Care plan example
| ✅ Paper Type: Free Essay | ✅ Subject: Nursing |
| ✅ Wordcount: 4153 words | ✅ Published: 07 Oct 2025 |
Post-hip replacement care plan
Scenario:
John Doe is a 75-year-old patient on the orthopaedic ward, Day 1 post right total hip replacement. He has a history of osteoarthritis and hypertension. He lives with his wife in a bungalow (one step at entry).
Current issues: He reports severe right hip pain (8/10) especially on movement. He is reluctant to mobilise due to pain and fear of falling. The surgical wound is dry with dressing intact. He has an indwelling catheter from surgery. He has not yet walked since the operation. The plan is for discharge on Day 3 post-op if mobilising safely.
From this scenario, we identify three priority areas for John’s nursing care plan: pain management, mobility, and discharge planning (including patient education and home support). We will formulate a plan addressing each, with interventions and rationales.
Pain management for post-operative hip surgery
Assessment findings:
Day 1 post-op, patient’s pain is 8/10, located at the surgical site, worsened by movement. He received analgesia (e.g. morphine) 4 hours ago. Pain is a top priority because uncontrolled pain can impede participation in physiotherapy and prolong hospitalisation.
Goal: Acute pain will be reduced to a tolerable level (patient reports ≤3/10) within 24 hours. Achieving this will help John mobilise early and rest adequately.
Interventions:
Frequent pain assessment:
Assess and document pain level, characteristics, and response to analgesia at least every 2 hours. Use a standard 0–10 pain scale and observe non-verbal cues (facial expression, guarding).
Rationale: Regular assessment ensures timely detection of inadequate pain control so that interventions can be adjusted. Continuous pain monitoring is recommended in postoperative care to guide analgesic titration (NICE NG180). It also involves the patient in rating his pain, which can improve communication about pain needs.
Administer prescribed analgesics on a schedule and as needed:
John likely has an analgesic regimen such as paracetamol and an opioid (e.g. morphine or oxycodone) ordered. Ensure he receives these around-the-clock as prescribed, not only on request.
Use multimodal analgesia: for example, paracetamol regularly and NSAIDs if not contraindicated, plus opioid for breakthrough pain. Consider patient-controlled analgesia (PCA) if ordered.
Rationale: Multimodal analgesia (combining different classes of pain relief) is recommended by NICE guidelines (NG180) and the Faculty of Pain Medicine (2021) to manage perioperative pain effectively, reduce opioid-related side effects, and facilitate early mobilisation. NICE NG180 also advises considering patient-controlled analgesia (PCA) or epidural analgesia when oral opioids are unsuitable.
Administering analgesia prior to physiotherapy sessions is advisable so that pain is controlled enough for him to participate in exercises.
Consistent pain relief improves patient comfort, prevents pain from becoming severe (which is harder to control), and thereby facilitates early mobilisation (Aprisunadi et al. 2023).
Non-pharmacological pain relief measures:
Implement adjunct comfort measures such as ice therapy on the hip if permitted locally, ensuring skin protection and limiting applications – apply ice ~20 minutes, never directly on skin (Cambridge University Hospitals, 2025), proper positioning with support pillows (keeping the operated leg in alignment as per hip precautions), and relaxation techniques (guided breathing or distraction). Encourage use of these adjuncts in between medication doses.
Rationale: Cold application can reduce swelling and numb pain locally, complementing medication (Faculty of Pain Medicine 2021). Proper positioning (avoiding internal rotation or excessive flexion of the hip) prevents strain on the surgical site and subsequent pain.
Relaxation techniques and reassurance can reduce anxiety, which often exacerbates the perception of pain. Combined pharmacological and non-pharmacological strategies are shown to provide better pain relief than medications alone (Lukey 2025). Furthermore, involving the patient in simple measures (like applying their own ice pack with guidance) gives a sense of control and participation in pain management.
Assess for and manage analgesic side effects:
Monitor for common opioid side effects such as respiratory depression, excessive sedation, constipation, or nausea. If John is very drowsy or has a low respiratory rate, withhold opioids and inform the medical team. Provide antiemetic medication if nausea is present (as prescribed). Ensure hydration and consider a gentle laxative routinely to prevent constipation.
Rationale: Safe pain management includes vigilance for adverse effects. Opioids are effective for severe pain but can cause serious side effects; proactive measures (like antiemetics, laxatives) increase tolerability and therefore continuity of pain relief (Faculty of Pain Medicine 2021).
For instance, constipation prophylaxis is standard when opioids are in use. By managing side effects, we ensure John can continue to receive needed analgesia without avoidable complications, supporting his recovery.
