Second case study

March 7 – Case Study #2

Background of Mrs. Smith’s hip replacement surgery

Mrs. Smith is an 88-year-old female who underwent total hip replacement surgery due to a fall.
She has a history of hypertension and osteoporosis. Mrs. Smith lives alone and has limited
mobility due to hip pain and stiffness prior to surgery. She has had repeated falls prior to her
current admission. She was admitted to the orthopedic surgical unit and is now postoperative
day 1 after her surgery.

Assessment of Mrs. Smith’s hip replacement surgery

· Mrs. Smith is alert but confused to place and time, she reports pain at the surgical site rated
7/10 on the pain scale.

· Vital signs: Blood pressure 140/90 mmHg, heart rate 88 bpm, respiratory rate 18 bpm,
temperature 37.5°C.

· Surgical incision: 15 cm incision over the lateral aspect of the right hip, with moderate
serosanguinous drainage.

· Limited weight-bearing status on the right leg as per surgeon's orders.

· Foley catheter in place for urinary drainage.

· Serosanguinous drainage in the surgical drain.

Evaluation of Mrs. Smith’s hip replacement surgery

· Mrs. Smith’s pain is not well managed, with her pain level remaining around 7/10 on the pain
scale within 24 hours post-surgery.

· Mrs. Smith has difficulty performing transfers and ambulation with appropriate assistive
devices as per the prescribed weight-bearing status.

· There are no signs of infection at the surgical site or systemic infection.

· Mrs. Smith is showing worsening confusion heading into the evening, she is agitated and
repeatedly attempting to climb out of bed.
Scenario Questions

1. What are the priority nursing diagnoses for Mrs. Smith?

● Acute pain from surgical incision

● Falls risk from post operative status and limited weight bearing status
○ Like confusion etc anythings possible
● Risk for infection from surgical wound and foley cath

2. What are the nursing interventions to address Mrs. Smith’s acute pain?

● Administering analgesic medication to reassess pain

● Using non pharmacological pain management techniques like repositioning heat or cold
therapy

3. What nursing interventions can be implemented to prevent infection in Mrs. Smith?

4. What could be causing Mrs. Smith’s new/worsening confusion?

5. What are some safety concerns for Mrs. Smith? How would we address these concerns