Nursing care plan total joint replacement

I. Purpose
a. Definitive treatment for advanced, irreversibly damaged
joints with loss of function and unremitting pain
b. Commom conditions: degenerative and rheumatoid arthritis
(RA); selected fractures, such as with hip and femoral neck;
joint instability; congenital hip disorders; avascular necrosis

II. Procedures
a. Performed on any joint except the spine, with hip and knee
replacements the most common procedures
b. Prosthesis may be metallic, polyethylene, or ceramic, or a
combination
c. Implanted with methylmethacrylate cement or may be a
porous, coated implant that encourages bony ingrowth

III. Statistics
a. Morbidity: In 2004, there were more than 1 million primary
and revision procedures performed; females accounted
for 62% of all procedures, with a mean age (at time of
procedure) of 66 to 68 years (U.S. Bone and Joint
Decade, 2008).
b. Mortality: Rate is very low, 0.29% in 2004, related to
advanced age and comorbidities (Liu et al, 2008).
c. Cost: In 2004, annual hospital cost estimated at over
$44 billion (U.S. Bone and Joint Decade, 2008).

Care Setting
Client is treated in inpatient acute surgical unit and subacute
or rehabilitation unit.

Related Concerns
Fractures
Psychosocial aspects of care
Rheumatoid arthritis (RA)
Sepsis/septicemia
Surgical intervention
Thrombophlebitis: deep vein thrombosis

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

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

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