Preventing Complications in Nursing Care

Post-Total Hip Arthroplasty

Preventing Dislocation

• Place two bed pillows between the legs when in bed.
• Encourage the client to lean forward when attempting to stand.
• Never elevate knees higher than hips when sitting (maintain >90° angle).
• Keep the wedge device (abduction pillow) in place when turning.

Nephropathy & Diabetes

Kidney Protection Strategies

• Limit protein intake to reduce renal workload.
• Strict hypertension control is essential.
• Regular monitoring of HbA1c and blood sugar levels.
• Early intervention with ACE inhibitors/ARBs often slows progression.

Type 1 Sick-Day Rules

• Monitor glucose every 4 hours during illness.
• Check urine for ketones if glucose is >240 mg/dL.
• Never skip insulin, even if nauseated.

Complications of Immobility

Recognition & Action

• Monitor for Confusion (early sign of hypoxia or infection).
• Perform Q2H repositioning to prevent pressure ulcers.
• Implement Passive/Active Range of Motion (ROM) to stop muscle atrophy.
• Collaborate with PT/OT to mitigate circulation decrease.

Cardiovascular Management

Angina & Meds

• Withhold Metoprolol if Heart Rate < 60 bpm.
• Administer Nitroglycerin sublingually; repeat q5min x3 for chest pain.

Post-Cardiac Catheterization

• Maintain affected extremity in extension to prevent hematoma.
• Check pedal pulses and site dressing every 15-30 mins initially.
• Note: Fluid intake should be encouraged to flush contrast dye.

Respiratory Interventions

Incentive Spirometry

• Mouthpiece must be sealed tightly.
• Inhale slowly and deeply; place hands on upper abdomen to feel expansion.
• Goal: Prevent atelectasis and pneumonia.

Thoracentesis Positioning

• Position: Upright, leaning over bedside table.
• This widens intercostal spaces for easier needle access.

Thyroid & Shock

Thyroid Storm (Graves')

• Watch for hyperthermia, tachycardia, and systolic HTN.
• This is a life-threatening emergency requiring immediate intervention.

Hypovolemic Shock

• Recognize decreased urine output and cool/clammy skin.
• Monitor GCS to determine neurological perfusion status.

Neurological & Urological

Brainstem Contusion

• Extreme thirst/polyuria may indicate Diabetes Insipidus.
• Anticipate a prescription for Desmopressin (DDAVP).

Bladder Irrigation (CBI)

• For spasms/low output: Manually flush with 0.9% NaCl.
• Ensure the drainage remains light pink to clear.

ABGs & Lab Findings

Acid-Base Balance

• PaCO2 48: Respiratory Acidosis.
• HCO3 20: Metabolic Acidosis.
• pH 7.4: Normal/Compensated.

Nephrotic Syndrome

• Expected: Proteinuria, Hypoalbuminemia, and Edema.
• Associated with Hyperlipidemia and Coagulation risks.

Pre-Op & Discharge Safety

Medication Safety

• Withhold Metformin 48hrs before/after IV contrast dye to protect kidneys.

AV Graft Care

• Avoid lifting with the graft arm; NO BP or blood draws in that arm.
• Palpate for Thrill / Auscultate for Bruit to ensure patency.