Total Hip Replacement
L. Jones

Preoperative Care.

Recommended procedures.

Necessary Pre-Op arrangements.

Old method

New minimally invasive method.

Basic Procedure.

Postoperative Care sedation

In the hospital

Discharge

Possible complications

Total Hip Replacement

Total Hip Replacement procedures are becoming increasingly common around the world. hereas once the replacement of a deteriorated hip joint was either impossible, or extremely difficult (both to perform, and recover from, successfully), today's new minimally invasive technology makes the procedure significantly less risky, painful, and beneficial.

As people age, many people are faced with the debilitating effects of late-stage degenerative hip disease. Unfortunately, the symptoms accompanying the disease are not only painful, but in the later stages (especially after a fracture), can make mobility close to impossible for the patient. In such a case, Total hip replacement or THR is indicated. Not only does it offer hope for significant relief from the pain of degenerative hip disease, but in most cases can result in the restoration of mobility previously lost.

The actual…...

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Works Cited

Medical Multimedia Group. Health Pages Org. "A Patient's Guide to Total Hip Replacement Surgery." Retrieved on September 21, 2004, from  http://www.healthpages.org/AHP/LIBRARY/HLTHTOP/THR/INDEX.htm 

EMedicine. "Total Hip Replacement." Retrieved on September 21, 2004, from  http://www.emedicinehealth.com/articles/5806-3.asp 

Winthrop University Medical Center. "Winthrop University Hospital Orthopedic Surgeon Performs New, Small Incision Minimally Invasive Hip Replacement Procedure." Retrieved on September 21, 2004, from  http://www.winthrop.org/newsroom/archives/release.cfm?id=160 

UCSD Orthomed. "Total Hip Replacement." Retrieved on September 21, 2004, from http://medicine.ucsd.edu/ortho/pdf/hip.pdf.

Case Study #3 Care of the Patient after a Total Hip Replacement Surgery
1. What would be three nursing diagnoses for M.Y. based on the data given?
· Impairment in physical movement
· Inadequate knowledge concerning the clinical procedure
· Severe pain
2. What would be three achievable goals that would coincide with the nursing diagnoses for M.Y.’s plan of care for today?
· Demonstrate as well as aid with utilizing mobility supports such as walkers, trapezes, etc., and transfer techniques, in addition to engagement in an exercise regime
· Offer diversion activities and comfort measures such as back rubs and repeated repositioning. Further, offer therapeutic touch when needed and promote stress management approaches which include progressive relaxation, meditation, guided imagery, and visualization.
· Articulate patient understanding of clinical diagnosis and process.
3. List two or three potential complications may occur for M.Y. which would be related to the procedure that she had.
· Hip dislocation
· Fracture
· Formation of leg clots…...

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References

Chen, Y., Liu, B. C., Glass, K., & Kirk, M. D. (2015). High incidence of hospitalisation due to infectious gastroenteritis in older people associated with poor self-rated health. BMJ, 5(12). Retrieved from

Foster, A. D., Sivarapatna, A., Gress, R. E. (2011). The aging immune system and its relationship with cancer, Aging Health, 7(5), 707-718. doi:  10.2217/ahe.11.56

Grimble, R. (2003). Inflammatory response in the elderly. Curr Opin Clin Nutr Metab Care, 6(1), 21-9. doi: 10.1097/01.mco.0000049047.06038.eb

Mayoclinic. (2018). Transurethral resection of the prostate (TURP). Retrieved from https://www.mayoclinic.org/tests-procedures/turp/about/pac-20384880

Okorie, C. O. (2015). Is continuous bladder irrigation after prostate surgery still needed? World J Clin Urol, 4(3), 108-114.  doi: 10.5410/wjcu.v4.i3.108

Pearce, E. N. (2006). Diagnosis and management of thyrotoxicosis. BMJ, 332(7554), 1369-1373. doi:  10.1136/bmj.332.7554.1369

Pebody, R. (2015). What are the stages of Chlamydia? Retrieved from http://www.thebody.com/content/76634/what-are-the-stages-of-chlamydia.html

Quizlet. (2018). Nursing assessment: Immune system. Retrieved from https://quizlet.com/148627624/nursing-assessment-immune-system-flash-cards/https://bmjopen.bmj.com/content/5/12/e010161

A collaborative communication strategy is pursued in relational, supportive, symmetrical channel conditions; and,
2. An autonomous communication strategy is pursued in transactional, unsupportive, asymmetrical channel conditions (Varney 2002, p. 139).

