A 55-year-old female patient with a history of developmental hip dysplasia presents with increased left hip pain and reduced range of motion. Recent diagnostic tests reveal early degenerative changes in the acetabulum, a slightly subluxated femoral head, and minor labral tears. The patient's ESR is slightly elevated. Based on this information, which nursing intervention is most appropriate to initially manage the patient's symptoms and prevent further deterioration?

C) Recommend the use of a supportive device, such as a cane, to reduce joint stress.

A) Encourage weight-bearing exercises to strengthen the hip joint.

B) Advise the patient to apply heat to the affected hip to reduce pain.

C) Recommend the use of a supportive device, such as a cane, to reduce joint stress.

D) Suggest dietary supplements such as glucosamine for cartilage repair.

A patient with developmental hip dysplasia and early signs of osteoarthritis is experiencing increased pain and limited range of motion. Based on the diagnostic findings, what is the most appropriate initial nursing intervention to assist in managing the patient's symptoms?

B) Educate the patient on the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for pain management.

A) Encourage the patient to engage in high-impact exercises to strengthen the hip joint.

B) Educate the patient on the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for pain management.

C) Advise the patient to apply heat packs to the hip joint to reduce inflammation.

D) Recommend complete bed rest to prevent further joint damage.

A 28-year-old female with hip dysplasia experiences worsening symptoms despite conservative management. During a follow-up appointment, she reports increased pain, a noticeable limp, and increased reliance on a cane. Her physical exam reveals decreased range of motion and a positive FABER test. Considering the patient's deteriorating condition, which intervention would be most appropriate as the next step in her management?

C) Refer the patient for surgical evaluation and potential intervention

A) Increase the dose of NSAIDs and continue physical therapy

B) Initiate corticosteroid injections to manage inflammation

C) Refer the patient for surgical evaluation and potential intervention

D) Recommend complete rest and use of a wheelchair for mobility

A 28-year-old female with worsening symptoms of hip dysplasia and osteoarthritic changes is being considered for surgical intervention due to ineffective conservative management. As a nurse involved in her care, which of the following is the most appropriate nursing action to support shared decision-making in this situation?

C) Facilitate a meeting with the healthcare team to discuss surgical options, risks, and patient preferences.

A) Recommend the patient undergo immediate surgery to prevent further joint damage.

B) Encourage the patient to continue conservative management and reassess in a few months.

C) Facilitate a meeting with the healthcare team to discuss surgical options, risks, and patient preferences.

D) Focus on managing the patient's pain with increased NSAID dosage while awaiting surgical consultation.

A patient undergoing arthroscopic labral repair for a significant labral tear and early osteoarthritic changes is preparing for surgery. Which preoperative nursing intervention is most critical to optimize the patient's surgical outcome and postoperative recovery?

C) Ensuring that the patient's inflammation is managed effectively with prescribed medications.

A) Educating the patient about the importance of postoperative pain management strategies.

B) Encouraging the patient to increase caloric intake to promote healing.

C) Ensuring that the patient's inflammation is managed effectively with prescribed medications.

D) Advising the patient to perform high-impact exercises to strengthen the hip joint.

A patient with a significant labral tear and early signs of osteoarthritis in the hip is scheduled for arthroscopic labral repair. Which preoperative nursing intervention is most important to optimize the patient's health before surgery?

C) Administer prescribed anti-inflammatory medications to reduce joint effusion.

A) Educate the patient on postoperative pain management techniques.

B) Initiate a physical therapy regimen to strengthen surrounding hip muscles.

C) Administer prescribed anti-inflammatory medications to reduce joint effusion.

D) Provide dietary counseling to increase calcium and vitamin D intake.

A patient with a labral tear in the hip is undergoing a preoperative assessment and is concerned about managing inflammation before surgery. Which nursing intervention is most appropriate to address the patient's concern and optimize surgical outcomes?

B) Instruct the patient to take NSAIDs as prescribed to reduce inflammation.

A) Encourage the patient to perform high-intensity exercises to strengthen the hip muscles.

B) Instruct the patient to take NSAIDs as prescribed to reduce inflammation.

C) Advise the patient to apply heat packs to the hip to alleviate swelling.

D) Recommend the patient to rest completely and avoid any physical activity until surgery.

A patient scheduled for arthroscopic hip surgery is currently experiencing increased pain and mild inflammation. The healthcare team has prescribed NSAIDs and referred the patient to physical therapy. What is the primary nursing consideration in managing this patient preoperatively?

B) Educate the patient on the importance of adhering to the NSAID regimen to reduce inflammation.

A) Encourage the patient to increase physical activity to enhance joint flexibility.

B) Educate the patient on the importance of adhering to the NSAID regimen to reduce inflammation.

C) Advise the patient to apply heat to the affected hip to alleviate pain and swelling.

D) Recommend complete bed rest to avoid further stress on the hip joint.

A patient scheduled for hip surgery reports increased pain and swelling despite NSAID use and physical therapy. Recent diagnostics show elevated white blood cells in synovial fluid and an MRI indicating increased joint effusion and labral tear. The healthcare team considers starting a corticosteroid taper. What is the primary nursing consideration in the decision to proceed with surgery?