Patient education on pain management:
Explain to John that keeping pain under control is important and encourage him to report pain before it becomes unbearable. Address any misconceptions or fears – for example, some older patients fear opioids; reassure him about safety measures in place. Involve him in setting a pain goal (maybe he feels 3/10 is acceptable) so he has a sense of ownership.
Rationale: Educating patients about the importance of pain control and how to communicate pain can improve outcomes. If John understands that adequate pain relief will actually help him heal faster (because he can move more easily), he may be more willing to ask for pain medicine timely rather than stoically enduring it. Patient involvement is a key aspect of person-centred care and can reduce anxiety and improve cooperation (Grover et al, 2022).
By implementing these interventions, we expect John’s pain to decrease to a mild level.
Evaluation:
After 24 hours, suppose John’s pain is now 3/10 at rest and 5/10 with movement after analgesia – this indicates partial success (goal of ≤3/10 at all times not fully met during activity). However, he is now able to participate in physiotherapy exercises.
The plan would be to continue the regimen, maybe add an extra dose before physiotherapy, and monitor. If pain remained >5/10 consistently, the nurse would need to liaise with the surgical team to adjust the analgesic plan (for example, consider a nerve block or stronger dose).
Achieving good pain control is an ongoing process, but the initial reduction shows progress. Good documentation of this evaluation and any changes in the plan would be made, aligning with professional requirements for record-keeping (NMC 2018).
Promoting mobility and rehabilitation
Assessment findings:
John has not yet mobilised post-surgery. He is anxious about moving, which may indicate risk of postoperative delirium, especially given his age. Consider performing a delirium risk assessment according to NICE CG103 to identify and address contributing factors early.
No dizziness reported, blood pressure is stable, but he has a urinary catheter (which could impede mobility if not managed). He is at high risk for impaired mobility and complications of immobility (such as muscle deconditioning, chest infection, pressure ulcers, or venous thromboembolism). Early mobilisation is crucial for recovery.
Goal: Patient will safely mobilise (ambulate) with a frame for at least 5 metres by Day 2 post-op, and be able to transfer into and out of bed/chair with minimal assistance.
A longer-term goal could be: By discharge (Day 3), patient will climb one step with supervision (simulating home entrance) and will perform prescribed physiotherapy exercises independently.
Interventions:
Physiotherapy referral and early mobilisation:
Ensure John is seen by a physiotherapist on Day 1 (the day of or after surgery) for an initial mobilisation session. Assist the physiotherapist and encourage John during exercises. The aim is to have him sit out of bed and stand or take a few steps on post-op Day 1 if possible. Continue mobilisation sessions at least twice daily.
Rationale: Best practice for joint replacement patients is to mobilise as early as possible—ideally within 24 hours post-op—to enhance recovery and reduce complications (NICE NG157). Early mobilisation is also embedded in NHS enhanced-recovery pathways (e.g. GIRFT ambulatory hip/knee guidance) and is associated with shorter hospital stays, fewer respiratory or thrombotic complications, and improved function (Aprisunadi et al. 2023; GIRFT 2023).
A physiotherapist’s expertise will ensure John learns the correct walking technique (e.g. weight-bearing status as allowed by the surgeon, use of a walker frame) and hip precautions (like not bending hip beyond 90 degrees). The nurse’s role is to reinforce these exercises and mobilisations throughout the day, not just during formal physio sessions. Early mobilisation might be uncomfortable, but coupling it with good analgesia (as above) and encouragement can help overcome initial hurdles.
Assist with ambulation and transfers using proper technique:
When helping John out of bed, use a gait belt and follow hip precautions (avoid adduction or bending his hip too far). Teach him how to use the walker: move it first, then step forward with the operated leg, etc., per physio guidance. Initially, two staff members may assist until he gains confidence. Use of safety measures is important – e.g. ensure non-slip socks or shoes, the floor is clear of hazards, and the bed/chair is at correct height.
Rationale: Safe mobility requires technique and caution to prevent falls. Falls are a significant risk after hip surgery due to pain, weakness, or unfamiliarity with new mobility aids. By physically assisting and supervising, the nurse ensures John practices mobilising under safe conditions, which will build his confidence. This hands-on support also allows the nurse to assess his balance, strength, and any dizziness. Each successful transfer or short walk is a positive reinforcement, enhancing John’s self-efficacy in mobility.
Involving occupational therapy if available can further help with transfer techniques (e.g. using adaptive equipment for toileting or chairs). The use of proper ergonomics and guarding during ambulation protects both John and the staff from injury. Nurses play a critical role in translating the physio’s rehabilitation plan into day-to-day activity – in effect, the nursing staff continue the rehab throughout the shift (Royal College of Nursing 2023 emphasises teamwork in such interdisciplinary care).
