H I P R E P L A C E M E N T PAT I E N T C A R E P L A N

Care Day of Surgery Day 1 Post-Op Day 2 Post-Op Days 3-4 Post-Op Discharge Goals Patient Pathway
Nutrition ⇒ Intravenous (IV) ⇒ Fluids taken as tolerated ⇒ Sit up in chair for all ⇒ Sit up in chair for all meals ⇒ Eating and bowel Day of Day 1 Day 2 Day 3 Day of
started for fluids & ⇒ Sit up for meals if able meals ⇒ Enema or suppository given movements returning to Surgery Post-Op Post-Op Post-Op Discharge
medications ⇒ IV as needed ⇒ Discontinue IV if no if no bowel movement normal
⇒ Catheter may be ⇒ Catheter removed nausea and no IV Diet
inserted in bladder. ⇒ Start bowel routine medications needed
Urine output ⇒ Go to bathroom by
monitored for 24 hrs commode chair/walker
⇒ Diet as tolerated with help
Begin food Sit up for
Hygiene ⇒ Assisted mouth & ⇒ Wash at sink or basin ⇒ Shower if able ⇒ Patient can manage
& drink as meals if
skin care as needed personal hygiene without able
tolerated
help

Wound ⇒ Dressing checked & ⇒ Wound checked daily ⇒ Dressing removed & ⇒ Incision exposed when ⇒ Surgical wound is clean &
Care changed or ⇒ Dressing removed & wound redressed if wound is dry dry, or wound care Activity
reinforced as needed wound redressed if draining management arranged for
draining home
⇒ Removal of staples or
stitches arranged

Pain ⇒ IV or oral ⇒ IV or oral pain ⇒ Pain medication taken ⇒ Pain control medication ⇒ Pain management
Control/ medications for pain medication continued as needed & taken prior to exercise discussed with &
Medication control once spinal Treatment
⇒ Patient asks for pain coordinated with ⇒ Patient reviews home understood by patient
wears off medication when activity or rehabilitation instructions for giving self ⇒ Required prescriptions
⇒ May have epidural needed schedule anti-coagulant to help provided to patient As ordered
(local anaesthetic) prevent blood clotting by
physician Increase Increase Increase Increase
Activity/ ⇒ Every hour when ⇒ Deep breathing & ⇒ Deep breathing & ⇒ Deep breathing & coughing ⇒ Patient is able to: flexion in flexion flexion flexion
Rehab awake patient does: coughing coughing ⇒ Progress to crutches as • Transfer to/from bed & leg
• Deep breathing & ⇒ Transfer to/from bed & ⇒ Increase frequency of appropriate chair, & stand
coughing chair with help transfers to/from bed & ⇒ Review procedure for going independently & safely
• Foot & ankle ⇒ Sit up in chair for short chair, & increase up & down stairs • Walk 30 metres using Medication
exercises periods independence of ⇒ Review home exercises walking aid without
⇒ Place pillow between ⇒ Walk using walker or transfers ⇒ Continue to increase exceeding doctor-
legs to keep knees crutches with help ⇒ Increase distance & independent transfers ordered weight limit on
apart (not exceeding frequency of walks & to/from bed & chair, & operated leg
⇒ Sit up on side of bed doctor-ordered weight progress to crutches as walking to bathroom & in • Go up/down stairs safely
& stand with help limit on operated leg) able hallway as able • Perform home exercises IV or pills IV or pills Pills for
⇒ Walk if able & as ⇒ Begin daily rehab to ⇒ Continue exercises ⇒ Attend physiotherapy & daily living activities for pain pain as
requested by doctor increase range of motion (with therapist & session safely (or has support in needed
in operated hip & independently) ⇒ Attend occupational therapy place at home for
exercises to strengthen ⇒ Occupational therapy session to review tub required activities)
operated leg & hip initiated as needed transfers & dressing if ⇒ Patient will be transferred Discharge
needed to sub-acute facility if Planning
more rehab needed

Discharge ⇒ Expected length of ⇒ Patient discusses ⇒ Nurse, physio & ⇒ Out-patient physiotherapy ⇒ Patient is given &
Planning stay is 3-4 days discharge needs (i.e. occupational therapists arranged if requested by understands:
⇒ Planned day of equipment, services) confirm discharge plan surgeon (when new hip • Discharge instructions
Discharge
discharge is written with care providers & equipment in place does not have enough • Required exercise
needs
on bedside ⇒ Resources contacted flexion and/or thigh routine
discussed
communication as needed (i.e. sub- muscles significantly weak) • Follow-up appointment
board acute facility, Home dates
Care, mobile lab) Adapted from Patient Care Guide for Total Hip Replacement.