Deviation in the Standard of Rehabilitative Care Following Hip Replacement

Evaluate breaches in the standard of care by analyzing the answers to the questions herein below to determine whether or not there has been a Deviation in the Standard of Rehabilitative Care Following Hip Replacement

Answer the following questions to find out if the standard of care was followed for your case.

  • Was pre-operative education provided prior to the hip surgery?
    Yes
    No
    Answer unknown
    Why is this important?
    All patients undergoing hip replacement surgery need to be educated about lifestyle modification, weight bearing instructions and rehabilitation necessity.
    (2009) 23 ECORTH 1 17-26

  • Was peri-operative pain managed? Why is this important?
    Answer this question
    
Adequate pain management must be continually re-evaluated as the patient progresses through post-operative rehabilitation and recovery.

    (2006) 17 SAPLST 2 88-92 



  • Was rehabilitation advised? Why is this important?
    Answer this question
    
Rehabilitation services are recommended in all patients undergoing hip replacement surgery for strengthening and mobility.

    (2006) 17 SAPLST 2 88-92 



  • To which of the following rehabilitative specialists was the patient referred?(Choose all that apply) Why is this important?
    Answer this question
    
The goal of the rehabilitation team is to enhance each patient’s physical capabilities by using the team member’s individual professional skills, expertise, and knowledge to evaluate, plan, and implement treatment interventions tailored to the needs of the patient.

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  • Were instructions provided regarding hip precautions? Why is this important?
    Answer this question
    
In the rehabilitation phase preceding and following Total Hip Arthroplasty(THA), education and instruction regarding hip precautions can help to reduce the risk of dislocation. 

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  • Were initial assessments performed for rehabilitation post surgery? Why is this important?
    Answer this question
    
The nursing staff, physical therapists, and occupational therapists need to work with patients immediately post-operatively. Initial assessments need to be performed once patients are medically stable. 

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  • Was a medical history obtained? Why is this important?
    Answer this question
    
A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's evaluation and enables the clinician to make the most judicious use of additional tests. 

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  • With which of the following risk factors for Deep Vein Thrombosis (DVT) did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    
A risk factor is a variable that has a causal association with a disease or disease process; the presence of the variable in an individual or a population is associated with an increased risk of the presence or future development of the disease. Thus, risk factors may be useful for identifying subjects at increased risk for a disease or for a particular outcome that results from a disease process.

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  • Which of the following Deep Vein Thrombosis (DVT) prophylaxes were given? (Choose all that apply) Why is this important?
    Answer this question
    
Deep vein thrombosis is a definite risk - a low molecular weight heparin should be given and the patient should be fitted with graduated compression stockings.

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  • With which of the following risk factors for decubitus ulcer did the patient present?(Choose all that apply) Why is this important?
    Answer this question
    
A risk factor is a variable that has a causal association with a disease or disease process; the presence of the variable in an individual or a population is associated with an increased risk of the presence or future development of the disease. Thus, risk factors may be useful for identifying subjects at increased risk for a disease or for a particular outcome that results from a disease process.

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  • Which of the following preventive measures were taken to prevent decubitus ulcer? (Choose all that apply) Why is this important?
    Answer this question
    
Prevention is the most important factor in managing pressure ulcers.

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  • Was an individualized plan of care devised? Why is this important?
    Answer this question
    
In an intense and individualized protocol, patients need to recover and rehabilitate and develop not just range of motionbut also proprioceptive activity and proprioceptive neurologic feedback to improve their function.

    (2006) 17 SAPLST 2 88-92 



  • Which of the following therapies were recommended following the hip surgery? (Choose all that apply) Why is this important?
    Answer this question
    
In the subacute phase following surgery, goals of therapy include continued strengthening of the lower extremity musculature, proprioceptive training to improve spatial awareness, endurance training to increase cardiovascular fitness, and functional training to promote independence in activities of daily living. Throughout the post-operative period, patients should be encouraged to work diligently with their therapists. Poor participation in therapy is associated with poorer functional outcomes.

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  • Was an informed consent obtained? Why is this important?
    Answer this question
    
The laws of most states require that clinicians obtain informed consent before providing treatment.

    (2011) 23 EOMSCA 3 475-484 



  • Were post-operative exercises initiated immediately post surgery? Why is this important?
    Answer this question
    
The post-operative rehabilitation of a patient after total hip arthroplasty begins immediately in the acute hospital setting. 

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  • Which of the following physical activities were instituted in the immediate post-operative period?(Choose all that apply) Why is this important?
    Answer this question
    
In the immediate postoperative period, range of motion of the hip, knee, ankle, and foot of the operative extremity should be instituted. Patients may begin with simple exercises such as foot/ankle pumps and ankle rotations.

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  • Which of the following assistive devices were provided during the post-operative rehabilitation?(Choose all that apply) Why is this important?
    Answer this question
    
The restoration of balance and gait is a primary goal of any post-operative rehabilitation program. Assistive devices are a routine component of a patient’s post-operative rehabilitation, as they provide stability and promote restoration of gait. Canes, crutches and walkers are examples of ambulatory assistive devices.

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  • Which of the following selection criteria for assistive devices were not followed? (Choose all that apply) Why is this important?
    Answer this question
    
The selection of an assistive device should be based on evaluation of the patient’s balance, coordination, mental status, strength, age, weight-bearing status, other joint impairments, and purpose for use. Assistive devices have a direct effect on a patient’s physical and psychological well being.

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  • Which of the following exercises were initiated?(Choose all that apply) Why is this important?
    Answer this question
    
Following a hip surgery, physical activity and goals of therapy should consist of a graduated series of events which include abduction, ankle pumps, ankle rotations, bed supported knee bends, buttocks contractions, exercycling, quadriceps set, resistive hip flexion, resistive hip abduction, resistive hip extension, stair climbing/descending, standing, standing hip abduction, standing hip extension, standing knee raises, straight leg raise and walking. 

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