Prevent complications of immobility:
While John is still limited in mobility, take measures to prevent common post-op complications. This includes: encouraging ankle pump exercises hourly to promote circulation, ensuring he wears anti-embolism stockings or pneumatic compression devices if prescribed, providing VTE prophylaxis as per NICE NG89 (extended pharmacological prophylaxis after hip replacement, choice of LMWH→aspirin, LMWH alone, or a licensed DOAC, according to local policy).
Also, assist with regular turning in bed and sitting up for periods to expand lungs, and do deep-breathing exercises or use an incentive spirometer if provided.
Rationale: These interventions address risks like deep vein thrombosis (DVT) and chest infections, which are higher after surgery and if mobility is reduced. Early mobilisation itself is the best prevention for many of these risks (Aprisunadi et al. 2023 found lower complication rates with early ambulation), but adjunct prophylaxis is critical.
UK guidelines (NICE NG89, 2018) recommend extended thromboprophylaxis following hip replacement, commonly low molecular weight heparin (LMWH) for 10 days followed by aspirin for a further 28 days, LMWH for 28–35 days, or a direct oral anticoagulant like rivaroxaban for approximately five weeks, depending on local NHS trust protocols.
Leg exercises keep blood flowing in the legs, reducing DVT risk. Repositioning and lung exercises combat atelectasis (partial lung collapse) and pneumonia risk by promoting good air entry. By incorporating these into the care plan, you show a holistic approach: even as you focus on getting John moving, you’re managing the period when he isn’t fully mobile yet. Document these preventative measures and their outcomes (e.g. calf exercises done, lungs clear on auscultation) as part of ongoing assessment.
Educate and encourage the patient:
Acknowledge John’s fear of falling and pain, and explain how the walker and our assistance will keep him safe. Educate him on the proper way to move to avoid dislocating the new hip – for example, remind him not to cross his legs, not to bend beyond 90°, and to keep pillows between knees when in bed if recommended. Inform him of the plan: “Today we’ll try standing and a few steps; it’s normal to feel nervous, but we’ll be right here with you.” Set small achievable targets each session and celebrate when he meets them (e.g. “Great, you walked to the doorway!”).
Rationale: Patient engagement and psychological readiness are important in rehabilitation. Knowledge about hip precautions and the reasons for them (to prevent dislocation of the new joint) will empower John to move correctly. Encouragement is a powerful nursing intervention – it can boost the patient’s confidence and motivation. By breaking the mobility goal into small steps, we make the process less daunting. Each success improves his confidence, creating a positive feedback loop.
Literature on recovery coaching suggests that positive reinforcement and involving patients in goal-setting can improve mobility outcomes (Lukey 2025). Moreover, addressing John’s fear (perhaps by having staff stand on either side of him initially, or using a wheelchair behind him for security in early attempts) can help overcome psychological barriers. John should know that feeling some discomfort is expected but that moving will ultimately decrease stiffness and pain. This educational support reflects a patient-centred approach: rather than just telling him to walk, we are acknowledging his emotions and partnering with him to achieve mobility safely.
With these interventions, John should gradually regain mobility.
Evaluation:
By Day 2, suppose John managed to walk 5 metres with a frame and one assistant – meeting the initial goal. He can get in and out of bed with minimal help using the correct technique. This indicates progress: we would mark the goal of ambulating 5m as achieved. The longer-term goal (climbing a step, doing exercises independently) can be evaluated on Day 3.
If by discharge he is able to practice going up a training step in physiotherapy and needed only supervision, and he demonstrates the home exercise routine correctly, we can consider the mobility goals met. We would note any remaining limitations (maybe he still needs moderate assistance for longer distances) and include plans for ongoing outpatient physio after discharge.
If goals were not met (e.g. if John refused to mobilise on Day 1 and therefore was delayed), we would adjust the plan: investigate barriers (was pain control adequate? did he need more reassurance or a different mobility aid?) and perhaps involve his wife if she can encourage him.
Overall, evaluating mobility outcomes is straightforward with clear measurable goals – either he could do the task or not, and how well. It’s important to document any improvement (distance walked, level of assistance reduced) as evidence of progress. Early mobilisation success is a key factor in timely discharge after hip replacement (NICE 2020 stresses criteria like safe ambulation for discharge readiness), so meeting these goals is pivotal for the next phase of care.
