PATIENTS PROFILE Patients Initials: Age: Birth Date: Gender: Civil Status: Religion: Address: P. P.

55 y/o September 30, 1958 Male Married Roman Catholic Guinobatan, Albay

Chief Complaint: Admission Date:

Pain and inability to move left hip January 17, 2014; 6:29 PM

Medical Diagnosis:

Fx close, complete Displaced Femoral neck Bipolar Hip Arthroplasty January 22, 2014

Surgery: Scheduled Date:

HISTORY OF PRESENT ILLNESS Patient had a history of fall (November 18, 2013) sustaining injury. Consult done, advised as, hence scheduled. LABORATORY RESULTS

SGOT/AST
Normal Range: up to 40 Results: 56.2 U/L

SGOT/AST
An aspartate aminotransferase (AST) test measures the amount of this enzyme in the blood. AST is normally found in red blood cells, liver, heart, muscle tissue, pancreas, and kidneys. AST formerly was called serum glutamic oxaloacetic transaminase (SGOT). Serum Glutamic Oxaloacetic Transaminase, called: AST, (Aspartate Aminotransferase) A blood chemistry test for the level of SGOT in blood (is released with tissue necrosis). This enzyme shows an elevation 8-12 hours after infarction. Peak levels are reached 24-48 hours after the MI. This enzyme is not particularly indicative of an MI. Other conditions can also cause a rise in the levels. High levels of SGOT may be obtained with trauma to the skeletal muscles, in liver disease, pancreatitis and others. SGOT is found in: heart muscle, liver, some also in skeletal muscle, kidneys and the pancreas. Demerol and morphine may elevate the levels temporarily. This enzyme then is used with other enzyme results to more definitely diagnose the MI. AST levels elevate in 6-10 hours following acute MI. They peak in 24 to 48 hours. Please note that decreased levels of enzyme are found in pregnancy, diabetic ketoacidosis, beriberi. Elevations can be caused by hepatitis, trauma, musculoskeletal disease, IM injection, pancreatitis, liver cancer, and strenuous exercise. Explain purpose of test to patient Do not give IM injections before the blood tests; and if serial specimens are taken, still give no IM injections, remember that very few meds can be given that do not affect the AST levels. Useful For Diagnosing and monitoring liver disease, particularly diseases resulting in a destruction of hepatocytes Clinical Information Aspartate aminotransferase (AST) is found in high concentrations in liver, heart, skeletal muscle and kidney. AST is present in both cytoplasm and mitochondria of cells. In cases involving mild tissue injury, the predominant form of AST is that from the cytoplasm. Severe tissue damage results in more of the mitochondrial enzyme being released. High levels of AST can be found in cases such as myocardial infarction, acute liver cell damage, viral hepatitis and carbon tetrachloride poisoning. Slight to moderate elevation of AST is seen in muscular dystrophy, dermatomyositis, acute pancreatitis and crushed muscle injuries. Normal Results Normal ranges for the AST are laboratory-specific, but can range from 3-45 units/L (units per liter).

Abnormal Results Striking elevations of AST (400-4000 units/L) are found in almost all forms of acute hepatic necrosis, such as viral hepatitis and carbon tetrachloride poisoning. In alcoholics, even moderate doses of the analgesic acetaminophen have caused extreme elevations (1,960-29,700 units/L). Moderate rises of AST are seen in jaundice, cirrhosis, and metastatic carcinoma. Approximately 80% of patients with infectious mononucleosis show elevations in the range of 100-600 units/L. Interpretation Elevated aspartate aminotransferase (AST) values are seen in parenchymal liver diseases characterized by a destruction of hepatocytes. Values are typically at least 10 times above the normal range. Levels may reach values as high as one hundred times the upper reference limit, although twenty to fifty-fold elevations are most frequently encountered. In infectious hepatitis and other inflammatory conditions affecting the liver, alanine aminotransferase (ALT) is characteristically as high as or higher than AST, and the ALT/AST ratio, which normally and in other condition is <1, becomes greater than unity. AST levels are usually elevated before clinical signs and symptoms of disease appear. Five- to 10-fold elevations of both AST and ALT occur in patients with primary or metastatic carcinoma of the liver, with AST usually being higher than ALT, but levels are often normal in the early stages of malignant infiltration of the liver. Elevations of ALT activity persist longer than do those of AST activity. Elevated AST values may also be seen in disorders affecting the heart, skeletal muscle and kidney.

