NCP Total Joint Replacement

Joint replacement is indicated for irreversibly damaged joints with loss of function and unremitting pain (e.g., degenerative and rheumatoid arthritis [RA]), selected fractures (e.g., hip/femoral neck), joint instability, and congenital hip disorders. The surgery can be performed on any joint except the spine. Hip and knee replacements are the most common procedures. The prosthesis may be metallic or polyethylene (or a combination) implanted with a methylmethacrylate cement, or it may be a porous, coated implant that encourages bony ingrowth.

CARE SETTING

Inpatient acute surgical unit and subacute or rehabilitation unit.

RELATED CONCERNS

Fractures
Psychosocial aspects of care
Rheumatoid arthritis
Sepsis/septicemia
Surgical intervention
Thrombophlebitis: deep vein thrombosis

Patient Assessment Database

ACTIVITY/REST
May report: History of occupation/participation in sports activities that wears on particular joint
Difficulty walking; stiffness in joints (worse in the morning or after period of inactivity)
Fatigue, generalized and muscle weakness
Inability to participate in occupational/recreational activities at desired level
Interruption of sleep, delayed falling asleep/awakened by pain; does not feel well rested
May exhibit: Decreased ROM and muscle strength/tone

HYGIENE
May report: Difficulty performing ADLs
Use of special equipment/mobility devices
Need for assistance with some/all activities

NEUROSENSORY
May exhibit: Soft tissue swelling, nodules
Muscle spasm, stiffness, deformity
Impaired ROM of affected joints

PAIN/DISCOMFORT
May report: Pain (dull, aching, persistent) in affected joint(s), worsened by movement

SAFETY
May report: Traumatic injury/fractures affecting the joint
Congenital deformities
History of inflammatory, debilitating arthritis (RA or osteoarthritis); aseptic necrosis of the joint head
May exhibit: Distorted joints
Joint/tissue swelling, decreased ROM, changes in gait

TEACHING/LEARNING
May report: Current medication use, e.g., anti-inflammatory, analgesics/narcotics, steroids, hormone replacement therapy (HRT), bone resorption inhibitor (e.g., Fosamax), calcium supplements

Discharge plan

DRG projected mean length of inpatient stay: 3–5 days (depending on joint replaced)

May need assistance with transportation, self-care activities, homemaker/maintenance tasks, possible placement in rehab/extended-care facility for continued rehabilitation/assistance

Refer to section at end of plan for postdischarge considerations.

DIAGNOSTIC STUDIES

X-rays: May reveal destruction of articular cartilage, bony demineralization, fractures, soft-tissue swelling; narrowing of joint space, joint subluxations or deformity.
Bone scan, CT/MRI: Determine extent of degeneration and rule out malignancy.

NURSING PRIORITIES

1. Prevent complications.
2. Promote optimal mobility.
3. Alleviate pain.
4. Provide information about diagnosis, prognosis, and treatment needs.

DISCHARGE GOALS

1. Complications prevented/minimized.
2. Mobility increased.
3. Pain relieved/controlled.
4. Diagnosis, prognosis, and therapeutic regimen understood.
5. Plan in place to meet needs after discharge.