Discharge planning and patient education
Assessment findings:
John is expected to go home on post-op Day 3 if criteria are met. He has a supportive wife at home, but both are elderly. It’s a single-level home, which is good for mobility (only one step at entry). We must plan for continuity of care after discharge, ensure home safety, and that John and his wife are prepared for self-care.
Goal: By discharge, patient (and caregiver) will demonstrate understanding of post-hip replacement care (including wound care, medications, mobility precautions), and the home environment will be prepared to support safe recovery. Additionally: Arrangements for any required community support (physiotherapy, nursing follow-up) will be in place before discharge. In essence, the goal is a safe transition home with adequate support.
Interventions:
Begin discharge planning early (from admission):
Coordinate a multidisciplinary meeting or communication by Day 2 to confirm discharge needs. This involves doctors (for medical fitness), physiotherapist and occupational therapist (for mobility and equipment needs), the ward nurse, and perhaps a hospital discharge coordinator or social worker if needed.
Identify whether John will need equipment like a raised toilet seat, shower chair, or grab rails, and ensure these are obtained. OT can assess his ability in personal care activities and perhaps do a home visit or at least a questionnaire regarding home setup.
Rationale: Early planning is crucial because arranging equipment or community services can take time. NICE guidelines (2020) on joint replacements highlight that patients should be given information throughout their care, including what to expect after surgery and at home. Proactively addressing these ensures John isn’t kept in hospital longer due to preventable issues (like waiting for a toilet frame).
Research shows that individualised discharge planning reduces length of stay and readmission rates (Shepperd et al. 2013). By involving a team, we cover all bases: for example, physiotherapy ensures he can climb that one step at home; OT ensures he can toilet and dress safely; nursing ensures medical aspects (wound, meds) are sorted. Document the discharge plan clearly in the notes, and update John and his wife regularly so they know what to expect.
Medication reconciliation and supply:
Review John’s discharge medicines with the medical team and pharmacy, making VTE prophylaxis explicit per NICE NG89. After hip replacement this usually means extended prophylaxis (total ~28–35 days, depending on local option used):
- LMWH for 10 days then aspirin 75–150 mg for 28 days, or
- LMWH for 28 days (stockings until discharge), or
- a licensed DOAC for ~35 days per local formulary.
Provide clear written instructions (dose, duration, missed-dose advice, bleeding red flags), confirm understanding, and arrange administration support if needed (e.g. district nurse for injections). Ensure supplies/prescriptions cover the full course.
Rationale: Ensuring continuity of medication is a key part of safe discharge. Errors commonly occur during transitions, so meticulous checking is needed. John should know which medications to take, their purposes, and side effects to watch for. For instance, if he’s sent home with strong analgesics, warn about constipation and advise on diet or laxatives. If he has anticoagulant injections, confirm they feel confident administering them (or arrange for a district nurse to visit if not). According to evidence, clear instructions and patient understanding of their medicines at discharge can prevent adverse events and readmissions (Royal College of Nursing 2023 supports thorough patient education as part of safe care). This intervention ensures that pain remains controlled at home and that prophylaxis continues, reducing risks of complications after discharge.
Wound care and signs of complications:
Before discharge, assess the wound with John (and wife) present. If staples or sutures are to be removed, inform them who will do that (often the GP practice nurse or district nurse around 10 days post-op). Teach them how to keep the wound clean and dry; if the dressing is to stay on, for how long; and how to shower safely without soaking it (usually allowed after a certain number of days if waterproof dressing, but clarify).
Explain signs of infection to watch for: increasing redness, swelling, warmth, discharge, or fever. Provide a contact number (ward or clinic) to call if they suspect any issue.
Rationale: Many patients feel anxious about wound management, so clear guidance is vital. Knowledge of when and whom to call can avert serious complications, as early identification of infection can lead to prompt treatment. By involving John and his wife in observing the wound while in hospital, they gain confidence in what is normal healing. This not only educates but also engages them in care, which aligns with person-centred practice. Involving them also serves as an assessment – you can gauge if they are able to handle the wound care or if community nurse follow-up is needed.
Given John’s age, a district nursing referral for a one-time wound check or staple removal is likely appropriate. All these arrangements should be written in the discharge summary that goes to his GP as well. This comprehensive approach to wound care education helps ensure continuity and safety.
Mobility and activity instructions:
Reinforce the physiotherapist’s guidance for home: how often John should do his exercises, and a walking program (e.g. gradually increase walking distance each day, but avoid high-risk activities).