C) The potential for corticosteroids to mask symptoms of infection.

A) The patient's current level of pain control and its impact on her quality of life.

B) The risk of increased infection due to elevated white blood cells in synovial fluid.

C) The potential for corticosteroids to mask symptoms of infection.

D) The patient's adherence to preoperative instructions and physical therapy regimen.

A patient scheduled for hip surgery presents with increased pain, swelling, and a change in gait. Diagnostic imaging indicates a progression of the labral tear and elevated white blood cells in synovial fluid. The healthcare team is considering a corticosteroid taper to manage inflammation preoperatively. Which nursing intervention is most important to prioritize in this scenario?

D) Discuss the potential benefits and risks of delaying surgery with the patient to ensure informed consent.

A) Educate the patient on the side effects of corticosteroids, including potential mood changes and increased appetite.

B) Monitor the patient's vital signs, particularly focusing on temperature and heart rate for signs of infection.

C) Reinforce the importance of continuing physical therapy to maintain joint mobility.

D) Discuss the potential benefits and risks of delaying surgery with the patient to ensure informed consent.

developmental hip dysplasia - Nursing Case Study

Pathophysiology

• Primary mechanism: Developmental hip dysplasia (DHD) primarily involves abnormal formation of the hip joint, where the acetabulum is shallow, impeding proper coverage of the femoral head. This can lead to joint instability, as the head of the femur may not be securely held within the socket, increasing the risk of dislocation.

• Secondary mechanism: Ligamentous laxity, often influenced by genetic factors or maternal hormones, exacerbates hip instability. This increased laxity allows excessive movement of the femoral head within the acetabulum, further contributing to the risk of subluxation or dislocation.

• Key complication: If untreated, DHD can lead to early-onset osteoarthritis due to abnormal joint mechanics, resulting in pain and impaired mobility, significantly affecting a patient’s quality of life. Early diagnosis and intervention are crucial to prevent long-term complications.

Patient Profile

Demographics:

16 years old, female, high school student

History:

• Key past medical history: Diagnosed with developmental hip dysplasia at 3 months old, underwent closed reduction at 1 year old

• Current medications: Ibuprofen as needed for pain

• Allergies: No known drug allergies

Current Presentation:

• Chief complaint: Increasing hip pain and difficulty walking

• Key symptoms: Limping, limited range of motion in the left hip, pain radiating to the knee, occasional clicking sound in the hip

• Vital signs: Temperature 99.1°F, Heart rate 102 bpm, Blood pressure 118/78 mmHg, Respiratory rate 20 breaths per minute

Section 1

New Diagnostic Results:

Following the initial assessment, the patient underwent a series of diagnostic tests to evaluate the current status of her hip joint and identify any new complications. An X-ray of the pelvis revealed that the left acetabulum was shallower than typical for her age, with signs of early degenerative changes suggestive of developing osteoarthritis. The femoral head appeared slightly subluxated, indicating increased instability within the joint. An MRI was subsequently ordered to provide a more detailed view of the soft tissue structures and revealed thinning of the articular cartilage and minor tears in the surrounding labrum. These findings align with the patient's symptoms of increased pain, limited range of motion, and occasional clicking, all of which are consistent with progressive cartilage deterioration and labral damage.

Additionally, a complete blood count (CBC) and erythrocyte sedimentation rate (ESR) were conducted to rule out any inflammatory or infectious processes contributing to her symptoms. The CBC returned within normal limits, but the ESR was slightly elevated at 30 mm/hr (normal range: 0-20 mm/hr), indicating some inflammatory activity likely associated with the degenerative changes observed. These results suggest that the patient's developmental hip dysplasia has progressed, leading to secondary osteoarthritic changes and mechanical instability, necessitating further intervention.

These diagnostic results provide a comprehensive understanding of the patient's current hip condition, guiding the healthcare team in formulating a targeted management plan. Given the early signs of osteoarthritis and labral involvement, the next steps may involve both conservative and potentially surgical options to stabilize the hip joint, reduce pain, and prevent further deterioration. This information sets the stage for careful clinical reasoning and collaborative decision-making to optimize the patient's functional outcomes and quality of life.

Section 2

Change in Patient Status

Several weeks after the initial diagnostic results, the patient, a 28-year-old female, returns to the clinic for a follow-up appointment. She reports that despite adhering to a conservative management plan involving physical therapy and non-steroidal anti-inflammatory drugs (NSAIDs), her symptoms have worsened. She now experiences increased pain that is particularly severe in the mornings and after prolonged activity. The pain is rated at 7 out of 10 on the pain scale, compared to her previous report of 5 out of 10. Additionally, she reports a noticeable limp and increased reliance on a cane for ambulation, indicating a decline in her functional mobility.

On physical examination, the patient exhibits a decreased range of motion in the left hip, with notable difficulty in internal rotation and abduction. There is tenderness upon palpation of the anterior hip joint and a positive FABER (Flexion, Abduction, and External Rotation) test, which further suggests hip joint pathology. Vital signs remain stable with a blood pressure of 120/78 mmHg, heart rate of 78 beats per minute, and respiratory rate of 16 breaths per minute, but her elevated ESR indicates persistent low-grade inflammation. These changes in her clinical status signal a progression of her hip dysplasia and associated osteoarthritic changes, raising concerns about the effectiveness of current conservative treatments.

