Which activity would be inappropriate to include in the plan of care for the first few hours after a hip arthroplasty?
1. Ambulation with assistance using a walker
2. Incentive spirometry every 2 hours while awake
3. Lab comparison of hemoglobin and hematocrit to presurgery levels
4. Application of bilateral sequential compressive devices
Ambulation with assistance using a walker
Rationale: Ambulation with a walker and assistance is begun the first day postoperatively. During the first few hours after surgery, fluid volumes, respiratory functions, pain management, bed positioning (abductor pillow), and bleeding are the priority of care. Getting out of bed to a chair begins the first day postop. Incentive spirometry is begun in the immediate postoperative period to prevent pulmonary complications. Hemoglobin and hematocrit levels need to be closely assessed for internal bleeding and blood losses that might have occurred in surgery and immediately postoperatively. Replacement therapy may be required if severe. Hypoxia from low RBC will delay healing and tissue repairs and increase risk of complications. Bilateral sequential compression devices (SCDs) are applied to prevent deep vein thrombosis, which is a common complication of postoperative orthopedic clients. Prevention is the best treatment; therefore, low-weight molecular heparin and SCDs are used prophylactically.
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