Name: Alex (male)
Age: 53 yrs (DOB: June 1, year not specified)
Marital / Living situation: Lives with wife in two–story colonial home; plans to recover in first-floor guest bedroom & half-bath
Occupation: High-school science teacher of 15 years
Hobbies/leisure:
Swimming (primary goal for return to activity)
Nature hikes with grandchildren
Playing cards, general family time
Driving status: Drives own car; drove self to surgery
Social supports: Wife at home; grandchildren nearby
Chief complaint: Progressive L-hip pain × 1 yr (although verbally later states ≈ 10 yrs)
Pain location & quality: Deep left groin pain; causes perceived instability
Aggravating factors: Sit→stand, stairs, uneven ground, prolonged physical activity
Alleviating strategies: OTC NSAIDs (Aleve, Advil) PRN; swimming perceived helpful
Sleep: Interrupted by pain; currently uses abduction wedge while supine post-op
Conservative care attempted: Physical therapy (unspecified regimen) without sustained relief
Surgical recommendation: Left total hip arthroplasty (THA) → completed last night via posterior approach; allowed full weight bearing
Hypertension x ≈3 yrs ➔ controlled on lisinopril 10\,\text{mg PO QD}
Right rotator-cuff repair (successful recovery)
Colonoscopy at age 50 (“routine”; no complications)
No known drug allergies (NKDA); no anesthesia complications historically
Denies alcohol use; no smoking documented
Father: CAD & diabetes; deceased age 72
Mother: Deceased age 83 (cause not specified)
Lisinopril 10\,\text{mg}\,\text{daily}
Post-op: Analgesic (unspecified); took 1 hr prior—pain now 8/10
Anticoagulation: Warfarin (dose unspecified) per ortho protocol
ENT: No nasal congestion
Respiratory: No SOB, cough
Cardiovascular: No chest pain, edema
GI: No diarrhea/constipation/heartburn/abdominal pain
GU: No dysuria/hematuria
Endocrine: No thermal intolerance, no fevers
Musculoskeletal: L-hip pain; otherwise denies back or muscle pain
Skin: Intact, no rash/lesions
Neuro: AO×4, no focal deficits
Vitals:
Temp 36.9\,°C
Resp rate 16\,/\text{min}
Pulse 76\,/\text{min}
BP 150/84\,\text{mmHg}
Weight 79.5\,\text{kg}
Height 182\,\text{cm}
BMI \approx 24 (normal)
General: Pleasant, alert, cooperative, mood/affect appropriate
HEENT: PERRL
Cardio: RRR, no murmurs, peripheral pulses equal
Resp: Clear bilaterally
Extremities: No swelling or deformity; gait “normal” pre-op; current L-hip ROM restricted by pain
Neuro: Speech clear, cognition intact; remembers name, DOB, hospital, surgery type
\text{WBC}=6.1\times10^9/\text{L} (normal)
\text{RBC}=4.98\times10^{12}/\text{L}
\text{Hgb}=14.5\,\text{g/dL}
\text{Hct}=43.4\%
INR/other coag results: Not specified; to verify before ambulation due to warfarin
Estimated blood loss during THA: \approx150\,\text{mL} (within safe limits)
Entry: 3 exterior steps
Stairway to 2ⁿᵈ floor: ~12 straight steps; railing on L side only
Bedrooms/Baths:
2ⁿᵈ-floor master bed & bath (raised toilet)
1ˢᵗ-floor guest bed & half-bath (standard height toilet) – will use during recovery
Shower: Walk-in shower + separate tub; no grab bars
DME on hand: Non-wheeled (standard) walker from mother; no other equipment
Mobility: Independent community ambulator pre-surgery; occasional pain-limited activity
ADL/IADL:
Self-care independent; occasional sock assist from wife on “bad days”
Cooking: Shared with spouse
Cleaning: Wife doing majority recently
Work: Full-time teacher; intends to resume
Leisure: Swimming, hiking, cards; participation limited “sometimes” pre-op due to L-hip pain
Falls: “Almost never”; no recent history
Procedure: Left THA via posterior approach
Weight-bearing: FWB allowed
Hip precautions (standard posterior):
No hip flexion > 90^{\circ}
No adduction past midline
No internal rotation
Devices: Indwelling catheter removed; no other lines noted
Pain: Current 8/10 despite med 1 hr ago; RN anticipates analgesia peak shortly (30 min post-dose)
Fall risk flagged; standard + hip precautions ordered
RN: Med timing, labs in chart, catheter removed, eager to ambulate to bathroom
Orthopedic PA: Confirms precautions, low blood loss, FWB, possible discharge tonight or tomorrow AM
Case Manager: Coordinating discharge; liaising with wife; wants OT/PT input at rounds
PT: Will test gait, balance & strength; collaborating with OT to avoid duplicate DME orders; bringing rolling walker & vitals equipment
OT: Will bring hip-kit tools for dressing assessment
Cognition intact (AO×4) ➔ understands & can learn precautions
Good upper-body strength (confirmed verbally) ➔ facilitates ADL with hip kit & potential NWB transfers if needed
Motivated, goal-oriented (“eager to get moving,” return to swimming/hiking)
