• Category:
  • Document type:
    Case Study
  • Level:
  • Page:
  • Words:

Nursing Care Of a Patient

Nursing Care Of a Patient

Patient Teaching; Post-Operative Breathing Exercises and Movement Restrictions

Poor surgical outcomes in the elderly are directly proportional to post-operative complications, a reality necessitating institution of evidence-based interventions to minimize complications, especially in elder patients. At 63 years of age, Gill is elderly which necessitates careful consideration for her plan of care in maximizing chances for a positive surgical outcome. Post-operative breathing exercises are critical for elderly surgical patients considering that postoperative pulmonary complications represent a considerable percentage of risks associated with anesthesia and surgery. Further, pulmonary complications occasion postoperative incapacitation, transience as well as extended hospital admission [ CITATION Sha091 l 1033 ].

Restricted movement is an expected outcome of the surgery, where a return to ambulation as was before the surgery requiring patience. Postoperative rehabilitation for Mrs. Gill’s hip surgery entails a restriction on weight-bearing, rotation and general movements of her hip area. Maximum recommended weight bearing capacity is 20 pounds accompanied by 8 to 12 to hours of unremitting passive movement. Physiotherapy is targeted to restore passive movements, trailed by active movements while strength exercises come last (Cecconi et al., 2011).

In managing postoperative pulmonary complications, implementation of several modifications in Mrs. Gill’s life is necessary, including smoking cessation, physical therapy incorporating breathing exercises as well as nutrition consisting of low albumin concentration. However, postoperative analgesia remains the principal measure in the prevention of postoperative pulmonary complications. Epidural/ intravenous patient-controlled analgesia appear to be superior to on demand opioids delivery in the in PPCs management. A combination of lung expansion measures such as spirometry, chest therapy, and deep breathing exercises have proved beneficial to patients in comparison to no therapy at all [ CITATION HuS09 l 1033 ].

Similarly, Mrs. Gill’s knowledge of the necessary movement restrictions is important in facilitating full recovery and return to normal ambulation. Measures implemented seek at joint protection, where avoidance of active lifting, flexing, or rotating the hip for a minimum of two weeks is recommended. Given that she lives alone, assistance from a caretaker is crucial in changing positions for the first week of surgery. Weight restrictions, as well as brace use, are important aspects of rehabilitation, where the assistance of the nurse is critical in ensuring proper use.

Mrs. Gill’s Post-operative Plan of Care

Pains, as well as a restricted movement, are two of the expected effects following Mrs. Gill’s surgery. Far-reaching tissue damage during major operations such as elective hip arthroplasty leads to alterations in the central, peripheral as well as sympathetic nervous systems. Further, the endocrine system is also affected, where catabolic hormones are released into the system including cortisol, glucagon, as well as growth hormone. The sum of these actions leads to reduced immunity, an elevated oxygen demand, as well as increased pressure on the cardiovascular system (Cecconi et al., 2011). Additionally, and given the importance of the hip joint in facilitating ambulation, Mrs. Gills postoperative plan of care must consider some restrictions in facilitating uneventful rehabilitation. Nonetheless, evidence-based care recommends for a swift return to physical activity for the patient, in turn facilitating a swift return to health for the patient. Sporting activities are not recommended, however, until after the third month after surgery[ CITATION HuS09 l 1033 ]. Conduct for Mrs. Gill’s postoperative care should occur while she is laid on her back to avoid putting pressure on the replaced hip joints. Further, I would advise her to sit in an upright position, avoiding bending more than 90 degrees. Seats should be high, placing the hips higher than the knees. Additionally, legs should never be crossed either at the knees or the ankles, legs apart being the recommended posture. Finally, twisting of the hip during the recovery period might place strain on the used tissue[ CITATION Kor12 l 1033 ].

