Post-Operative Complications Associated With Orthopedic Surgery
Risks components with most orthopedic operations include injury to nerves or blood vessels, blood clots, infection, joint stiffness, and failure of the surgery.
Failure of the surgery — where common injuries are a repaired ligament that may fracture again; the bones not healing together of a repaired fracture; a joint becoming arthritic; the operation failing to relieve the pain.
Infection — there is a 1-2% chance of a post-surgery infection occurring. The infection may be minor or more serious with, in the latter case, possibly requiring another operation.
Stiffness of loss of motion of the joint or of nearby joints — therefore joints have to be exercised, but, nonetheless, in some cases permanent reduction in motion is noticeable. Some experience arthrofibrosis which is intense pain response and permanent loss of motion may be a result.
Blood clots — Clots in the deep vessels of the legs that can occur post-surgery. Symptoms are swelling in the leg and pain in the calf. Blood clots are more common with procedures such as joint replacements; they are less common with arthroscopic surgery.
Injury to major nerves or blood vessels — This rarely happens. (www.ofc-oregon.com) Other common post-operative complications include post-operative fever, atelectasis, and embolism.
Mrs. Well’s risks are several.
Firstly, she is older. She is also overweight to obese which is a definite risk factor. The fact that she lives in a trailer may indicate, although not necessarily, that she has little exercise. Most importantly, the smallness of the trailer indicates plenty of conditions for the possibility of her falling, and demonstrates constraint of movement. Mrs. Wells needs plenty of room for her to move about unhindered. Her living conditions seem to indicate absence of this. She needs constant movement to reduce the possibility of re-fracturing of the limb and of blood clots forming. Nurses do transfer her from bed to chair three times a day, but nonetheless this does not constitute exercise, and the fact that she is staying in bed so much does not bode well, as is the fact that she is experiencing a burning discomfort over her tailbone. This may lead to an infection occurring. In fact, she may already have one since her skin on the sacrum is red and this redness does not depart even 290 minutes after being off her back. Moreover, incidence of post-operative complications spike 1-3 days after the operation and this is the 3rd day after Mrs. Well’s operation.
Her urine output, too, is small and, although frequent, this is not a good sign. On the other hand, her diet seems to be constant and good. She has no fever, nausea, vomiting, or confusion, nor bowel obstruction. In short, symptoms are mixed regarding Mrs. Well’s risk factors.
The symptoms that I would focus on are the following:
1. Obesity — since this prevents her from moving around and exercising her limb as well as keeping her more stationary and more reluctant to exercise.
2. The fact that she has been kept almost totally stationery for 3 days following surgery, when she should have been exercising her limb
3. The small urine output that may signal post-operation infection.
4. Her living quarters — in a trailer that provide plenty of opportunity for falling and re-fracturing of limb.
5. Her age which again places her at greater risk for falling.
6. Mrs. Well’s desire to return to her housework. “Only very light work should be performed post-surgery of the hip with no bending, twisting, or crossing the legs at the hip joint, or at the ankles”(Queen Elizabeth Hospital Birmingham). Similarly, Mrs. Wells lives in a rural area- she should avoid gardening. Only light housework should be engaged in.
7. Mrs. Wells needs someone to help her do routine tasks such as bathing and dressing. She only has a son who lives with her, and she is poor. This may indicate that she may not receive the necessary care (Queen Elizabeth Hospital Birmingham: online
An Individualized teaching plan for Ms. Wells
I would explain the physiology of the hip joint and the performance of the surgery so that Ms. Wells understand the physiology of her injury and why she needs to take care of the spot so that re-fracturing not occur. I will also tell Ms. Wells that the 3 months following surgery is the period when the joint is weaker and can become dislocated more easily therefore special care needs to be taken.
Instructions include:
1. Only very light work with no bending, twisting, or crossing the legs at the hip joint, or at the ankles”(* Queen Elizabeth Hospital Birmingham). Movements should not be forced at hip. She should not sit on low seats. She should avoid standing for long periods of time, and then stand with her feet slightly apart. She should not garden.
2. She should not cross legs or ankles when sitting. Other instructions about sitting (and demonstration) will be given her.
3. Demonstration of how to sleep (not to cross leg with pillow between legs) will be given her.
4. Occupational therapist will show her how to use the toilet. Whilst bathing should be avoided for at least 3 months following surgery.
5. Therapist will show her how to dress (essentially she has to dress operated leg first and undress it last, and should never bend down more than 90 degrees to touch below either knee.
6. Instructions on how to get in and out of car will be given to her. Her knee must be kept straight at all times.
References
Queen Elizabeth Hospital Birmingham. Information for patients about precautions following Hemiarthroplasty surgery http://www.ihb.nhs.ik/pdf/Pifollowing Hemiarthroplasty.pdf www.ofc-oregon.com Complications of orthopedic surgery http://www.ofcoregon.com/assets_ofc/COMPLICATIONS_OF_ORTHOPEDIC_SURGERY.pdf
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