The nurse is caring for a client who has just returned from surgery following an open reduction internal fixation (ORIF) of a fractured hip. The nurse should monitor for which of the following complications?
A.
Fat embolism
B.
Pulmonary edema
C.
Deep vein thrombosis
D.
Myocardial infarction.
The Correct Answer and Explanation is:
The correct answer is C. Deep vein thrombosis (DVT).
Explanation:
After an open reduction internal fixation (ORIF) procedure, which is commonly performed to repair a fractured hip, several complications can arise, but deep vein thrombosis (DVT) is a primary concern. This is due to a combination of factors that are common in post-surgical patients, especially those undergoing orthopedic surgeries.
- Immobility: Following surgery, patients with hip fractures often have limited mobility. Reduced mobility or being bed-bound for an extended period increases the risk of blood stasis, which is one of the key components in the development of DVT. The venous return from the legs becomes sluggish when a patient is immobilized, allowing blood clots to form in the deep veins of the legs.
- Venous stasis and endothelial injury: Surgical procedures, particularly orthopedic ones, can cause direct damage to blood vessels and tissues, increasing the risk of clot formation. Additionally, the trauma from surgery can release clotting factors, further contributing to DVT risk.
- Hypercoagulability: After surgery, especially in orthopedic cases like hip fractures, the body’s clotting mechanisms may become overactive as part of the healing process. This hypercoagulability can predispose a patient to forming clots in the deep veins, most commonly in the legs.
If a DVT is left untreated, it can lead to a pulmonary embolism (PE), where a clot dislodges and travels to the lungs, causing life-threatening complications.
Other Complications Considered:
- A. Fat embolism: This complication is more commonly associated with long bone fractures, such as the femur, and while it can occur with hip fractures, it is less common than DVT.
- B. Pulmonary edema: This condition involves fluid accumulation in the lungs and is typically associated with heart failure or fluid overload, but it is not a direct complication of ORIF surgery.
- D. Myocardial infarction (MI): While possible, it is not specifically linked to ORIF surgery or fractured hips unless the client has underlying heart conditions.
Thus, DVT remains the most likely and significant complication to monitor for post-ORIF surgery. Prevention strategies such as early mobilization, anticoagulants, and the use of compression devices are critical in minimizing this risk.