Therefore, marketers at Smith & Nephew can fine-tune their marketing communications with business partners and customers depending on the existing relationship in order to maximize the return on their investment of resources in the marketing campaign (Varney 2002). These respective communication strategies are set forth in Table 2 below.

Table 2

Collaborative and Autonomous Marketing Communication Strategies

Collaborative communication strategy

Autonomous communication strategy

Interaction is frequent and prolonged with bi-directional flows of data through informal media, and direct efforts to change behaviour through requests, recommendations, promises, and appeals to legal obligations

Interaction is infrequent and mostly unidirectional and formal, concentrating on indirect efforts to change the beliefs and attitudes about the desirability of intended behaviour with no specific request for action (e.g. discussion of general business issues…...

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References

'About us.' 2011 Smith & Nephew. [online] available:  http://global.smith-nephew.com/master/33216.htm .

'Anthology Hip Replacement System.' 2011 Smith & Nephew. [online] available: http://global.

smith-nephew.com/master/ANTHOLOGY_HIP_SYSTEM_22438.htm.

Chang, C-M, Wu, E. C, Chang, I-S & Lin, K-M (2008) 'Benzodiazepine and Risk of Hip

HIP PAIN
A Caucasian Man with Hip Pain

Decision Point One

The patient presents physical, social, and psychological complications. He is experiencing pain in his hip but is considered to be an unsuitable candidate for a hip replacement because of his age. The initial diagnosis was torn cartilage but the patient has also been diagnosed with complex regional pain syndrome (CPS). He previously worked as a machinist but has since been unemployed and has a conflicted relationship with his girlfriend who has accused him of being a junky. The patient does exhibit some symptoms of depression.

The patient has previously complained about the negative side effects of some of the drugs he has been given to address his pain symptoms, including constipation and sleepiness. Given this, the use of the tricyclic antidepressants like amitriptyline would seem counterproductive given that these drugs often produce similar side effects ("Amitriptyline," 2016). However, Savella is a drug designed…...

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References

Amitriptyline. (2016). Mayo Clinic. Retrieved from:

 http://www.mayoclinic.org/drugs-supplements/amitriptyline-oral-route/side-effects/drg-20072061 

FAQs. (2017). Biofreeze. Retrieved from:  http://www.biofreeze.com/faqs 

Lidocaine. (2017). Mayo Clinic. Retrieved from:

Synovial joints like the knee and hip are qualified by their possessing a liquid that serves as a lubricant; that liquid is called synovia or synovial fluid. The fluid is surrounded by the synovium, which is the soft connective tissue that holds the synovial fluid. Whereas the synovium is actually permeable to water, the synovial fluid is far more viscous. Furthermore, a synovial membrane generates the synovial fluid. The name synovia comes from the words syn (like) and ovium (egg), due to its thick, stringy consistency resembling that of egg white (Laptiou, 2014). With age, the synovial fluid may become thinner, leading to insufficient lubrication and symptoms such as reduced range of motion, painful movements, stiffness, and swelling. Other classes of tissue that comprise the synovial joint system include the bone and cartilage, as well as the surrounding tensile tissues and ligaments. (Lapitou, 2014). epair of synovial joints depends on…...

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References

Barry, F. & Murphy, M. (2013). Mesenchymal stem cells in joint disease and repair. Nature Reviews Rheumatology 9, 584-594.

Feingold, D. (2009). Joint reconstruction. Retrieved online:  http://www.davidfeingoldmd.com/joint_reconstruction.php 

Laptiou, D. (2014). Normal joint structure. Retrieved online: http://www.sportsmed-forum.com/index-1/st_pag_patients-home/sm_pag_normal-joint-structure/sm_pag_normal-muskel.htm

Pavlovich, R.I. (2008). Current concepts in synovial tissue of the knee joint. Orthopedics 31(2). Retrieved online:  http://www.healio.com/orthopedics/knee/journals/ortho/2008-2-31-2/%7B06da86cf-3ac6-4fe7-850f-1170c97e9403%7D/current-concepts-in-synovial-tissue-of-the-knee-joint

Globalization and American Health Care
What explains the directionality of flows in health care? Patients, health workers, managerial practices?