Discuss precautions: hip precautions after replacement surgery typically last around 6 weeks, but specific guidance varies. Follow your local NHS trust or surgeon-specific Enhanced Recovery After Surgery (ERAS) guidelines, as some centres now recommend tailored precautions rather than blanket restrictions (NHS 2024; Royal Orthopaedic Hospital ERAS protocol, 2024). National ERAS and perioperative resources emphasise early mobilisation and individualised precautions aligned to surgical approach and trust policy.
Advise on using recommended aids (walker or crutches) until told to transition to a cane. Also, address daily activities: for instance,
“It’s important to keep moving regularly throughout the day, but also rest when tired. Avoid heavy lifting or bending down; use that long-handled reacher provided for putting on socks or picking things up.”
Encourage him to gradually resume light activities he enjoys (with guidance, e.g. short walks in the garden), as staying active aids recovery.
Rationale: Clear instructions on allowed and restricted activities help prevent injury (like dislocation of the new hip) and manage patient expectations. Often, patients are unsure how much they can do; providing a balanced plan prevents both overexertion and under-activity. According to NHS advice (NHS 2024), patients should walk daily and follow their exercise regimen to build strength, but avoid high-risk movements and positions for the first 6–8 weeks. Emphasising adherence to exercises and precautions is evidence-based: it leads to better functional outcomes and fewer complications.
By documenting that you have given these instructions, you also cover an important legal aspect – if a patient has an adverse outcome from not following precautions, it’s important that they had been properly educated (NMC 2018 underscores the duty to educate and communicate for patient safety). This intervention thus bridges hospital rehabilitation with home recovery, giving John a roadmap to continue improving.
Follow-up and community support:
Arrange the follow-up appointments – typically, a surgeon or orthopaedic clinic review at 6 weeks post-op, and perhaps a physio outpatient appointment within the first week or two after discharge. Provide John with the details (date/time or how it will be communicated). If John or his wife have any limitations in getting to appointments, involve the hospital’s discharge services to help with transport arrangements (e.g. patient transport if needed).
Additionally, ensure they have contact numbers: the ward or a specialist nurse’s phone for any urgent queries, and their GP’s number for any general health issues.
Rationale: A well-coordinated handover to community care is associated with fewer readmissions and greater patient satisfaction (Shepperd et al. 2013). Knowing that follow-ups are scheduled provides reassurance to John that his recovery is being monitored. It also gives an opportunity to catch any post-op issues (e.g. at 6 weeks X-ray to check prosthesis position, etc.).
Having clear points of contact means John is less likely to feel abandoned once home – he knows exactly whom to call if, say, he develops significant pain or a fever. This continuity is an essential aspect of quality care. From the nurse’s perspective, making these arrangements and documenting them in the discharge summary ensures that nothing falls through the cracks as John transitions home. It exemplifies holistic care – we are not just treating him in hospital, but also planning for his ongoing recovery in the real world.
Evaluation:
Discharge planning interventions are evaluated by how smoothly the discharge occurs and whether the patient’s post-discharge needs are met. Let’s say it’s now Day 3 and John is ready to go home: evaluation would include checking off that all arrangements are in place – equipment delivered, wife trained in exercises and injections, follow-up booked, discharge medications in hand, and John successfully walked with physio on stairs (the one step at his front door) indicating he can enter his home.
If all is done, we consider the discharge plan goal met: John and his wife demonstrate understanding (e.g. they correctly explain back the precautions and medication schedule), and they feel confident about managing at home.
We might get feedback: perhaps a week later, a follow-up call or the GP’s report indicates John is doing well at home. That would further validate success. However, if on the morning of discharge something is amiss – e.g. the raised toilet seat hasn’t arrived – we would delay discharge slightly or find an interim solution (maybe loan one from hospital stores) because a key safety piece is missing. Or if John/wife seemed confused about the anticoagulant injection despite teaching, we might arrange a community nurse to visit daily instead.
Our goal is zero unmet needs at discharge.
The measure of success in discharge planning is often no preventable readmission and high patient satisfaction. According to evidence, patients who receive individualised discharge education and planning are more satisfied and have better health outcomes (Shepperd et al. 2013).
So in an assignment, you would write an evaluation statement such as:
“Goal met: patient and carer demonstrate understanding of all instructions; necessary home adaptations and follow-up are arranged. Patient discharged safely with no complications. Will follow up in 6 weeks at clinic.”
This emphasises the comprehensive nature of the discharge plan.
It’s important to note any patient feedback too, e.g. “Patient voiced that the preparation made him feel confident to go home.”
If goals were partially met (maybe they understand most things but are still a bit unsure about one aspect), you’d note that and perhaps what fallback is in place (like “wife has district nurse number if any wound concerns”). Overall, a thorough discharge plan is often the difference between a successful recovery at home and potential setbacks, so it dese
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