Mrs. Gill’s Medication

Acute joint pain, stiffness, and swelling are common complications associated with advanced osteoarthritis, a reality necessitating the prescription of pain relieving medication for patients with arthritis. Mrs. Gill has a history of acute pain around the hip area because of the osteoarthritis, which has resulted in her receiving a prescription for diclofenac orally. Derry, Derrym Moore, and McQuay (2009) explained an oral diclofenac dose as an effective treatment for relieving moderate to acute pain normally caused by damage to body tissues. According to Derry, Derrym Moore, and McQuay (2009), medical personnel prescribes non-steroidal anti-inflammatory drugs such as diclofenac due to their ability to prevent the synthesis of thromboxanes, and prostaglandins by inhibiting the enzyme cyclooxygenase. The pain resulting from the narrowing of the joint space in the hips and bone spurring is the major reason behind prescribing oral diclofenac for Mrs. Gill. The use of diclofenac before and after surgery may, however, present problems including excessive bleeding due to platelet aggregation inhibition (Derry, Derry, Moore, & McQuay, 2009). One of the nursing responsibilities that should be taken after prescription of diclofenac includes regular observations for any bleeding signs such as blood in urine or bleeding gums. Continous diclofenac use may also result in liver injury; therefore, necessitating regular lab test to ensure healthy liver functioning.

Treatment of osteoarthritis involves the use of natural supplements such chondroitin and glucosamine. Gill has been using these two supplements to help with the osteoarthritis symptoms while at home; therefore, prompting medical personnel at the hospital to prescribe a combination of the supplements before and after the surgery. Matsuno et al. (2014) explained glucosamine and chondroitin to result in reduced progression of arthritis by repairing damaged articular cartilages in patients. According to Matsuno et al. (2014), the administration of these two sugar supplements results in reduced swelling and joint pain among patients suffering from osteoarthritis. The use of glucosamine has however been linked to reduced metabolism of sugars in the body. Dostrovsky, Towheed, Hudson, and Anastassiades (2011) reviewed past literature on the effects of glucosamine supplements and reported alteration of glucose metabolism among humans and other animals. Although Gill is not diabetic, it is important for the registered nurse to considered the effects of glucosamine on her glucose metabolism. Regular blood sugar tests while Gill is in the hospital should help to assess the rate at which the glucosamine inhibits Gill’s sugar absorption.

Hip replacement surgery often comes with the risk of developing venous thrombosis, which is characterised by clotting of blood due to restricted leg movement. Enoxaparin is a common drug prescribed to patients to help prevent blood clotting in the leg blood vessels. Gill’s is set to receive a Subcutaneous enoxaparin injection four hours after the surgery. Prescription of this drug is mainly aimed at preventing pulmonary blockage, which may arise due to the blood clot travelling to the heart or lungs. Sobieraj et al. (2012) conducted a review of the most common treatment methods used to deal wth venous thrombosis especially after instances of hip surgery. The report explained the subcutaneous enoxaparin as an effective drug for dealing preventing blood clots a few days after surgery. Prolonged use of enoxaparin may, however, result in increased risks of the patient bleeding; therefore, the constant need to always monitor the patient. Gill’s wounds will need to be increased supervision for the first few days after the surgery.

Gill’s nursing plan works towards several discharge goals whereby complications arising from surgery are avoided/ reduced, increased mobility, control and relief from pain, understanding prognosis, diagnosis as well as an understanding therapeutic regimen while instituting a planning meeting needs after discharge. The prepared plan of care addresses various facets of Gill’s health, recommending interventions in reaction to risks inherent to the condition.