The healthcare team, considering the patient's deteriorating status, discusses potential adjustments to her management plan. Surgical intervention, such as arthroscopic labral repair or even osteotomy, is now being considered to address the structural abnormalities and prevent further joint damage. The team must weigh the benefits and risks of surgical options, considering the patient's age, activity level, and overall health. This scenario requires careful clinical reasoning to ensure that the chosen intervention aligns with the patient's goals and provides the best opportunity for improved quality of life. The decision-making process is collaborative, involving the patient in discussions about her preferences and expectations for treatment outcomes.

Section 3

Following the consideration of surgical intervention options, the patient undergoes further diagnostic imaging, including an MRI of the left hip. The MRI results reveal a significant labral tear and early signs of osteoarthritis, with cartilage thinning and subchondral sclerosis, which were not as prominent in previous imaging. These findings confirm the progression of structural damage in the hip joint, explaining the increase in pain and functional limitations. Additionally, the MRI highlights a mild effusion in the joint, indicative of ongoing inflammation.

In light of these new diagnostic results, the healthcare team convenes to discuss the implications and refine the patient's management plan. The presence of a labral tear alongside early osteoarthritic changes suggests that conservative management alone may no longer be sufficient. The team proposes a plan to move forward with arthroscopic labral repair, which could address the tear and potentially slow the degenerative process. This decision involves weighing the risks of surgery, including possible complications and recovery time, against the potential for improved joint function and pain relief.

The patient is actively involved in the decision-making process, expressing her desire to regain mobility and reduce pain while maintaining her active lifestyle. She agrees to proceed with the surgical option, understanding the potential benefits and risks. Preoperative preparations are initiated, with a focus on optimizing her health before surgery, including managing inflammation and ensuring appropriate physical conditioning. The team plans for a comprehensive postoperative rehabilitation program to maximize recovery and support her return to daily activities. This collaborative approach underscores the importance of personalized care and aligns the intervention with the patient's long-term goals, setting the stage for the next steps in her treatment journey.

Section 4

As the surgical date approaches, the patient undergoes a preoperative assessment to ensure her readiness for the arthroscopic procedure. During this assessment, her vital signs reveal a blood pressure of 138/86 mmHg, a heart rate of 82 beats per minute, and a temperature of 98.6°F. These values are within normal limits, but the nurse notes that the patient reports increased pain in her left hip, rating it at 6 out of 10 on the pain scale, particularly after prolonged periods of standing. Upon physical examination, there is visible swelling around the hip joint and a mild decrease in range of motion. The patient also describes a catching sensation in the hip, consistent with the labral tear findings.

Laboratory tests are conducted to evaluate her inflammatory status, showing a C-reactive protein (CRP) level of 1.2 mg/dL, indicating mild inflammation, and a normal erythrocyte sedimentation rate (ESR) of 15 mm/hr. These results correspond with the MRI findings of joint effusion but suggest a low-grade inflammatory process. Given these findings, the healthcare team emphasizes the importance of managing inflammation preoperatively to optimize surgical outcomes. The patient is started on a short course of nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and improve her comfort levels before surgery.

In preparation for surgery, the patient is also referred to physical therapy with a focus on gentle range-of-motion exercises to maintain joint mobility and strength. The physical therapist educates her on using assistive devices like crutches to minimize stress on the hip. The multidisciplinary team reinforces the importance of adhering to the preoperative plan, aiming to address the inflammation and manage pain effectively. This approach is designed to enhance surgical success and facilitate a smoother recovery, setting the stage for the next phase of her treatment journey.

Section 5

As the surgical date nears, the patient returns for a follow-up preoperative assessment. She reports that while the NSAIDs have somewhat reduced her pain, she continues to experience significant discomfort, especially during nighttime. Her pain now intermittently spikes to 7 out of 10, disrupting her sleep. Upon examination, the swelling around the hip has slightly increased, and her range of motion at the hip joint remains restricted despite her diligent participation in physical therapy. The nurse notes a subtle change in her gait, reflecting a more pronounced limp, possibly due to pain and mechanical instability in the joint.

New diagnostic imaging, including an updated MRI, reveals an increased joint effusion and a small progression in the labral tear. The synovial fluid analysis indicates an elevation in white blood cells, now at 9,000/mm³, suggesting a more active inflammatory process than previously detected. These findings raise concerns about the potential exacerbation of the inflammatory state just before surgery. The healthcare team decides to adjust her medication regimen, incorporating a corticosteroid taper to more aggressively manage the inflammation, aiming to stabilize her condition.

The multidisciplinary team reassesses the surgical plan, weighing the risks of proceeding with the current level of inflammation against the potential benefits of delaying the procedure to achieve better preoperative control. They engage the patient in this decision-making process, ensuring she understands the implications of each option. This collaborative approach is intended to optimize her surgical outcomes and minimize postoperative complications, setting the stage for her next clinical milestone.