SGPT/ALT
Normal Range: up to 42 Results: 53.4 U/L

Alanine transaminase (ALT) is an enzyme found in the highest amounts in the liver. Injury to the liver results in release of the substance into the blood. An alanine aminotransferase (ALT) test measures the amount of this enzyme in the blood. ALT is found mainly in the liver, but also in smaller amounts in the kidneys, heart, muscles, and pancreas. ALT was formerly called serum glutamic pyruvic transaminase (SGPT). ALT is measured to see if the liver is damaged or diseased. Low levels of ALT are normally found in the blood. But when the liver is damaged or diseased, it releases ALT into the bloodstream, which makes ALT levels go up. Most increases in ALT levels are caused by liver damage. The ALT test is often done along with other tests that check for liver damage, including aspartate aminotransferase (AST), alkaline phosphatase, lactate dehydrogenase (LDH), and bilirubin. Both ALT and AST levels are reliable tests for liver damage.

How the Test is Performed A blood sample is needed. This may be taken from a vein. The procedure is called a venipuncture. Why the Test is Performed This test is used to determine if a patient has liver damage. Normal Results The normal range is 10 to 40 international units per liter (IU/L). The normal range depends on many things, including your age and gender. Normal value ranges may also vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results. The example above is the common results for these tests. Some laboratories use different measurements or may test different samples. What Abnormal Results Mean Increased levels of ALT often means that liver disease is present. Liver disease is even more likely when levels of other liver blood tests are also increased. An increase in ALT levels may be due to:

Cirrhosis (scarring of the liver) Death of liver tissue (liver necrosis) Hepatitis Hemochromatosis Lack of blood flow to the liver (liver ischemia) Liver tumor or cancer Medications that are toxic to the liver Mononucleosis ("mono") Pancreatitis (swollen and inflamed pancreas)

Other Labs: CBC, U/A, CP X-ray did not show any significant findings

PELVIC XRAY

SURGICAL MANAGEMENT

TOTAL HIP ARTHROPLASTY Arthroplasty of the hip may be categorized as a total hip arthroplasty or a hemiarthroplasty. In a total hip arthroplasty, the articular surfaces of both the acetabulum and femur are replaced. This involves either replacement of the femoral head and neck or replacement of the surface of the femoral head, sparing the remainder of the head and neck in order to preserve bone stock (resurfacing total hip arthroplasty) (see the images below); both procedures also replace the acetabulum. A total hip replacement (total hip arthroplasty) consists of replacing both the acetabulum and the femoral head while hemiarthroplasty generally only replaces the femoral head.

Image from a patient who had a normal Resurfacing Total Hip Arthroplasty. This anteroposterior radiograph shows the femoral (metal head and stem) and acetabulum components (metal, cementless). Note the large femoral head and the preserved femoral neck.

Image from a patient who had a normal unipolar Hemiarthroplasty (same patient as in the previous image). This frog-leg radiograph shows the femoral component of the unipolar hemiarthroplasty (metal, cementless). Note the normal sclerotic bone of the acetabulum (which indicates no surgical reaming) and the normal lucent hyaline cartilage between the acetabulum and the femoral head (arrow).

What not to do after hip surgery Do not force hip into greater than 90 degrees of flexion Do not force into adduction Do not force hop into internal rotation Do not cross legs Do not put on shoes or stockings until 8 weeks after surgery without adaptive device Do not sit on chairs without arms to aid rising to a standing position.

What you should do after hip surgery Use toilet elevator on toilet seats. Place chair inside shower or tub and remain seated while you wash. Use pillow between legs for 8 weeks when lying on the good side or when supine. Keep hip in neutral , straight position when sitting, walking or lying. Notify surgeon of severe pain, deformity or loss of function. Inform dentist of presence of prosthesis before dental work so that antibiotics can be given. NURSING DIAGNOSES Impaired physical mobility related to surgical procedure Pain related to edema from surgery site High risk for infection related to surgical procedure Impaired skin integrity related to immobility and to surgical procedure