Question

Case Based Experience Prep Work

	Assessment #4b CB: Mobility Scenario
Purpose	To provide students with the opportunity to assess and implement nursing interventions for a postoperative patient with pain, atelectasis, and impaired physical mobility.
Overview	Boyd Dubois is a 58-year-old Caucasian male admitted Wednesday morning for total right hip arthroplasty. He has a 10-year history of osteoarthritis and increased pain over the past 12 months affecting his ability to walk and overall quality of life. After surgery, he was admitted to the inpatient orthopedic unit. He has an abduction pillow in place, a Jackson-Pratt drain at the surgical site with the original surgical dressing, and IV fluids infusing. The scenario takes place on Thursday morning, his first postoperative day.
Skill Review: Please review the following skills.	Vital Sings Head to toe assessment Pain Assessment Medication Administration (IM and subQ) Jackson Pratt Pouch Management Mobility/Immobility
Pharmacology Review: Please review the following medications.	Enoxaparin Lactated Ringers Acetaminophen Hydrocodone Morphine
Questions 1: What is the importance of adequate pain management in postoperative recovery?
Question 2: Boyd Dubois has an order for incentive spirometry. What is the rationale for this intervention?
Question 3: Boyd Dubois has an order for an anticoagulant (enoxaparin) to be administered subcutaneously. What is the rationale for this medication? What are precautions for administration?

Nursing Diagnosis
	For each of the following nursing diagnosis for Mr. Dubois, write a SMART goal.
Impaired physical mobility related to surgical procedure in right hip as evidenced by decreased range of motion in right hip
Impaired gas exchange related to immobility as evidenced by abnormal lung sounds and increased respiratory rate
Acute pain related to hip surgery

Answer 1

Questions 1

Post operative pain management provide patient comfort. In addition, it also enhances speedy recovery and reduce the chances of some of the post operative complications. Immobilization due to pain can lead to pulmonary complications like pneumonia as well as chances of development of thrombosis. Adequate pain management reduce the pain and provide comfort to the patient as well as help the patient to do early mobolization and effective breathing exercise.

Question 2

The patient has undergone total right hip arthroplasty. The expected postoperative pulmonary complications include atelectasis, pneumonia, and pulmonary thromboembolism. Lung expansion excersises like deep-breathing exercises and incentive spirometry can prevent the risk of these type of postoperative pulmonary complications. Incentive spirometry can improve total lung capacity and breath holding time therby reduce the postoperative pulmonary complications.

Question 3

Enoxaparin is an anticoagulant which is prescribed as a thromboprophylaxis agent for this patient as the patient is at high risk for the development of venous thromboembolism (VTE), including deep-vein thrombosis (DVT) and subsequent pulmonary embolism following total right hip arthroplasty.

Bleeding precautions to be taken while administering anticoagulants and blood levels of anticoagulants to be checked frequently. Side effects like nose or gum bleeding, bleeding from the surgical site, blood in urine or stool.