Globalization has brought in the information revolution and this has again brought changes in the medical profession and the way health care is being administered. It has also brought in unforeseen problems and expansion of the health care issues and running debates on health care is still strong. The flows of healthcare primarily have to deal with the patient -- how the patient is induced to seek treatment and the process of the treatment and the final discharge and post treatment care. This also involves lot of information exchange, and abiding by insurance contracts, payment options and quality care for the patients. (Phillips, 2005)

The second set is the personnel who include doctors, paramedics and all staff. The flow of work of these sections follows the patient and there are changes in the way…...

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References

Bloche, Maxwell Gregg. (2003) "The privatization of health care reform: legal and regulatory perspectives" Oxford University Press.

Briesacher, Becky; et al. (2003) "Racial and Ethnic Disparities in Prescription Coverage and Medication Use" Health Care Financing Review, vol. 25, no. 2, pp: 63-66.

Edelheit, Jonathan. (2007) "Understanding the American Healthcare System" Global

Healthcare Magazine, Retrieved 14 June, 2011 from  http://www.globalhealthcaremagazine.com/issue-detail.php?item=5&issue=1

Jody Smith: Application of the Moral Model…
Applying Ethical Decision Making Model

"Jody Smith Case Study: Application of Thiroux's Moral Model"

The decision making model that will be applied in this work is the Moral Model (Thiroux 1977) and the case it will be applied to is the Jody Smith case. The reason this model was chosen is because the model lends itself best to a situation, such as Smith's where an impasse has been reached between the patients values and desires and that of family and the health care team. In this case the ethical dilemma is one clearly of informed consent as Smith has been excluded from conversations associated with her prognosis and care and this is contrary to her values and her identity. Without inclusion of this communication standard Smith has very little to go on regarding her prognosis and may be seeing her situation as insurmountable not only because…...

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References

Burkhardt, M. & . (2008). Ethics issues in Contemporary Nursing. Clifton Park: Delmar.

Chorney, J., McGrath, P., & Finley, G. (2010). Pain as the neglected adverse event. CMAJ: Canadian Medical Association Journal, 182(7), 732. Retrieved from EBSCOhost.

Guido, G.W. (2010). Legal & Ethical Issues in Nursing (5 ed.). Vancouver, Washington: Julie Levin Alexander.

King, J.S., Eckman, M.H., & Moulton, B.W. (2011). The Potential of Shared Decision Making to Reduce Health Disparities. Journal of Law, Medicine & Ethics, 3930-33. doi:10.1111/j.1748-720X.2011.00561.x

Nursing - Discharge planning
Discharge Planning in Nursing

Mr. Trosack's Case

The three main health issues include movement hindrance where by Mr. Trosack will move with the help of a walker. Mr. Trosack diabetic condition is main health issue. Mr. Trosack is depressed and lonely and requires a special care and assistance. Mr. Trosack lives in a crowded apartment located at a second floor in a 3-storey building. The building does not have an elevator and thus Mr. Trosack has to use the stairs to reach to his apartment. The house has furniture and personal valuables and thus making it hard for him to use his walker once inside the room. e takes the garbage by himself since he lives alone because his wife died two years ago. e fears climbing up the stairs because of pain that emanate from the strain. is family works for 60 hours a week hence there is…...

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Hip fracture is a main health issue that happens in the United States. This study uses the baseline (1993) and data collected in 2006 in order to evaluate the aftermath of hip placement discharge. Patient discharge depends on the status code from the Medicare inpatient claim. They categorize discharge status depending on the condition of the patient. Mr. Trosack would fall for nursing facility because he would not get the required professional assistance from his family. In this study, most of the hip fracture patients went to a nursing facility.

