What is the priority nursing intervention after total hip replacement?

Priority Nursing Intervention After Total Hip Replacement

The priority nursing intervention after total hip replacement is preventing venous thromboembolism through early mobilization, combined with maintaining adequate pain control to enable this mobilization. 1, 2

Immediate Postoperative Priorities (First 24-48 Hours)

1. Early Mobilization to Prevent Thromboembolism

• Begin mobilization as soon as medically appropriate - this is the single most critical intervention as deep vein thrombosis occurs in 58% of hip replacement patients, with clinical prevalence of 1-3% for DVTs and 0.5-3% for pulmonary embolism 3, 2
• Early weight-bearing and toe-off exercises specifically reduce thromboembolism risk, prevent pressure sores, and improve overall rehabilitation outcomes 2
• Delaying mobilization unnecessarily leads to increased thromboembolism risk and prolonged hospital stays 2

2. Multimodal Pain Management to Enable Mobilization

• Establish adequate analgesia immediately, as uncontrolled pain prevents the mobilization needed to prevent life-threatening complications 1
• Continue paracetamol as baseline treatment for all pain intensities 1
• Maintain peripheral nerve blocks (femoral or posterior lumbar plexus) or spinal analgesia effects from the operative period 1
• Include pain evaluation as part of routine postoperative nursing observations 1

3. Respiratory Support

• Administer supplemental oxygen for at least 24 hours, as older patients are at high risk of postoperative hypoxia 1
• Oxygenation and respiratory function improve with mobilization, creating a positive feedback loop 1

Critical Monitoring and Prevention (First 24-72 Hours)

Fluid and Elimination Management

• Remove urinary catheters as soon as possible (ideally within 24 hours) to reduce urinary tract infection risk 1, 4
• Encourage early oral fluid intake rather than routine intravenous fluids, as hypovolemia is common 1, 4
• Monitor for urinary retention, which increases delirium risk in the 25% of patients who develop postoperative cognitive dysfunction 1, 4

Cognitive Function Assessment

• Screen for postoperative cognitive dysfunction/acute confusional state, which occurs in 25% of hip fracture patients 1, 4
• Optimize care through adequate analgesia, nutrition, hydration, electrolyte balance, appropriate medication, bowel management, and mobilization 1
• Identify and treat silent complications: chest infection, myocardial ischemia, urinary tract infection 1

Medication Management Pitfalls to Avoid

• Use cyclizine with extreme caution due to antimuscarinic side effects that worsen cognitive function in older patients 1, 4
• Minimize opioid doses to reduce urinary retention and cognitive impairment risk 4
• Reserve haloperidol or lorazepam only for short-term symptom control of severe agitation 1

Ward-Level Care Standards

Appropriate Staffing and Monitoring

• Hip replacement patients require ward care with a nurse-to-patient ratio of 1:4 1
• Regular input from physicians specialized in medicine for the elderly is essential 1
• Some patients may require prolonged monitoring in recovery units or HDU/ICU 1

Nutritional Support

• Assess nutritional status early, as up to 60% of hip fracture patients are clinically malnourished on admission 1
• Provide nutritional supplementation and dietetic support, which may reduce mortality and length of stay 1

Common Pitfalls to Avoid

1. Delaying mobilization due to pain concerns - this increases thromboembolism risk more than it protects the surgical site 2
2. Leaving urinary catheters in place "just in case" - this significantly increases infection risk 1, 4
3. Liberal use of anticholinergic medications (like cyclizine) - these worsen cognitive dysfunction in elderly patients 1, 4
4. Inadequate pain assessment - prevents the mobilization needed to prevent life-threatening complications 1
5. Overlooking silent complications - myocardial ischemia, infections, and electrolyte imbalances often present atypically in elderly patients 1