Student Simulation Prep Assignments (Post op Hip)

1. Identify items and their purpose in the care of postoperative hip patient.
Item Purpose
Clinical attire It helps in the formation of professional identity in healthcare. It
also  provide adequate protection against bodily fluids. Clinical attire
including medical scrubs are made of fabric thick enough to prevent
a patient's bodily fluids from making direct contact with the wearer's
skin.
Watch with One of the most common uses for medical watches is tracking
second hand patient vitals. This includes vitals such as respiratory rate and apical
pulse rates. Watches with a second hand or digital watches with
second counters provide accurate time tracking for better healthcare
assessments.
Goggle This serves as protection to your eyes against splashes of blood and
body fluids .
Stethoscope It allows the practitioner to assess a patient's cardiac, respiratory
and intestinal state and is an integral tool in professional nursing
practice. It is used to listen (auscultation) to the body's sounds
during a physical examination and assessment.
Clinical work to facilitate patient care and allow you or another practitioner to
sheet continue the management of the patient. The worksheet provides
patient demographic information, specific problems and conditions,
the patient's current medication profile, laboratory test results
pertinent to patient problems, and disease-specific or preventive care
actionable advisories.

2. Identify team members and their specific roles in the care of a postoperative hip
patient
Team Role
Member
Nurse A nurse is a caregiver for patients and helps to manage physical
needs, prevent illness, and treat health conditions. They are
responsible for the holistic care of patients, which encompasses the
psychosocial, developmental, cultural, and spiritual needs of the
individual.
Charge RN They are responsible for the operation of the nursing unit over a
specific time period. Leadership for charge nurse leaders is primarily
about making accurate decisions, delegating, appropriately, managing
 conflict, acting ethically and with integrity, nurturing others with
emotional intelligence and connectedness, maintaining a safe work
environment, and communicating across disciplines and within teams.
UAP The responsibilities and duties of a UAP include: Observing,
documenting and reporting clinical and treatment information,
including patients' behavioral changes. Assisting with motion exercises
and other rehabilitative measures. Taking and recording blood
pressure, temperature, pulse, respiration, and body weight.
Physician The physician takes medical histories and performs a physical
examination to assess the patient to determine a possible diagnosis for
both acute and chronic conditions. The physician provides education to
patients, families and support staff as it relates to the patient
condition, diagnosis and treatment.
Respiratory A respiratory therapist helps patients who are having trouble
Therapy breathing. Respiratory therapists work under the direction of doctors
and treat a range of patients, from premature infants whose lungs are
not fully developed to elderly people with lung disease.
Physical Physical therapists are movement experts who improve quality of life
Therapy through prescribed exercise, hands-on care, and patient education.
Physical therapists examine each person and then develops a
treatment plan to improve their ability to move, reduce or manage
pain, restore function, and prevent disability.
Pharmacist Pharmacists are responsible for the quality of medicines supplied to
patients and ensuring that the medicines prescribed to patients are
suitable. advising patients about medicines, including how to take
them, what reactions may occur and answering patients' questions.

3. Relevant Data Exercise: Fill in the columns below.

Relevant Relevant Data Data Missing Sources for Data Requiring
Data from from Other Missing Data Follow-Up
Report Sources
Past  Admission  Vital  Complete  Complet
health sheet Signs physical e Shift
history:  Medication  Physical assessmen Assessm
administra Examinat t findings ent
Medical- tion record ion  Cephaloca  Double
smoked  Nursing  X-ray udal check
for 30 assessmen patient’s
years (1
pack a report t. pain
day) and  Patient  Hip X-ray level
mild care sheet  Keep an
hypertensi eye to
on that the
was patient’s
diagnosed urine
4 years level.
ago for  Laborato
which he ry report
takes
metropolol
12.5 mg
po daily.
Denies
previous
hospital
admission
s.

Surgical:
Denies
previous
surgeries
or hospital
admission
s.

Family
history:
Depressio
n.

