A Practical Guide to Hip Surgery: From Pre-Op to Recovery by M. E. Hecht, North Branch, MN, 2011; An Introduction to Orthopaedic Nursing 4th Edition, edited by Cindi M. Mosher and published by National Association of Orthopaedic Nurses, Chicago, IL, 2010.
Two newly published books were reviewed with one being directed toward the patient population and the other toward the orthopaedic nursing population. Although both are highly informative resources, the writing and delivery of content differs greatly. Whether academic or patient directed, both publications reviewed were found to be useful in advancing the field of orthopaedics and standards of patient care.
A Practical Guide to Hip Surgery
The first book reviewed titled A Practical Guide to Hip Surgery: From Pre-Op to Recovery by M. E. Hecht, MD, was written to assist prospective surgical patients in understanding and preparing for surgery. Surgical intervention is an important decision. There are many resources available for patients seeking health information, but between the internet (which can be highly unreliable) and medical publications (which tend to be overwhelming) some may have a difficult time finding a quality source to. This publication guides the prospective total hip replacement (THR) or Hip Resurfacing (Resurf) patient from beginning to end to aid them in their surgical journey. This book is directed toward "the astounding 450,000 people who undergo hip replacements annually in the United States" (p. 4). Chapters reviewed include My Story, How You Know It's Your Hips, The Decision to Have Surgery, Total Hip Replacement and Resurfacing Step by Step, Complications, Choosing Your Medical Team and Scheduling Surgery, Pre-surgery, In the Hospital, Before You Go Home, The First Few Months, and Odds and Ends.
The beginning of this guide starts with an introduction of the author, Dr. Mary Ellen Hecht, who is an orthopaedic surgeon practicing in New York City. She found herself in the reversed role of patient after performing THRs for many years. After a long course of conservative treatment along with other medical issues, Dr. Hecht was ready to undergo a double THR. She had been a teacher of hip surgery and now found herself as a patient undergoing the same procedure she had been doing for so many years. This experience inspired her to share her knowledge, thoughts, tips, and experiences through the journey of being a knowledgeable surgical patient.
The publication assists readers in recognizing the signs and symptoms that often lead to hip surgery and helps patients in deciding whether surgery is for them. The author breaks down and describes the disease processes that cause hip symptoms often leading to surgical intervention. Osteoarthritis, traumatic arthritis, autoimmune disorders, gout, and hematological problems are all listed as causes for hip arthritis, which often leads to THRs and Resurf's. No matter the cause, Dr. Hecht states, "if the condition has progressed to the point that symptoms dominate your life, it is time for surgery" (p. 19). Ploys, such as deferment and evasion, which people use to avoid surgery were addressed. The author describes deferment tactics (such as hip arthroscopy, medication, and activity modification) and evasion (such as steroid injections and glucosamine/cohondroitin sulfate) as different ways people often avoid surgical intervention. The author tends to make conservative interventions to surgery sound extremely temporary but does support the "You tell me when you're ready for surgery" standpoint. Questioning surgery is also acknowledged and encourages prospective patients to receive second and third opinions regarding the need for surgical intervention.
Basics of surgery are discussed and the common questions asked by patients before undergoing surgery are addressed. This easy-to-read guide goes over incision size and location, surgical procedures, antibiotic usage, Foley catheter insertion, use of blood products intraoperatively, and other processes to expect in surgery. These standards of care are often routine to healthcare professionals but can be overwhelming and unknown to many patients. Each step is explained in detail with medical reasoning for each intervention. There is clarification between the two surgical procedures, THRs and resurfacing, throughout this publication. Charts are used as visuals to show the differences between THRs and Resurf's. Appropriate candidates for each are based on factors such as age, gender, and other health conditions. Risks and complications of surgery are described in detail along with the intraoperative and postoperative precautions taken by the surgeon to prevent these problems from occurring. One example given was the use of sequential compression devices, TED hose, anticoagulation administration, and passive range of motion to prevent blood clots and pulmonary emboli. Included in these sections are some questions that the surgeon should be asked. For example, what his or her specific infection rate is and what specific precautions will be taken against infection.
Prospective patients are assisted on how to find the surgeon that is right for them and how to be organized before entering the hospital. Dr. Hecht supports referrals from internists, intranet searches, and taking into account years of experience. Asking the chosen surgeon to provide the name of previous patient who underwent the same operation is encouraged. Second opinions, weight loss, "prehab," research, and insurance coverage should be discussed and settled ahead of time. These chapters also cover ideas in preparing a "hip proof house," which will be beneficial and safe for postoperative recovery. Simple To Do List's are listed for 6-8 weeks preoperation, 2-3 weeks preoperation, 1 week preoperation, and the night before surgery.
People tend to handle stress better with education and preparation. This guide covers what to expect during the hospitalization period. From admission to discharge, all aspects of care are addressed in detail. Descriptions are given regarding what procedures will occur, where procedures will occur, and why these procedures are necessary. These in-depth bullet point lists prepare prospective patients for everything from hospital equipment, therapeutic activities, and pain management to rehabilitation and discharge. Along with easy-to-read lists, there are pictures with directions for safe "posthab" exercises that should also be reinforced by physical therapy. Differences between postoperative THRs and Resurf's are delineated.
