Question

You are the nurse of an 82 years old elderly male in a rehabilitation facility who underwent right hip surgery. please provide a teaching plan to prevent complication for this patient who has impaired physical mobility

Answer 1

Home care

• Take your pain medicine exactly as directed.

• Don’t drive until your healthcare provider says it’s OK. And never drive while taking opioid pain medicine.

• Wear the support stockings you were given in the hospital. Wear them for 24 hours a day for 3 to 4 weeks.

• To relieve discomfort at night, get up and move around.

• Tell all your healthcare providers—including your dentist—about your artificial joint before any procedure. You may need to take antibiotics before dental work and other medical procedures to reduce the risk of infection.

• Arrange to have your staples removed around 2 weeks after surgery. The staples were used to close the skin incision.

Incision care

• Check your incision daily for redness, swelling, tenderness, or drainage.

• Prevent infection by washing your hands often. If an infection occurs, it will need to be treated right away. Call your healthcare provider right away if you think you may have an infection. Symptoms include a fever, chills, redness, warmth or an incision that leaks white, green, or yellow fluid.

• Don't soak your incision in water until your provider says it’s OK. This means no hot tubs, bathtubs, or swimming pools.

• Wait 5 to 7 days after your surgery to start showering. Then shower as needed. Carefully wash your incision with soap and water. Gently pat it dry. Don’t rub the incision, or apply creams or lotions to it. And to prevent falling when showering, sit on a shower stool.

Sitting and sleeping

• Don’t sit for more than 30 to 45 minutes at a time.

• Use chairs with arms, and sit with your knees slightly lower than your hips. Don’t sit on low or sagging chairs or couches.

• Don’t lean forward while sitting.

• Don’t cross your legs.

• Keep your feet flat on the floor. Don’t turn your foot or leg inward. This stresses your hip joint.

• Use a raised toilet seat for 6 weeks after surgery.

• Ask your healthcare provider if it’s OK to sleep on your stomach or on the side that has the new hip. Use pillows between your legs when sleeping on your back or on your side.

• Sit on a firm cushion when you ride in a car and don’t sit too low. Try not to bend your hip too much when getting in and out of the car.

Moving safely

• Don’t bend at the hip when you bend over. Don't bend at the waist to put on socks and shoes. And don't pick up items from the floor.

• Use a cane, crutches, a walker, or handrails until your balance, flexibility, and strength improve. And remember to ask for help from others when you need it.

• Free up your hands so that you can use them to keep balance. Use a fanny pack, apron, or pockets to carry things.

• Follow your healthcare provider’s orders about how much weight to put on the affected leg.

• Walk often and do prescribed exercises as instructed.

• Arrange your household to keep the items you need within reach.

• Remove electrical cords, throw rugs, and anything else that may cause you to fall.

• Use nonslip bath mats, grab bars, a raised toilet seat, and a shower chair in your bathroom.

Follow-up

Make a follow-up appointment as directed by your healthcare provider.

Intervention:

Assist patient for muscle exercises as able or when allowed out of bed; execute abdominal-tightening exercises and knee bends; hop on foot; stand on toes - Adds to gaining enhanced sense of balance and strengthens compensatory body parts.

Present a safe environment: bed rails up, bed in down position, important items close by - These measures promote a safe, secure environment and may reduce risk for falls.

Establish measures to prevent skin breakdown and thrombophlebitis from prolonged immobility:

• Clean, dry, and moisturize skin as necessary.
• Use anti embolic stockings or sequential compression devices if appropriate.
• Use pressure-relieving devices as indicated (gel mattress).

Execute passive or active assistive ROM exercises to all extremities - Exercise enhances increased venous return, prevents stiffness, and maintains muscle strength and stamina. It also avoids contracture deformation, which can build up quickly and could hinder prosthesis usage.

Promote and facilitate early ambulation when possible. Aid with each initial change: dangling legs, sitting in chair, ambulation - These movements keep the patient as functionally working as possible. Early mobility increases self-esteem about reacquiring independence and reduces the chance that debilitation will transpire.

Give positive reinforcement during activity. Patients may be unwilling to move or initiate new activity because of fear of falling - This is to boost the patient’s chances of recovering and to increase his or her self-esteem.

Reinforce principles of progressive exercise, emphasizing that joints are to be exercised to the point of pain, not beyond - No pain, no gain” is not always true! Pain occurs as a result of joint or muscle injury. Further damage is expected if inappropriate movement is continued.

Give explanation about progressive activity to patient - Providing small, attainable goals helps increase self-confidence and reduces frustration.