Jason Wolf, a 38 year old was involved in a car accident and sustained fracture of the left hip and required a left hemiarthroplasty. He works as a carpenter, lives alone and has a history of smoking 2 packs per day and weighs 110 kg. On return to the ward from theatre his vital signs are: BP 143/89, T 37. 2 P97, R 18, O2 sat – 96% RA. Pain Score 5/10. He has an indwelling catheter insitu with 500 mls of clear urine; IV (Peripheral) N/Saline 0.9% infusing in left hand at 100 ml/hr, wound dressing is intact with no drainage on the dressing, but hemovac with 30 mls of hemoserous drainage. O2 running at 2 l/minute via nasal prongs. GCS is 14. Review the case study and complete the following:

• Discuss risk factors for post-operative complications
• Discuss one potential post-operative complication for Mr Wolfe related to each of the following: cardiac, pulmonary, renal, integumentary, gastrointestinal, musculoskeletal and neurological status and discuss the related etiology of each complication.
• Develop a care plan (using the care plan template on Blackboard) to address 4 of the potential complications for Mr Wolfe.
• Describe the role of the physiotherapist in preventing complications and promoting recovery

• Describe the education required for Mr Wolfe prior to discharge to support his recovery at home.

                                                                   SAMPLE SOLUTION

This essay discusses the risk and potential post-operative complications relevant to Mr. Jason Wolf as a case of interest after he experienced left hip fracture. Wolf underwent left hip hemiarthroplasty as a result of a car accident. According to Han et al. (2012), bipolar hemiarthroplasty is a fundamental treatment modality for displaced femoral-neck factures. The etiology of each complication is identified and a nursing care plan for each and every potential post-operative complication developed. The role of patient education as well as a physiotherapist in prevention or promotion of post-operative outcomes is also exploited. The goal is to improve and promote desired post-surgical outcomes and to hasten recovery.

Risk Factors to Post-Operative Complications

Some of the potential risk factors for post operative complications include history of heavy cigarette smoking (2 packs per day), being overweight (110kg), loneliness, and on-surgical site or catheter infections. According to Schroeder (2013), smoking increases mortality rate three-fold among smokers compared with non-smokers. Smokers rarely attained more than 85 years of age (Schroeder, 2013). In addition, smoking was linked as the cause of 5 million deaths in 2010 and the number will probably rise to over 10 million deaths in a few decades to come (Jha et al., 2014).There is a strong link between smoking and non-Hodgkin and Hodgkin lymphomas (Taborelli et al., 2017). It is feared that Wolf may stand a risk of dying as a result of smoking.

Transfusing a patient with leukocyte-containing allogeneic blood products is a fundamental risk factor for establishment of post-operative bacterial infections (Yoon et al., 2017). Other risk factors include use of poorly sterilized surgical or invasive devices. Wolf’s blood pressure of 143/89 is interpreted as prehypertension or high normal. However, the systolic value (143) is regarded as too high and a marker of hypertension stage 1. In this case, hypertension stage 1 is attributed to Wolf’s overweight status. Hypertension stage 1 can lead to substantial damage to the kidneys, heart, and liver. Stage 1 hypertension is managed through administration of lisinopril, thiazide, dilriazem or nadolol (BloodpressureOK, 2017). Wolf is actively removing excess fluid from his body (through 500mls of clear urine) and hemovac drainage (30ml) compared with what is obtained through intravenous normal saline infusion (100ml/hr), thus lower risk of edema.

Body temperature (37°C) and respiratory rate of 18 breaths per minute (normal is 12-18 breaths per minute) are both normal and not significant as risk factors (Medscape, 2015). Heart rate is abnormally high at resting state since normal heart rate for adults in resting state is 50 to 80 beats per minute (MedScape, 2015). Wolf’s oxygen saturation level of 96% RA is normal since 95 to 98% range lies relatively within normal. Usually, oxygen saturation of 96 to 100% is regarded as normal. Respiratory failure is thus ruled out. Oxygen running setup of 2l/minute can be continued untill the patient recovers from anesthetically administered coma (Lawrence & Johnson, 2011).