Risk for Infection

Risk factors include a limitation in primary defenses following incision of the skin as well as joint exposure. Further, secondary defenses are suppressed predicting extended corticosteroid use as well as compromised ambulation. The desired outcome of this intervention involves proper healing of the wound while ensuring that it is free of pus as well as be afebrile[ CITATION Mac09 l 1033 ]. Nursing interventions sought in minimizing risk of infection include patient and staff sterilization, using sanitary techniques in changing dressings or in handling erythema and drainage. Regular assessment of the incised area helps in identifying early infection, thus helping in its control. Elevated temperatures could as well indicate infection, and intervention is critical in managing osteomyelitis, sepsis as well as necrosis and implant failure. Sufficient fluids should be administered, in addition to a high protein diet-aiding tissue perfusion as well as cell growth and regeneration in the healing process. Protective isolation will be of importance in the plan of care, where initial contact with sources of infection is discouraged. An appropriate antibiotics administration both in the operating room as well as during the first 24 hours is essential in reducing chances of infection.

Risk for Peripheral Neurovascular Dysfunction

The potential for neurovascular dysfunction emanates from orthopedic surgery as well as mechanical compression from stabilizing devices such as cast or braces, causing vascular blockade and immobilization. The desired nursing outcomes, in this case, pertain to maintained function as relating to sensation and movement. Further, the patient should demonstrate tissue perfusion identifiable by discernible pulses, swift capillary refill, normal skin coloration as well as a warm and dry skin manifestation.


Cecconi, M., Fasano, N., Langiano, N., Divella, M., Costa, M. G., Rhodes, A., & Rocca, G. D. (2011). Goal-directed haemodynamic therapy during elective total hip arthroplasty under regional anaesthesia. BioMed Central. doi:10.1186/cc10246

Derry, P., Derry, S., Moore, A., & McQuay, H. J. (2009). Single dose oral diclofenac for acute postoperative pain in adults. Cochrane Database Syst Rev, 7. Retrieved from

Dostrovsky, N., Towheed, T., Hudson, R., & Anastassiades, T. (2011). The effect of glucosamine on glucose metabolism in humans: a systematic review of literature. Osteoarthritis and Cartilage, 375-380. Retrieved from

Hu, S., Zhang, Z.-Y., Hua, Y.-Q., Li, J., & Cai, Z.-D. (2009). A comparison of regional and general anaesthesia for total replacement of the hip or knee. The Bone and Joint Journal, 91B(7), 935-944. Retrieved from

Korean Knee Society. (2012). Guidelines for the Management of Postoperative Pain after Total Knee Arthroplasty. Knee Surgery and Related Research, 24(4), 201-207. Retrieved from

M, T., T, W., J, G., C, Z., Z, F., & X, G. (2016). HEMOSTASIS EFFECT OF COMPRESSION DRESSING THERAPY AFTER TOTAL HIP ARTHROPLASTY. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi., 30(4), 416-420. Retrieved from

Macfarlane, A. J., Prasad, G. A., Chan, V. W., & Brull, R. (2009). Does regional anaesthesia improve outcome after total hip arthroplasty? A systematic review. British Journal of Anaesthesia, 103(3), 335-345. doi:10.1093/bja/aep208

Matsuno, H., Nakamura, H., Katayama, K., Hayashi, S., Kano, S., Yudoh, K., & Kiso, Y. (2014). Effects of an Oral Administration of Glucosamine-Chondroitin-Quercetin Glucoside on the Synovial Fluid Properties in Patients with Osteoarthritis and Rheumatoid Arthritis. Bioscience, Biotechnology, and Biochemistry, 288-292. Retrieved from

McNaught, H., Jones, T., Immins, T., & Wainwright, T. W. (2015). Patient-reported importance of assistive devices in hip and knee replacement Enhanced Recovery after Surgery (ERAS) pathways. British Journal of Occupational Therapy. doi: 10.1177/0308022616656194

Sharma, V., Morgan, P. M., & Cheng, E. Y. (2009). Factors Influencing Early Rehabilitation After THA: A Systematic Review. Clinical Orthopaedics and Related Research, 467(6), 1400-1411. Retrieved from

Sobieraj, D., Coleman, C., Tongbram, V., Lee, S., Colby, J., Chen, W., . . . White, C. (2012). Venous Thromboembolism Prophylaxis in Orthopedic Surgery. Hartford, CT: Agency for Healthcare Research and Quality.