Question

Scenario: You are working on the postoperative surgical unit and admitted Mrs. X, a 58-year-old client with a history of obesity, hypertension, hypothyroid and sleep apnea. Mrs. X who lives independently at home falls and sustains a fractured right hip. The client will have an open reduction and internal fixation (ORIF) of the right hip this afternoon. Her preoperative weight was 190 pounds (86 kg), and she is 5 feet, 5 inches (165 cm) tall. CASE STUDY PROGRESS: On postoperative day 2, Mrs. X is refusing to get out bed to ambulate or to transfer to the bedside recliner. She is requesting to be left alone and lie in bed all day.

1. List at least 3 interventions you should encourage for the immobile patient with risk for postsurgical complications.

2. What are the 3 risk factors associated with immobility and bed rest after surgery?

3. What other postoperative complications is this client at most risk for experiencing? What is the physiological basis for the development of each complication?
4. What education should you give to Mrs. X about the importance of using the incentive spirometer (IS)?

Answer 1

INTERVENTIONS YOU SHOULD ENCOURAGE FOR IMMOBILE PATIENTS :

a . Turn and reposition the patient every two hours to prevent bed sores.

b. Elevate the head end to 30 degrees unless contraindicated.

c. Encourage the patient to do incentive spirometry as exercise for lungs.

d. Advice physiotherapist who helps the patient to do range of motion exercises in the extremities which prevents further thrombus formation.

RISK FACTORS ASSOCIATED WITH SURGERY AND BED REST :

1. Thrombus formation in the extremities.

2. Decreased lung function.

3 . Risk for loss of bone mass.

4. Pulmonary embolism risk.

RISK OF POST OPERATIVE COMPLICATIONS :

1. Venous thromboembolism disease : Lack of movement post operatively causes slow movement of blood which results in clot formation and cause venous thrombosis.

2. Sepsis : Surgical procedure involves in exposure to microorganisms which may cause infection and if left untreated can result in sepsis.

3. Bleeding : Bone related surgery involves blood loss which can lead to heavy bleeding depleting the blood levels.

4. Anemia : Heavy levels of blood loss can result in anemia. Therefore, blood is arranged prophylactically inorder to prevent complications.

IMPORTANCE OF USE OF INCENTIVE SPIROMETRY :

As the post operative complication and procedures such as intubation, bed rest results in decreased lung capacity. Use of incentive spirometer increases the lung capacity and teaches to take deep breaths after surgery. Teach Mrs. X about how to use spirometer . Take a deep breath with the nozzle of spirometer and notice the balloons going up . Aim to raise all the three ballons which comes by practice and is a good lung exercise post operatively and prevents complications relating to lungs.

Thank you.