. Nursing management
in this phase consists of facilitating safe recovery from
the anaesthetic and surgery, and the initial stages of
rehabilitation. Hip replacement surgery may be carried
out using a variety of anaesthetic techniques, depending
on the patient’s medical condition, the anaesthetist’s
skills and patient preference.
Adele Cambridge may have a general, spinal or epidural
anaesthetic, or a combination of these depending upon
her past medical history (Royal College of Anaesthetists,
2008). Each carries its own risks, which patients should
be aware of. For those having general anaesthesia the
risk of death for a healthy person is 1 per 100 000
general anaesthetics; for those having spinal or epidural
anaesthesia, less than 1 in 100 000 suffer significant
permanent nerve damage resulting in the loss of use
of their legs (Royal College of Anaesthetists, 2004).
As it is recommended for Adele Cambridge to spend
the immediate recovery period after surgery with the
hospital, nurses have a responsibility to ensure that
they play their part in promoting recovery after anaesthesia
and surgery through the use of early warning systems
(EWSs), in which acceptable parameters for physiological
signs, such as heart rate, are set; any deviations from
these are managed according to an agreed protocol with
early medical involvement (Cullinane et al, 2005). The
past history of Adele Cambridge with coronary artery
bypass grafts and atrial fibrillations puts her at a
higher risk of complications.
Infection can occur at the time of surgery, while
the wound is healing, or in the longer term. In the
last case, it occurs through haematogenous seeding,
when bacteria from a distant infection travel to the
joint replacement via the bloodstream. Infections occur
in approximately 0.2–1.1% of hip repayment prostheses
(Phillips et al, 2003). While, nurses within primary
and secondary care are key in detecting early and late
infection, which manifests as physical symptoms (discharge,
redness, swelling, pain) and through abnormal blood
results (high white cell count, erythrocyte sedimentation
rate and C-reactive protein) (Della et al, 2004), in
Adele Cambridge, if the infection develops in the later
stages of recovery then, she will have to seek medical
attention on her own. Infection that cannot be eradicated
can lead to loosening of the prosthesis. Both aseptic
loosening and loosening caused by infection may mean
that the prosthesis has to be removed and a revision
replacement implanted. |
