Clinical Scenario: Postoperative Care for a Total Hip Replacement Patient
In this scenario, you are a registered nurse assigned to care for Mrs. Johnson, a 68-year-old female patient, who has just undergone a
total hip replacement surgery. As the primary nurse, you are responsible for her postoperative care during her stay in the hospital. This includes pain management, monitoring for complications, assisting with mobility, and educating the patient and her family on postoperative care.
Initial Assessment
Upon receiving Mrs. Johnson from the recovery room, your first task is to perform a comprehensive
initial assessment. This includes checking her vital signs, which are currently stable: blood pressure 128/76 mmHg, heart rate 82 beats per minute, respiratory rate 18 breaths per minute, and oxygen saturation 97% on room air. You also assess her surgical site, which shows minimal drainage with the dressing intact. Mrs. Johnson is awake and alert but reports a pain level of 8 out of 10.
Pain Management
Pain management is crucial in postoperative care. You administer the prescribed analgesic, 4 mg of morphine IV, and reassess her pain level 30 minutes later. Mrs. Johnson now reports a pain level of 3 out of 10. You also educate her on the use of the
Patient-Controlled Analgesia (PCA) pump, ensuring she understands how to use it effectively to manage her pain.
Monitoring for Complications
Postoperative patients are at risk for various
complications. You closely monitor Mrs. Johnson for signs of infection, evidenced by increased redness, swelling, or discharge at the surgical site, and systemic signs such as fever. You also monitor for signs of a deep vein thrombosis (DVT), including calf pain, swelling, or redness, and ensure she wears compression stockings and performs ankle exercises to promote circulation.
Mobility and Physical Therapy
Early
mobilization is essential to prevent complications such as DVT and pneumonia. You assist Mrs. Johnson in sitting up on the edge of the bed with the help of a physical therapist. She progresses to standing and taking a few steps with a walker. You provide continuous encouragement and ensure she follows the
weight-bearing restrictions as prescribed by her surgeon.
Patient Education
Education is a critical component of nursing care. You educate Mrs. Johnson and her family on
postoperative care including the importance of pain management, signs of complications, and the need for physical therapy. You also teach them how to care for the surgical site at home, the importance of maintaining a healthy diet to promote healing, and the need for follow-up appointments.
Discharge Planning
Effective
discharge planning ensures a smooth transition from hospital to home. You collaborate with the interdisciplinary team, including the surgeon, physical therapist, and social worker, to develop a comprehensive discharge plan. This includes arranging for home healthcare visits if necessary, ensuring Mrs. Johnson has the necessary equipment such as a walker, and providing written instructions on medication management and follow-up care.
Conclusion
Through comprehensive assessment, effective pain management, vigilant monitoring for complications, assistance with mobility, patient education, and thorough discharge planning, you play a vital role in Mrs. Johnson's recovery. Your holistic approach not only addresses her physical needs but also provides emotional support, ensuring she feels confident and prepared for her recovery journey at home.
