Free Nursing Dissertations - 1997) it Is Commonest In Caucasian Races But Much Rarer In African And Asian
1997)
It is commonest in caucasian races but much rarer in African and Asian races it affects men and women equally. It is made more likely by anatomical abnormality in the hip joint (congenital or trauma) or inflammatory conditions involving the joint. It is invariably associated with loss of intra-articular cartilage and typically presents with pain, restriction in movement and stiffness. (Walker-Bone K et al 2000) We will not discuss treatment options here as they are not relevant to the post op. period.
Post op considerations
We shall discuss the management of the patient from the point of hand-over when the patient returns to the ward. The management of the immediate post-operative patient involves a multitude of nursing skills. In general terms, the immediate post op. analgesia is likely to have been taken care of by the anaesthetist and one must ensure that some form of PRN analgesia is written up for the patient.
Analgesia
The issues relating to post op analgesia are complex and deserve some detailed consideration
A basic overview of the pathophysiology of pain suggests that it can be divided into three modalities, each one being both functionally and anatomically different although there is a great deal of overlap and redundancy between pathways. They are the nocioceptive, idiopathic and neuropathic modalities. (Sreenarasimhaiah J 2003).
In terms of our considerations here we only really need to concern ourselves with the nocioceptive modality. The peripheral nocioceptive receptors respond to the inflammatory tissue chemistry changes that result from tissue trauma. They respond in particular to chemicals such as bradykinins, histamine and prostaglandins (De Leo JA et al. 2001). Other substances such as prostaglandins (sensitising substances) lower the stimulatory threshold of the nocioceptors so that they fire off with lesser stimuli. (Konttinen YT et al 1994)
The practical consequence of all this is that the more tissue damage there is, the greater will be the tissue levels of these biochemicals and the greater the pain perception. The surgeon will try to minimise the necessary tissue damage during the operation but proper evidence based nursing procedures (Berwick D2005). We can cite evidence to show that immobilisation of the damaged tissue and cooling of the damaged tissue can both reduce the levels of the tissue chemicals and the levels of pain experienced. This immobility has to be balanced against the problems of the post op. nursing of the overweight patient and the increased risk of thrombo-embolism. (Macintyre P. 2001). We shall discuss this point further later in the essay.
The other significant point about pain management to consider is that there is a lot of evidence to show that a reduction of the overall pain experience reduces that likelihood of the development of chronic pain syndrome.
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