An evaluation in this study reveals that at the time of placement, the patients had gone home for 90 days, and 180 days for patients discharged at a nursing facility. The evaluation of the care of hip placement patients needs consideration when choosing a discharge placement for them. Mr. Trosack, in addition to the surgery, is diagnosed with diabetes, hypertension, and obesity. The family, despite knowing all this, does not provide or hire a medical officer for a regular check up on him.

In order for Mr. Trosack to get well, it is crucial to refer him to a nursing facility. In this study, the home and rehabilitation discharge seems to decline while many people opt for the nursing placement, which increased. In these nursing facilities, patients are not likely to report any health issue compared to those placed at their homes. In addition, these nursing facilities offer functional needs to patients and may reduce hip fractures in elderly people.

Discharge Plan
Assessment of the Situation

As a case manager for patient in this case scenario there are at least four easily identifiable healthcare issues associated with the discharge of patient; 1. Patient safety related to second floor placement of apartment and navigation of two flights of stairs with walker while using pain medication and recovery time needed for hip replacement 2. Patient safety with regard to size and condition of apartment with limited room to navigate with walker, cluttered space and rug placement all of which are barriers to proper use of walker and ambulation an essential aspect of recovery, 3. The potential for patient non-compliance with new medication regimen for diabetes and dietary plan for weight and glucose control 4. Patient well being with regard to isolation and the inability to follow normal routines such as helping in bakery (two flights down) eating in bakery and interacting with others…...

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References

Borg, C., Hallberg, I., & Blomqvist, K. (2006). Life satisfaction among older people (65+) with reduced self-care capacity: the relationship to social, health and financial aspects. Journal Of Clinical Nursing, 15(5), 607-618.

Byers-Lang, R.E., & McCall, R.A. (1993). Peer support groups: Rehabilitation in action. RE:View, 25(1), 32-36.

French, D.D., Bass, E., Bradham, D.D., Campbell, R.R., & Rubenstein, a. Z. (2008). Rehospitalization After Hip Fracture: Predictors and Prognosis from a National Veterans Study. Journal Of The American Geriatrics Society, 56(4), 705-710. doi:10.1111/j.1532-5415.2007.01479.x

Lin, P., Hung, S., Liao, M., Sheen, S., & Jong, S. (2006). Care needs and level of care difficulty related to hip fractures in geriatric populations during the post-discharge transition period. The Journal Of Nursing Research: JNR, 14(4), 251-260.

Flows in Health Care
Since the government had started the practice of handing over major departments to private sector like health care and education, these areas are now more focused on employing techniques that can draw major profit flow. On examining the three crucial aspects of profit earning such as the number of patients, quality of staff and management, we come to a conclusion that all three areas go side by side and need to be checked upon regularly (Michael, 2006 ).

The numbers of patients are important, to a hospital; patients are the customers who are taking advantage of the health care services provided by that respective hospital. Another item that is associated to the number of patients is the type of patients coming in which is directly associated with the services that a hospital is providing at that particular time. In order to earn more profit in this field,…...

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References

Del. Donna M., Christensen M.D. (Oct 2003). Women on the Cutting Edge of Health Care and Research. Ebony, 82.

Funtleyder, L. (2008). Healthcare Investing: Profiting from the New World of Pharma, Biotech, and Health Care Services. McGraw-Hill Professional.

Harry A. Sultz, Kristina M. Young. (2010). Health Care USA. New York: Jones & Bartlett Learning.

Leiyu Shi, Douglas A. Singh. (2011). Delivering Health Care in America. Jones & Bartlett Publishers.

Do not sit on the bottom of the tub, this causes too much bending of the hip. Use liquid soap to avoid dropping the bar of soap. A long-handles bath sponge will help in bathing below the knees."
The necessary precautions for the post-operative housekeeping process, according to the Center for Patient and Community Education (2009), "sit for rest breaks as needed. Slide objects along the countertop rather than carrying then. Use a utility cart with wheels to transfer items to and from the table. Attach a bag or basket to your walker or wear a fanny pack to carry small items. Use a long-handled reacher to reach objects on the floor. emove all throw rugs and long electrical cords to avoid tripping in your home. Watch out for slippery/wet areas on the floor." (Center for Patient and Community Education, 2009) Certainly watch out for slippery floors if pets are…...