The
patient’s
lungs are
clear,
heart is
normal
sinus
rhythm,
he is
febrile, his
dressing
are clean,
dry, intact.
His JP
drain us
charged
and
working.
His pain is
under
control
now that
the nurse
gave
medicatio
ns
including
metoprolol
,
morphine,
Tylenol,
ancef and
lovenox.
He has IV
infusing,
normal
saline, at
100
mL/hr.
tolerating
clear
liquids. He
is not
passing
gas yet.
His
abductor
pillow is in
place and
must be
turned
q2hr. the
nurse last
turned the
patient is
at 0630.
He has
had
minimal
urine
output,
but it has
been 30
ml per
hour. The
patient
diet is
clear liquid
advance
as
tolerated.
 4. Diagnostic Tests
What diagnostic test results relevant to the patient’s current problem are needed to
plan care?
Diagnostic Significance to This Patient’s Problem
Test
CBC The CBC is very useful because it can indicate many different common
problems that occur in patient during surgery and during their
recovery. For this reason, a CBC may be drawn prior to surgery to
"establish a baseline" for comparison with labs drawn after surgery

The diagnostic test results relevant to the patient’s current

problem are needed to plan care are WBC and RBC because the rest
are in normal range.
The patient wbc has 12,000 which indicate the immune system
is working to destroy an infection that results of having patient in
febrile.
The patient Rbc has 4 million which indicate low.
Almost all hip fractures require surgery. People with hip fracture often
receive red blood cell transfusions that aim to correct their anaemia
(low levels of haemoglobin in the blood; haemoglobin is an oxygen-
carrying molecule found within red blood cells) resulting from blood
loss from their fracture or surgery.
Electrolytes Postoperative surgery patients are prone to electrolyte derangements
related to the loss of blood and bodily fluids, the stress response to
surgery, intravenous fluid administration, blood transfusion, and the
underlying surgical disease. Proper management of fluid and
electrolytes facilitates crucial homeostasis that allows cardiovascular
perfusion, organ system function, and cellular mechanisms to respond
to surgical illness.

Coagulation Coagulation tests measure the patient’s blood's ability to clot, and how
 Studies long it takes to clot. Testing can help your doctor assess the patient
risk of excessive bleeding or developing clots (thrombosis) somewhere
in your blood vessels.

The diagnostic test results relevant to the patient’s current

problem are needed to plan care are APTT and PTT because the rest
are in normal range.
The patient APTT has the result of 36 sec which indicate clotting is
taking longer to occur than expected as well as the PTT that has a
result of 77 which considered as high and can indicate clotting is
taking longer to occur than normal.

5. Treatment
Identify drugs that are used to treat a patient with ORIF right hip.
Medicati Dose Indications Side Effect Nursing Implications
on Route,
Frequency
Morphin 5 mg IV Morphine is  breathing  Monitor blood
e push q 2- indicated for problems; pressure prior
4hr and the relief of  drowsiness, to
prn severe acute dizziness; administration. 
and severe  constipation Hold if systolic
chronic pain , nausea, BP < 100 mm
vomiting; Hg or 30 mm
 sweating; Hg below
or. baseline.
 numbness,  Monitor
tingling, or patient's
cold feeling respiratory rate
in your prior to
hands and administration.
feet.  Reassess pain
after
administration
of morphine.
 Monitor for
respiratory
depression and
 hypotension
frequently up
to 24 hours
after
administration
of morphine.
 Place call light
signal close to
patient. 
Accompany
patient if need
to get out of
bed to minimize
risk of falls.

Tylenol 1,000 mg It indicates to  nausea,  Monitor for S&S

po q 8 hr. temporarily  stomach of:
prn for relieve minor pain, hepatotoxicity,
mild pain aches and pains  loss of even with
due to appetite, moderate
headache,  itching, acetaminophen
muscular aches,  rash, doses,
backache,  headache, especially in
minor pain of  dark urine, individuals with
arthritis, the  clay-colored poor nutrition
common cold, stools, or who have
toothache, and ingested
premenstrual alcohol over
and menstrual prolonged
cramps. periods;
Acetaminophen poisoning,
is also used to usually from
temporarily accidental
reduce fever. ingestion or
suicide
 attempts;
potential abuse
from
psychological
dependence
(withdrawal has
been
associated with
restless and
excited.
 Do not take
other
medications
(e.g., cold
preparations)
containing
acetaminophen
without medical
advice;
overdosing and
chronic use can
cause liver
damage and
other toxic
effects.
 Do not self-
medicate adults
for pain more
than 10 d (5 d
in children)
without
consulting a
physician.
 Do not use this
medication
without medical
direction for:
fever persisting
 longer than 3
d, fever over
39.5° C (103°
F), or recurrent
fever.
 Do not give
children more
than 5 doses in
24 h unless
prescribed by
physician.
 Do not breast
feed while
taking this drug
without
consulting
physician.

