A nurse is caring for a patient who has had hip replacement. Which of the following findings are importance?

AIIMS Bhopal NO - 2018 (Shift-1st)

Medical Surgical Nursing

Hard

Appeared in: AIIMS Bhopal NO - 2018 (Shift-1st)

Explanation

An elevated temperature of 101.8°F (38.7°C) is a significant systemic sign that strongly suggests a postoperative infection.
Surgical site infections (SSIs) are a severe complication after joint replacement surgery, which can lead to sepsis, require long-term antibiotic therapy, or even necessitate removal of the prosthesis.
While a low-grade fever might occur in the first 24-48 hours due to atelectasis or the inflammatory response, a temperature this high is a critical finding that requires immediate reporting to the healthcare provider.
Early identification and treatment of infection are crucial to prevent further complications and ensure a positive patient outcome.

Option A: A scant amount of bloody or serosanguineous drainage is an expected finding on a surgical dressing immediately following surgery.
Option B: Pain during repositioning is an expected finding after the significant surgical trauma of a hip replacement. It requires management but is not the most critical finding.
Option D: Pain following physical therapy is also an expected part of the recovery process. Mobilization is necessary for rehabilitation, and it normally causes some degree of pain and discomfort.

Clinical Relevance

Nursing practice connection: Use the key finding related to Prioritization of postoperative assessment findings in a patient after total hip arthroplasty to guide bedside assessment, documentation, and the next nursing action.
A key nursing responsibility in postoperative care is to differentiate between expected findings and signs of life-threatening complications. Infection is a major risk after orthopedic surgery.
Early detection and reporting of fever can lead to prompt initiation of antibiotics, which is critical to prevent the infection from seeding the new prosthesis—a complication that is very difficult to treat and often requires revision surgery.
What if the temperature was 99.8°F (37.7°C) on the first postoperative day? This would be considered a low-grade fever, more likely related to atelectasis or the systemic inflammatory response to surgery. The priority action would be to encourage deep breathing, coughing, and use of an incentive spirometer, while continuing to monitor the patient closely.

How to Approach the Question

First, identify the question type. This is a priority question, asking for the 'most important' finding.
Analyze the patient's context: they are postoperative from a major surgery (hip replacement). This puts them at risk for specific complications like infection, bleeding, DVT, and dislocation.
Evaluate each option by asking: 'Is this an expected or an unexpected finding after this procedure?'
Scant drainage and pain with movement are generally expected. A high fever is not expected and points to a serious systemic issue like infection.
Prioritize the findings. Systemic signs of a serious complication (like fever for infection) usually take precedence over expected, localized issues (like managed pain or minimal drainage).

Concept Tested & Keywords

Concept Tested: Prioritization of postoperative assessment findings in a patient after total hip arthroplasty.
Stem keywords: hip replacement, findings, caring for a patient
Lead-in keywords: importance
Clinical cues: Postoperative patient
Clinical cues: Temperature of 101.8°F (38.7°C)