Mrs Joan Hartley (78)

Case notes

Notes: You are a registered nurse on the orthopaedic ward of Eastfield General Hospital.
Mrs Hartley is being discharged home today after a right total hip replacement.

Patient details
  Name:            Joan Hartley
  DOB:             14/03/1947 (78 yrs)
  Address:         12 Willow Crescent, Newtown
  Next of kin:     Daughter, Karen (lives 40 min away, visits weekends)
  Admission date:  02/06/2025
  Discharge date:  09/06/2025
  Diagnosis:       Osteoarthritis R hip — elective R total hip replacement (03/06/2025)

Social background
  - Widowed (husband d. 2019), lives alone, 2-storey house, bathroom upstairs
  - Retired primary school teacher
  - Independent with ADLs pre-op; drives
  - Enjoys gardening; member of local book club
  - Non-smoker; 1 glass wine/week

Medical history
  - Hypertension (2010) — amlodipine 5 mg daily
  - Hypothyroidism (2015) — levothyroxine 75 mcg daily
  - Mild osteoporosis
  - Appendicectomy (1972)
  - NKDA

Nursing management and progress
  03/06  Surgery uneventful. Spinal anaesthetic. Post-op pain 6/10 → oxycodone PRN
  04/06  Mobilised with physio, walking frame, 10 m. Nausea → resolved with ondansetron
  05/06  Wound: 14 cm lateral incision, dry, clips intact. Pain 4/10, paracetamol regular
  06/06  Hb 98 g/L (pre-op 128) — no transfusion; iron supplement commenced
  07/06  Stairs assessed by physio — managing 12 steps with rail + stick, slow
         Pt anxious about being alone at night; afraid of falling
  08/06  Small amount serous ooze lower end of wound — dressing changed, no signs of infection
  09/06  Pain 2–3/10. Mobilising independently with walking frame (indoors)

Discharge plan
  - Enoxaparin 40 mg subcut daily × 28 days (pt taught self-injection — still hesitant, needs supervision)
  - Paracetamol 1 g QID; oxycodone 5 mg PRN (max 2/day)
  - Ferrous sulphate 1 tab daily × 3 months
  - Wound check + dressing change every 2–3 days; clips removal day 12–14 (14–16/06)
  - Hip precautions 6 weeks: no bending > 90°, no crossing legs, raised toilet seat (supplied)
  - Daughter staying first 3 nights only
  - Outpatient physio 2×/week; orthopaedic review 6 weeks
  - Falls risk — consider personal alarm

Writing task