Going home without around-the-clock medical care can be not only an exciting time but also of anxiety and doubt. The end of this guide covers the first few months at home along with questions people often have postoperatively. Do's and don'ts are outlined and is crucial information that should be reiterated by the patients' primary surgeon and/or staff. Questions regarding sex, travel, metal detectors, and follow-up office visits are common questions posed to care providers and answered in the final chapters.
This resource contains a 15-page Hip Surgery Organizer at the back of the book that includes check-off lists, medication lists, exercise logs, question to ask your surgeon, important names and numbers, and a resource list. This useful feature, as well as an easy-to-use CD that is included with the guide, keeps patients organized and makes sure that they are as prepared as possible for their upcoming THR or Resurf. The Latin phrase used by Dr. Hecht to describe the essence of this guide is vade mecum, meaning "go with me." She wrote this in hopes that "you pack this companion book when you leave for the hospital and keep it with you during your hip replacement or resurfacing experience and recovery" (p. 6). A Practical Guide to Hip Surgery is easy to read, easy to comprehend, and full of useful concrete medical information. Although directed toward the prospective surgical patient, this publication will be useful for practicing nurses, practitioners, and assistants who engage in patient teaching and surgical preparation.
An Introduction to Orthopaedic Nursing, 4th Edition
The second resource titled An Introduction to Orthopaedic Nursing, 4th edition, comes from the National Association of Orthopaedic Nurses. This scholarly text was written and reviewed by various registered nurses, nurse practitioners, and physical therapists from all over the United States. This book is directed toward novice nurses as well as seasoned nursing professionals with the main purpose of "providing an overview of basic anatomy, common conditions, nursing assessment and nursing care" (p. iv). There are nine chapters based on several learning objectives with key terms and their definitions. An index is included for easy navigation while reviewing content.
The beginning of this text starts with the basics of musculoskeletal anatomy and its relation to the neurovascular system. "Vascular structures and nerves are close to bone and therefore often traumatized simultaneously," which makes it imperative for nurses to be knowledgeable on both systems (p. 2). After covering the basics, there are five chapters that separate the body into specific groups: upper extremity, spine, knee, hip/foot/ankle, and trauma. Each chapter starts with basic anatomy and understanding on the specific joint. Common conditions, symptoms, physical examination, imaging, and treatments (both conservative and surgical) are discussed in detail for each body structure covered. After building an understanding of these conditions, the nursing considerations at the end of the chapters are helpful in determining what common themes emerge when caring for each specific patient population. For example, nurses caring for patients who undergo anterior cervical spine surgery should be aware that difficulty swallowing is common postoperatively, but airway obstruction due to a hematoma formation is a concern and is an emergent situation. These considerations for nursing care are extremely educational and necessary for the staff caring for the orthopaedic population.
Within the specific chapters, common surgical interventions are listed. There are pictures of injuries as well as pictures and explanations of the indicated surgical correction. One important factor noted are pictures of medical equipment utilized, such as casts, braces, external fixation, and traction. This prepares nurses for what to expect and how to manage this equipment. This knowledge is necessary in that nurses are most often the ones to prepare and educate the family on how to handle the equipment when they are discharged home.
There is often one commonality between all of these different orthopaedic conditions and that is pain. There is a whole chapter focusing solely on pain management for people with different kinds and sources of pain. A proper pain assessment is described in this chapter and reiterates what is drilled into the heads of nurses everywhere in that "pain is what the experiencing person says it is" (p. 106). All of the influences on pain such as physical, emotional, social, and spiritual factors are covered so that nurses can tend to all these different aspects when trying to achieve adequate pain control for their patients. Different types of medications, side effects, dosages, and contraindications are listed out in a table format for easy reading, although looking in a pharmacology book would be recommended in everyday usage. Information regarding nonpharmacologic pain management and modalities is noted and specifies which modalities are appropriate for which condition. For example, electromagnetic therapy is helpful with osteoarthritic knees but has no impact on neurogenic pain. It was appreciated that geriatric considerations were noted in this section as well.
The final chapters reviewed covered body mechanics, mobility techniques, and postsurgical precautions. This essential information regarding technique affects both patients' and caregivers' well-being. Proper handling of orthopaedic patients can significantly reduce work-related injury and is therefore crucial in nursing education. Safe transfer and lifting techniques, for both staff and patients, are outlined with pictures and charts. Devices such as slide boards, walkers, crutches, and adaptive equipment are displayed and described for appropriate use. Along with transfer and devices, body alignment precautions are crucial in patient safety. These precautions are listed for different orthopaedic conditions such as total hip arthroplasty, hip fracture, total knee arthroplasty, shoulder surgery, and spine surgery. For example, total hip arthroplasty patients should avoid crossing legs or ankles and keep pillows in between their legs (p. 157). This information helps nurses become competent and confident in patient care and safety. Being knowledgeable on these safety precautions helps build trust with both patients and covering surgeons and their healthcare team.
With shorter hospital stays, nurses need to reinforce self-care and patient education. This text provides nurses with expert knowledge and the proper tools to provide top-notch care to the large spectrum of orthopaedic patients. With a text published by a national organization and information from various well-known professionals, this resource is reliable and a thorough scholarly introduction to orthopaedic nursing.