Social support: Wife available for assistance; no environmental barriers inside main living level once downstairs
Prior independence in ADLs/IADLs and driving ➔ high baseline function to build upon
Acute post-op pain 8/10 ➔ interferes with mobility & participation in therapy
Posterior hip precautions restrict common movements used in self-care (bending to don socks/shoes, tub entry, low-chair transfers)
Home environment:
3 exterior steps without details of handrail(s)
Second-floor master bed/bath inaccessible until stair safety cleared
No grab bars; standard-height toilet on recovery floor may be too low (hip flex > 90^{\circ})
Existing walker lacks wheels ➔ sub-optimal for efficient indoor ambulation; may impede gait mechanics
Warfarin therapy ➔ increased bleeding risk from falls or transfer mishaps
Pain-related disrupted sleep ➔ fatigue may limit therapy tolerance
Reports occasional light-headedness/nausea post-op (needs monitoring during mobility)
Underlying factors
Post-surgical pain & inflammation
Hip ROM restrictions + posterior precautions
Limited adaptive equipment (no wheeled walker, no raised toilet on 1ˢᵗ floor, no grab bars, lacks hip-kit supplies at home)
Potential deconditioning from pre-op activity avoidance
Resulting functional gap
Inability to perform lower-body dressing & bathing within precautions
Unsafe toilet/shower transfers due to low seat height & absence of grab bars
Ambulation limited to bed-to-chair; stairs not yet trialed
Leisure/work participation (swimming, teaching, driving) currently halted
Consequence if unresolved
Risk of fall or hip dislocation
Delayed discharge or readmission
Reduced quality of life & prolonged caregiver burden
Inpatient (today–discharge)
Pain management check-ins; schedule sessions 30–60 min post-analgesic
Educate & practice posterior hip precautions with demonstrations & teach-back
ADL training with hip-kit (reacher, sock aid, long-handled shoehorn, dressing stick)
Bed mobility & supine-to-sit using abduction wedge
Transfer training: Raised chair, toilet, tub bench; recommend bedside commode over standard toilet if no riser available
Ambulation within room & hallway with rolling walker; monitor hemodynamics (BP, HR, SpO₂) given antihypertensive & warfarin
Stair simulation once pain controlled; verify ability to manage 3 exterior steps and 12-step staircase with railing (L side ascending, R side descending per precaution)
Home safety education: Remove throw rugs, ensure adequate lighting, set up recovery area on 1ˢᵗ floor
Coordinate with PT to issue DME orders:
• Rolling walker (2-wheel or front-wheel per PT gait findings)
• 3-in-1 bedside commode or elevated toilet seat (1ˢᵗ floor)
• Tub transfer bench + non-skid mat
• Grab bar installation recommendations (bath & near exterior steps)
Initiate energy-conservation & pacing techniques for teaching duties
At Discharge
Provide written HEP: Precaution review, LE gentle isometrics, UE strengthening to assist with transfers
Arrange outpatient OT (or home-health if mobility/stairs not safe): focus on advanced ADL, IADL (meal prep, cleaning), community re-integration, driving readiness
Target timeline: Outpatient OT 2–3×/wk × 4–6 wks, then re-evaluate
Set measurable goals:
• Within 1 wk: Independent UB/LB dressing with adaptive equipment, pain ≤ 4/10 during task
• Within 2 wks: Independent ambulation \ge 200\,\text{ft} with rolling walker on level surfaces
• By 4 wks: Safe navigation of 12 stairs with railing using appropriate sequence
• By 6 wks: Resume driving pending MD clearance & pain ≤ 2/10 on brake reaction test
• By 8–12 wks: Return to swimming laps 3×/wk, 30-min duration, no pain > 3/10
Monitor & Communicate
Daily team huddles with RN/PT/case manager
Verify INR values each morning prior to therapy sessions (warfarin)
Document progress & update goals; adjust DME requests to avoid duplication with PT
Age: 53\,\text{yrs}
Height/Weight/BMI: 182\,\text{cm},\;79.5\,\text{kg},\;BMI\approx24
Vitals: T=36.9\,°C\;|\;HR=76\,/\min\;|\;RR=16\,/\min\;|\;BP=150/84
Labs:
\text{WBC}=6.1 \text{RBC}=4.98 \text{Hgb}=14.5 \text{Hct}=43.4\%
EBL during THA: 150\,\text{mL}
Pain ratings: Pre-session 8/10; goal ≤ 4/10 for ADL tolerance
Informed decision-making: Alex is cognitively intact; include him in all goal setting
Fall prevention vs. independence: Balance autonomy with precaution adherence
Home safety modifications: Discuss cost, insurance coverage, and feasible DIY vs. professional installation (e.g., grab bars)
Teaching obligations: Coordinate gradual RTW plan to avoid extended sitting/standing that violates precautions