nursing diagnosis for ortho patient

[emeraulde]

MY patient is a 65y/o female who suffered a fall and had undergone partial hip replacement last nov. 4, '08. Her problem right now is she can't lift her affected leg, and cannot place her foot on the ground. SHe said it isnt painful but only weak. ( she used a walker)

here are some nursing diagnosis I made but I dunno if its right:

1. Impaired physical mobility of the left leg r/t loss of bone integrity.

2. impaired physical mobility of the left leg r/t continuing bone healing with implanted prosthesis of the hip. ( I was going to say implanted prothesis for partial hip replacement but I think this is a medical diagnosis).

thanks....

P.S. what do you call the prosthesis used for partial hip. I only know the ball and socket for total hip replacement.

[Daytonite, BSN, RN]

how do you know that the cause (the related to part of the nursing diagnosis) is because of "loss of bone integrity" or "continuing bone healing with implanted prosthesis of the hip" since it is a year later? bone loses integrity with bone diseases none of which you mentioned this lady has. bone doesn't take a year to heal.

here are the related factors that nanda and ackley/lagwig lists for this diagnosis:

• medications
  
• prescribed movement restrictions
  
• discomfort
  
• lack of knowledge regarding value of physical activity
  
• body mass index greater than 30 (obesity)
  
• sensoriperceptual impairments
  
• neuromuscular impairment; pain
  
• musculoskeletal impairment
  
• intolerance to activity/decreased strength and endurance
  
• depressive mood state or anxiety
  
• cognitive impairment
  
• decreased muscle strength, control, and/or mass
  
• reluctance to initiate movement
  
• sedentary lifestyle or disuse or deconditioning
  
• selective or generalized malnutrition
  
• loss of integrity of bone structures
  
• developmental delay
  
• joint stiffness or contractures
  
• limited cardiovascular endurance
  
• altered cellular metabolism
  
• lack of physical or social environmental supports
  
• cultural beliefs regarding age-appropriate activity

after a year and the patient telling you she is weak and has now fallen, i would say the related factor would be more closer to decreased muscle strength (weakness, which is what the patient told you), disuse, reluctance to move or being sedentary. based on the patient saying she was weak i would say she had impaired physical mobility r/t decreased muscle strength. that is why she wasn't, and isn't, able to make independent, purposeful physical movement of the body or of one or more extremities (the definition of impaired physical mobility). do not be fooled into thinking that you are diagnosing the reason for her messed up hip or fall. the nursing question is why she is having so much trouble moving?

see this webpage impaired physical mobility for more information about this diagnosis.

p.s. what do you call the prosthesis used for partial hip. i only know the ball and socket for total hip replacement.

hip arthoplasty. here is a weblink to a page that describes the procedure:

http://www.surgeryencyclopedia.com/fi-la/hip-replacement.html.

if the prosthesis was ruined when she fell, it may need to be revised:

http://www.surgeryencyclopedia.com/fi-la/hip-revision-surgery.html

[emeraulde]

Her Operation for partial hip replacement arthroplasty is just about 15 days ago. ( nov 4, 2008 ). I was thinking that it just need more time to heal. and physical therapy.

[Daytonite, BSN, RN]

to me, my patient is a 65y/o female who suffered a fall and had undergone partial hip replacement last nov. 4, '08 means her surgery was a year ago! so, she is newly post-op! her movement restriction is because of the pain from the remaining inflammation. whenever tissue is traumatized from a fracture + the cutting of surgery the body responds by initiating the inflammatory response followed by healing. healing occurs in 3 phases and internal tissues take a little longer than 15 days to heal. bone takes up to 6 weeks. also, the doctor has ordered "no weight bearing" on the operative hip, hasn't he?

impaired physical mobility r/t discomfort, surgical incision and restricted weight bearing on operative extremity aeb [evidence]