A subcutaneous pain pump is used for a client with a hip replacement surgery. Which statement by the client during the first 24 hours after the surgery requires additional assessment by the nurse?
1. "I feel numbness all the way down to my ankle.".
2. "I feel sleepy when I push my PCA (patient control analgesia) button.".
3. "I cannot believe how good I feel when I get up; I expected more pain.".
4. "I will need to use a toe-touch method even if there is no pain present.".
"I feel numbness all the way down to my ankle.".
Rationale: Numbness that has extended to the ankle from a hip surgery means some compression is present on the nerves that supply the foot with sensation. Additional assessments are required to gather when and under what circumstances the numbness began and continued. Feeling sleepy with the PCA is common since most of the drugs are narcotics or opiates that control pain, and the CNS will be depressed also. PCA given with the SQ pain pump needs close assessments to include the observations for potential overdosing of narcotics. Feeling sleepy is an acceptable level of comfort. Inability to awaken the client would require additional assessment for an overdose situation. With most hip replacements, the cause of the pain has been removed. Bone is not on bone, infection or inflammation has been cleared out, and mal-alignment is corrected by the surgical procedure. The SQ pain pump gives direct relief and minimizes the pain experienced in the immediate postoperative time frame. Toe-touch walking is the correct method of ambulating until weight bearing is authorized by the health care provider. Weight bearing is allowed based upon the type of replacement structures that are involved in the surgery.
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