Metoprol 25 mg po Metoprolol is  dizziness or  Monitor blood

ol daily dec indicated for lightheaded pressure and
rease to the treatment ness. apical pulse
12.5 mg  of angina, heart  tiredness. prior to
when BP failure,  depression. administration.
<140/80 myocardial  nausea.  Cardiac monitor
infarction, atrial  dry mouth. should be used
fibrillation, atrial  stomach on patients
flutter and pain. receiving
hypertension.  vomiting. metoprolol IV
Some off-label  gas or boluses.
uses of bloating.  ·         Do not
metoprolol stop taking this
include drug unless
supraventricular instructed to do
tachycardia and so by your
thyroid storm. health care
provider.
   Swallow the
extended-
 release tablets
whole;do not
cut, crush, or
chew. If using
ER tablets,you
can divide the
tablets at the
score; divided
tablets must be
swallowed
whole, not
crushed or
chewed.
 You may
experience
these side
effects:
Dizziness,
drowsiness,
light-
headedness,
blurred vision
(avoid driving
or dangerous
activities);
nausea, loss of
appetite (eat
frequent small
meals);
nightmares,
depression
(discuss change
of medication);
sexual
impotence.
  Report
difficulty
breathing, night
 cough, swelling
of extremities,
slow pulse,
confusion,
depression,
rash, fever,
sore throat.

Lovenox 30mg SQ Lovenox is Mild irritation, pain,

bid indicated for: bruising, redness,
 the and swelling at the  Assess for signs
inpatient injection site may of bleeding and
treatmen occur. Fatigue or hemorrhage,
t of fever may also including
acute occur. If any of bleeding gums,
deep these effects nosebleeds,
vein persist or worsen, unusual
thrombo tell your doctor or bruising,
sis with pharmacist black/tarry
or promptly. stools,
without hematuria, and
pulmona a fall in
ry hematocrit or
embolis blood pressure.
m, when  Notify physician
administ or nursing staff
ered in immediately if
conjuncti enoxaparin
on with causes
warfarin excessive
sodium. anticoagulation.
 the  Lab tests:
outpatie Baseline
nt coagulation
treatmen studies;
 t of periodic CBC,
acute platelet count,
deep urine and stool
vein for occult
thrombo blood.
sis  Monitor platelet
without count closely.
pulmona Withhold drug
ry and notify
embolis physician if
m when platelet count
administ less than
ered in 100,000/mm3.
conjuncti  Monitor closely
on with patients with
warfarin renal
sodium. insufficiency
and older
adults who are
at higher risk
for
thrombocytope
nia.
 Monitor for and
report
immediately
any sign or
symptom of
unexplained
bleeding.

Ancef 1 gr  IV  Ancef is Swelling, redness, Assessment & Drug

q  6hr x 3 indicated for pain, or soreness Effects
days the treatment at the injection site  Determine
of the different may occur. This history of
infections when medication may hypersensitivity
caused by also rarely cause to
susceptible loss of appetite, cephalosporins,
bacteria nausea, vomiting, penicillins, and
including diarrhea, or other drugs,
Respiratory headache. If any before therapy
Tract of these effects is initiated.
Infections, persist or worsen,  Lab tests:
Urinary Tract tell your doctor or Perform culture
Infections, Skin pharmacist and sensitivity
and Skin promptly. testing prior to
Structure and during
Infections,  therapy.
Biliary Tract Therapy may
Infections,Bone be initiated
and Joint pending results.
Infections, etc.  Monitor I&O
rates and
pattern: Be
alert to
changes in
BUN, serum
creatinine.
 If patient has
had a reaction
to penicillin, be
alert to signs of
hypersensitivity
with use of
cefazolin.
Cross-
allergenicity
between
cephalosporins
and penicillin
has been
reported.
Prompt
attention
should be given
to onset of
signs of
 hypersensitivity
(see Appendix
F).
 Promptly report
the onset of
diarrhea, which
may or may not
be dose
related. It is
seen especially
in patients with
history of drug-
related GI
disturbances.
Pseudomembra
nous colitis, a
potentially life-
threatening
condition,
starts with
diarrhea.
Patient & Family
Education
 Report
promptly any
signs or
symptoms of
superinfection
(see Appendix
F).
 Report signs of
hemostatic
defects:
ecchymoses,
petechiae,
nosebleed.
 Do not breast
feed while
 taking this
drug.

