Conclusions

Appropriate patient selection and education, skillful implementation of the surgical procedure, and a properly constructed rehabilitation program are all important factors in the success of hip arthroscopy. It is also important that the patient's expectations are properly matched with the results anticipated by the surgeon.

An optimal outcome is dependent on coordination of the perioperative care, from preoperative assessment through postoperative rehabilitation. The clini cal nurse helps facilitate the patient's smooth transition through this experience and serves as a vital resource person for other members of the health care team. The nurse is an educator, practitioner, consultant, and collaborator. By serving in this multifaceted role, the nurse helps ensure appropriate and efficient use of resources through close patient follow-up and timely response to changes in the clinical circumstance. Thus, the other members of the health care team, whether it is as the patient, caregiver, surgeon, operating room personnel, or physical therapist, can better fulfill their respective roles.

References

1. Sutherland E: Day surgery: all in a day's work. Nurse Times 1991;87(ll):26-m

2. Weber J: Nurses* Handbook of Health Assessment. Philadelphia: Lippincott, 1988:1-7.

3. Dougherty J: Same-day surgery: the nurse's role. Orthop Nurs 1996;15(4):15-18.

4. Oberle K, Allen M, Lynkowski P: Follow-up of same day surgery patients. AORN J 1994;59|5J:1016-1025.

5. Stephenson ME: Discharge criteria in day surgery. J Adv Nurs 1990;15(5):601-613.

6. Knight KL: Cryotherapy. Am Fam Physician 1990;23(3):;141-144.

7. McDowell JH, McFarland EG, Nalli BJ: Cryotherapy in the orthopaedic patient. Orthop Nurs 1994;13(S):21^30.

8. Burden N: Telephone follow-up of ambulatory surgery patients following discharge is a nursing responsibility. J Post Anesth Nurs 1992;7(4):256-261.

APPENDIX: POSTOPERATIVE INSTRUCTIONS FOR ARTHROSCOPIC SURGERY OF THE HIP

The following information is designed to answer some frequently asked questions regarding what to expect and do after arthroscopic surgery. These are general guidelines; if you have any questions or concerns, please call.

Dressing and Wound Care

During arthroscopic surgery, the joint is irrigated with water. There are typically three small incisions closed with sutures. Your hip will be covered with a bulky dressing. Water may gradually leak through these incisions, saturating the bandage. This blood-tinged drainage may persist for 24 to 36 hours. If it has not significantly decreased by this time, call our office.

The bandage may be removed the day after surgery. The incisions should be cleaned with hydrogen peroxide and water and then covered with an adhesive bandage. As soon as the incisions are dry, you may leave them uncovered. Do not use ointments such as Neosporin on the incisions. You may shower the day after surgery, but avoid water running directly over the incisions. The incisions should not be soaked (e.g., bathtub, hot tub, swimming pool).

If the incisions show any signs of infection, contact our office. Specifically, if there is increased redness, persistent drainage, if you have fever, or if the pain does not progressively decrease, call the office.

During the first 48 hours, ice can be helpful to decrease pain and swelling and is especially important during the first 24 hours. Ice bags/packs should never be applied directly to the skin. They should be wrapped in a towel and applied for only 15 minutes at a time every 2 to 3 hours. If the skin becomes very cold or burns, discontinue the ice application immediately.

Ambulation and Movement

Unless you have been otherwise instructed, you will be allowed to bear as much weight on your leg as is comfortable immediately after surgery. Crutches may be used as necessary to help decrease discomfort while walking for the first few days after surgery. Please use crutches at least until your first physical therapy appointment.

Your level of discomfort will most often be your best guide in determining how much activity is allowed. Remember that it is easy to overdo the amount of activity in the first few days after surgery, and any increase in pain or swelling usually indicates that you need to decrease your activities. Please be careful on slippery surfaces, steps, or anywhere you might fall and injure yourself.

Medications

You will be given a prescription for pain medication. If you have any known drug allergies, check with the nurse before taking any medication. Please note that we are unable to call in prescriptions for narcotics after office hours. If you need a refill, please call early in the day so the nurse can call in your prescription. This is especially important if the weekend is approaching.

Some medications have side effects. If you have any difficulty with itching, nausea, or other side effects, discontinue the medication immediately and call our office. Pain medication often causes drowsiness, and we advise that you do not drive, operate machinery, or make important decisions while taking medication.

Aspirin serves as a mild blood thinner and may decrease the chance of blood clots forming in the leg. Although this is uncommon, it can be a difficult problem. If you are able to take aspirin, you should take one aspirin ยก325 mg) twice daily for 2 weeks following your surgery. It is best to take one in the morning and one in the evening and to avoid taking them on an empty stomach. If you are under the age of 16 or have any unusual medical problems, please check with the nurse about whether you should take aspirin.

Exercise and Physical Therapy

Physical therapy usually begins within a few days after your surgery. The therapist will outline an exercise program specific to your type of surgery. The purpose of physical therapy is to help you regain the use of your hip in a safe and progressive fashion. If you have any questions regarding your exercise program, please contact the physical therapist. If you are unaware of when or where your therapy is, please call the nurse and she can help you determine this.

First Postoperative Visit

Your first postoperative appointment will be within 1 week of your surgery. The findings at surgery, long-term prognosis, and plans for rehabilitation will be discussed at this appointment. If you are unsure of when your first postoperative visit is, please call the office and someone will help get one scheduled.

Communications

If you are having any problems, contact us right away. If it is after office hours, the answering service will contact the nurse or doctor on call.

Remember, if your pain increases, check for signs of infection (redness, fever, and so forth), decrease your activities, use ice, and take your pain medication as prescribed. If the pain persists, or if there are signs of infection, call our office.

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