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References

Case-Smith, J. (2003). Outcomes in hand rehabilitation using occupational therapy services. American Journal of Occupational Therapy, 57, 409-506

(2009) Center for Patient and Community Education in association with the Department of Outcomes Management and the Communications & Marketing Department at California Pacific Medical Center.  http://www.cpmc.org/learning/documents/rg-thr-home.html 

Cipriano, L.E., Chesworth, B.M., Anderson, C.K., & Zaric, G.S. (2007). Predicting joint replacement waiting times. Health Care Management Science, 10(2), 195. Retrieved from  http://search.proquest.com/docview/227985557?accountid=13044 

Cleveland Clinic (2011) Total Hip Replacement.  http://my.clevelandclinic.org/services/hip_replacement/or_overview.aspx

unning head: MATIX [Type text] [Type text] [Type text]13MATIXMatrix DocumentMatrixAPA Citation:Lassen, M. ., Gallus, A., askob, G. E., Pineo, G., Chen, D., & amirez, L. M. (2010). Apixaban versus Enoxaparin for Thromboprophylaxis after Hip eplacement. New England Journal of Medicine, 363(26), 24872498. https://doi.org/10.1056/NEJMoa1006885Variable and key conceptsThe study sought to compare the effectiveness of apixaban and enoxaparian as treatments for thromboprophylaxis following hip replacement. The hypothesis was not clearly stated, but from the background information provided, it is implicit that the researchers hypothesized that apixaban is more effective for treating venous thromboembolism (VTE) after hip replacement surgery.Sampling5,407 patients scheduled for hip replacement were recruited from 160 healthcare facilities in 21 countries to participate in the study. This is without a doubt a sufficient sample size. Potential subjects were singled out during a screening exercise conducted 14 days prior to scheduled surgery. Out of the 5,407 patients initially recruited, only 72% were…...

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ReferencesLassen, M. R., Gallus, A., Raskob, G. E., Pineo, G., Chen, D., & Ramirez, L. M. (2010). Apixaban versus Enoxaparin for Thromboprophylaxis after Hip Replacement. New England Journal of Medicine, 363(26), 2487–2498.   M. R., Raskob, G. E., Gallus, A., Pineo, G., Chen, D., & Hornick, P. (2010). Apixaban versus enoxaparin for thromboprophylaxis after knee replacement (ADVANCE-2): a randomized, double-blind trial. The Lancet, 375(9717), 807–815.  https://doi.org/10.1016/S0140-6736(09)62125-5 Nieto, J. A., Espada, N. G., Merino, R. G., & González, T. C. (2012). Dabigatran, Rivaroxaban and Apixaban versus Enoxaparin for thromboprophylaxis after total knee or hip arthroplasty: Pool-analysis of phase III randomized clinical trials. Thrombosis Research, 130(2), 183–191.  https://doi.org/10.1016/j.thromres.2012.02.011 Raskob, G. E., Gallus, A. S., Pineo, G. F., Chen, D., Ramirez, L.-M., Wright, R. T., & Lassen, M. R. (2012). Apixaban versus enoxaparin for thromboprophylaxis after hip or knee replacement. J Bone Joint Surg Br, 94–B(2), 257–264.  https://doi.org/10.1302/0301-620X.94B2.27850 Yan, X., Gu, X., Zhou, L., Lin, H., & Wu, B. (2016). Cost Effectiveness of Apixaban and Enoxaparin for the Prevention of Venous Thromboembolism After Total Knee Replacement in China. Clinical Drug Investigation, 36(12), 1001–1010.  https://doi.org/10.1007/s40261-016-0444-5https://doi.org/10.1056/NEJMoa1006885 Lassen,

Elder Care Case Study
Elder Care - Case Study

The objectives of this study are to discuss how social isolation can affect an older adult's recovery from surgery or illness and to identify safety issues when older adults return home from the hospital after a major illness or surgery. This work will additionally assess the safety of an older adults living environment in a given scenario and determine appropriate discharge placement for an older adult based on a given physical or psychological status. This work will explain how specified psychological factors can play a role in the recovery process. Finally this work will assess the adequacy of the family or caregiver's knowledge of skills necessary to deliver care to an older adult in a given situation and collaborate with a given patient's family to develop a plan of care for an older adult upon discharge from the hospital.

