Answer 1

  • Problem list:
    • Patient deconditioned
    • Post-operative pain
    • Risk of DVT
    • Risk of infection
    • Risk of failure of prosthesis 
    • Risk for respiratory complications
  • Treatment plan
    • Patient deconditioned
      • If DVT and other complications are cleared and the patient can be mobilized as indicated by the surgeon, then move the patient to the edge of the bed if able.
      • Monitor blood pressure while changing positions. 
      • Perform ankle pumps and heel slides for bed mobility 
    • Post-operative pain
      • Soft tissue mobilization around scar 
      • Soft tissue release of other tight structures around the hip. 
      • Pain modalities 
      • Change to comfortable positions
      • Liaise with nursing staff on timing of medications
      • Liaise with the most responsible physician regarding pain medication
    • Risk of DVT
      • Educate patient on symptoms of DVT
      • Perform ankle pumps
      • Monitor symptoms of DVT
        • Redness
        • Swelling 
        • Warmth 
        • Pain with dorsiflexion
    • Risk of infection
      • Redness
      • Warmth 
      • Fever
      • Swelling
    • Risk of failure of prosthesis
      • Educating the patient on symptoms of prosthesis failure
        • External rotation of foot
        • Extreme pain with weight bearing
        • Trendelenburg sign
        • Pain in thigh, groin, and hip
    • Respiratory complications
      • Deep breathing exercises
      • Pacing education
      • Active cycle of breathing
      • Incentive spirometry 
      • Secretion clearance
      • Postural drainage in comfortable positions if not able to work on segmental breathing
    • Comorbidity: Hypertension
      • Perform cardiovascular training (when able)
      • Ensure that the patient’s blood pressure is within normal limits. 
      • Perform home exercise program
      • Slow changes of positioning
      • Educate patient on symptoms of hypotension and hypertension