6. Nursing Problems/Diagnosis
Identify three priority nursing problems/diagnoses
Assessment Priority Intervention Expected Patient
Data Problem Outcome
1) Impaired The nurse educates and -The patient will
Subjective: physical provides the patient with verbalize
Mr VanDyke mobility reading material on hip surgery. understanding of
states that he related to -The nurse will assess the surgery.
was cleaning the decreasing patient’s questions and -The patient will
garage strength concerns about her hip surgery. demonstrate how
yesterday when and -The nurse and physical to properly change
he fell endurance therapy will educate and positions to relieve
approximately 3 secondary demonstrate to the patient the pressure with
ft from a ladder to hip post-opt exercises to increase a little pain as
and broke his fracture as mobilization. possible.
right hip. evidenced -The nurse will ensure patient -The patient will
by total wears compression stockings be free from any
Objective: right hip and SCD device daily to DVTs.
Height: 5 ft 11 replacemen decrease DVT development.
inches t. -The nurse will educate the
Weight: 210 lb patient how to correctly how to
use the trochanter roll to help
hip alignment.
-The nurse will educate the
patient how to properly change
positions to relieve pressure
with a little pain possible.
.

2) Readiness  Monitor intake and  Intake and

Subjective: N/A for output. Adequate fluid output are
 enhanced intake ensures adequate;
Objective: urinary hydration; adequate patient
 urinary elimination urinary output minimizes exhibits
output related to urinary stasis. normal
has been immobility  Avoid/minimize use of voiding
25 mL/hr as evidence indwelling catheter. patterns
for the by minimal  Perform intermittent
past 2 urine catheterization for  Demonstrat
consecuti output. urinary retention.Empties es no
ve hours. bladder; reduces urinary evidence of
tract infections. urinary
tract
infection 

3) Readiness  Encourage patient to  Patient

Subjective: N/A for express concerns and to describes
enhanced discuss the possible feelings
Objective: coping impact of fractured hip. concerning
Surgical: denies related to Verbalization helps fractured
previous injury, patient deal with hip and
surgeries or anticipated problems and feelings. implications
hospital surgery, Clarification of thoughts for lifestyle.
admissions. and and feelings promotes  Uses
Family History: dependenc problem solving. available
Depression e as  Support use of coping resources
evidenced mechanisms. Involve and coping
by denying significant others and mechanism
previous support services as s; develops
surgery and needed.Coping health
had family mechanisms modify promotion
history of disabling effects of strategies
depression. stress; sharing concerns  Uses
lessens the burden and community
facilitates necessary resources
 modification as needed
 Explain anticipated  Participates
treatment regimen and in the
routines to facilitate developmen
positive attitude in t of health
relation to care plan 
rehabilitation.Understand
ing of plan of care helps
to diminish fears of the
unknown. 
 Encourage patient to
participate in
planning.Participating in
care provides for some
control of self and
environment

4) Acute pain  Assess type and location  Expresses

related to of patient's pain whenever confidence in
Subjective:
fracture as vital signs are obtained efforts to
The patient states evidenced by and as needed. Pain is control pain
that his pain at pain scale of expected after fracture;  Expresses
that time is 6/10 6/10 soft tissue damage and comfort with
muscle spasm contribute position
to discomfort; pain is changes
Objective: subjective and is best  Expresses
evaluated on a pain scale comfort when
Height: 5 ft 11
of 0 to 10 and through leg is
inches
description of positioned
Weight: 210 lb
characteristics and and
location, which are immobilized
important for identifying  Minimizes
cause of discomfort and movement of
for proposing extremity
interventions. Continuing before
pain may indicate reduction and
development of fixation
neurovascular problems.  States that
 Pain must be assessed positioning
periodically to gauge provides
effectiveness of continuing comfort
analgesic therapy.  Appears
 Acknowledge existence of comfortable
pain; inform patient of and relaxed
available analgesics;
record patient's baseline
discomfort. Reduces stress
experienced by the patient
by communicating concern
and availability of help in
dealing with pain.
Documentation provides
baseline data.
 Handle the affected
extremity gently,
supporting it with hands or
pillow. Movement of bone
fragments is painful;
muscle spasms occur with
movement; adequate
support diminishes soft
tissue tension.
 Position for comfort and
function. Alignment of
body facilitates comfort;
positioning for function
diminishes stress on
musculoskeletal system
 Assist with frequent
changes in position.
Change of position relieves
pressure and associated
discomfort.