Assessment of the Situation

This patient…...

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References

Sweet, Richard A. (nd) Total Hip Replacement: Rapid Recovery Time Line after Minimally Invasive Surgery. Retrieved from: https://www.louortho.com/documents/THR%20RAPID%20RECOVERY%20MIS%20%20-%20Sweet%20web_1.pdf

Wong, Julia and Wong, Shirley (1999) Criteria for Determining Optimal Time of Discharge after Total Hip Replacement. British Journal of Clinical Governance. Vol. 4 Iss: 4, pp. 135-141.

Scheerlinck, T. et al. (2003) Hip Fracture Treatment: Outcome and Socio-Economic Aspects. A One-Year Survey in a Belgian University Hospital. Acta Orthopaedica Belgica, Vol. 69-2 -- 2003. Retrieved from http://www.actaorthopaedica.be/acta/download/2003-2/69_2-scheerlinck.pdf

DeFrances, Carol J. And Podgornik, Michele N. (2006) 2004 National Hospital Discharge Survey. No. 371. 4 May 2006. Advance Data from vital and Health Statistics. CDC. Retrieved from:  http://www.cdc.gov/nchs/data/ad/ad371.pdf

esearch eport: Gance-Cleveland (2004)

1) This study sought to explore the characteristics, clinical elements, methods, and benefits of school-based support groups for children of alcoholics (COA). Identification of this information may aid in the intervention process of adolescents who are coping with the addiction of a loved one and could improve long-term outcomes for the adolescent.

2) the author found that the support groups educated on the dangers of drug and alcohol use, improved coping strategies, enhanced resiliency factors, improved relationships, and increased school achievement. Of equal importance where the observed positive changes in behavior and an increased awareness of the effect of addiction on their lives (Gance-Cleveland, 2004). The findings of the current study were consistent with previous literature including the ability of the group process to empower youth and create a sense of awareness that can be correlated to improved decision making and long-term outcomes.

3) This study has some significant…...

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References

Gance-Cleveland, B. (2004). Qualitative evaluation of a school-based support group for adolescents with an addicted parent. Nursing Research, 53(6), 379-386.

Ridge, R.R., & Goodson, a.S. (2000).The relationship between multidisciplinary discharge outcomes and functional status after total hip replacement. Orthopaedic Nursing, 19(1),

Greenhalgh and Taylor (1997) describe quantitative research as that which examines one clearly formed question using multiple research methods. In this study the authors utilize the sickness impact profile (SIP), the hip outcome tool, and pain and mobility to test functional status pre- and post-operatively.
3. In this study, the independent variables are pain and mobility. The dependent variable is functional status. The patient's perception of his/her illness depends on his/her level of pain and ability to ambulate. The research hypothesis is that functional status improves post-operatively.

4. The authors talk about the history of hip replacement surgery outcome reporting. The authors state that although hip surgery has been used since 1970 it was not until 1988 that a study by Gartland proposed the need for health based outcome research as opposed to only surgical outcomes. The study indicates that as of 2000 there still was a lack in health status…...

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References

Denzin, N.K., & Lincoln, Y. (2000). Handbook of qualitative research. Thousand Oaks, CA: Sage

Gartland, J.J. (1988). Orthopaedic clinical research: Deficiencies in experiemental design and determinations of out-come. The Journal of Bone and Joint Surgery, 70-a (9), 1357-1364. Retrieved from  http://www.ejbjs.org/ 

Greenhalgh, T., & Taylor, R. (1997). How to read a paper: Papers that go beyond numbers (qualitative research). British Medical Journal, 315, 740-743. Retrieved from  http://group.bmj.com/products/journals/ 

Leidy, N.K. (1994). Functional status and the forward progress of merry-go-rounds: Toward a coherent analytical framework. Nursing Research, 43, 196-202. Retrieved from  http://journals.lww.com/nursingresearchonline/pages/default.aspx