Instructions:
In this assignment, you will work through one patient scenario listed under the case study below
and create a total of 6 SMART goals:
For each goal, you will develop 1 evidence-based nursing interventions with rationales and
citations from reputable sources (e.g., ATI, textbooks, peer-reviewed articles, .edu, .org, .gov
websites).
Case Study: Mrs. Maria Lopez Post-Surgical Recovery and Education
Patient Overview:
Name: Mrs. Maria Lopez
Age: 58
Diagnosis: Mrs. Lopez underwent a Total Hip Replacement (THR) surgery due to severe
osteoarthritis of the hip. Her osteoarthritis had caused chronic pain and significantly impaired her
mobility, leading to difficulty performing daily tasks. After exploring conservative treatments,
including physical therapy and anti-inflammatory medications, she opted for a hip replacement
as a more effective long-term solution. The surgery was performed successfully, and Mrs. Lopez
is recovering well, though she is still experiencing moderate pain and some anxiety related to her
mobility restrictions.
Current Condition:
Mrs. Lopez is currently hospitalized, recovering after her Total Hip Replacement surgery. She
is stable but continues to experience mild pain at the surgical site, especially during movement or
when changing positions. Her mobility is still quite limited, and she requires assistance with
most Activities of Daily Living (ADLs), including bathing, dressing, and getting in and out of
bed. She has also expressed concerns regarding how to manage these activities once she is
discharged and returns home, mainly due to the fear of re-injury or overexerting her new hip
joint. Mrs. Lopez is also anxious about adjusting to the limitations of her new physical condition,
particularly regarding household tasks and her overall independence.
Vitals:
and physical therapy exercises)
Medications:
o Acetaminophen 500 mg every 4-6 hours as needed for pain
o Oxycodone 5 mg every 6 hours as needed (post-surgical)
o Ibuprofen 200 mg three times a day for inflammation and pain
o Cefazolin 1g IV every 8 hours (prophylactic for post-surgical infection
prevention)
o Enoxaparin 40 mg subcutaneously once daily to prevent deep vein thrombosis
(DVT)
o Ondansetron 4 mg IV every 8 hours as needed for nausea
o Docusate sodium 100 mg daily to prevent constipation due to opioid use
o Vitamin D 1000 IU daily to support bone health
Labs:
o White Blood Cells (WBC): 6.2 x 10/L
o Hemoglobin (Hgb): 13.0 g/dL
o Hematocrit (Hct): 39%
o Platelets: 225 x 10/L
o Sodium: 137 mEq/L
o Potassium: 4.2 mEq/L
o Chloride: 104 mEq/L
o Bicarbonate: 25 mEq/L
o Blood Urea Nitrogen (BUN): 12 mg/dL
o Creatinine: 0.9 mg/dL
o Glucose: 95 mg/dL
o Prothrombin Time (PT): 12.5 seconds
o International Normalized Ratio (INR): 1.0 (on enoxaparin)
o Activated Partial Thromboplastin Time (aPTT): 29.7 seconds
o Clear, yellow; no signs of infection
o Post-operative hip replacement appears stable, with proper alignment and no signs
of infection or complications.
Prior Health and Social History:
o Osteoarthritis of the hip (diagnosed 8 years ago), progressively worsening over
the years.
o Hypertension (diagnosed 5 years ago) well-controlled with medication.
o Type 2 Diabetes (diagnosed 3 years ago), well-managed with oral medications
(metformin 500 mg twice daily).
o Hyperlipidemia (diagnosed 4 years ago), currently treated with atorvastatin 20 mg
daily.
o No prior history of major surgeries other than minor arthroscopic knee surgery
several years ago for meniscal tear.
o No known allergies to medications or food.
o Total Hip Replacement (THR) Right hip (recent surgery)
o Knee Arthroscopy for meniscus tear (5 years ago)
o Appendectomy (25 years ago)
o Father: Hypertension, heart disease, and stroke (died at age 72).
o Mother: Osteoporosis, diabetes, and breast cancer (currently living at age 80).
o Siblings: One brother (age 55) with hypertension and one sister (age 60)
with arthritis.
o No known family history of hip fractures, cancer, or chronic respiratory diseases.
o Occupation: Mrs. Lopez works as an administrative assistant in a local medical
office and has been on medical leave for several weeks due to her hip condition.
o Tobacco Use: Non-smoker
o Alcohol Use: Social drinker, consumes 1-2 drinks per week
o Exercise: Prior to surgery, Mrs. Lopez was active with daily
walking and stretching exercises for her hip, although she was limited due to pain.
o Living Situation: Mrs. Lopez lives with her husband in a single-story home. They
have two adult children who live in the area but are not present on a daily basis.
Mrs. Lopez’s husband provides assistance with household tasks but is aging and
suffers from mild arthritis in his knees.
o Support System: She has a strong support system from family and close friends,
though her anxiety about future dependence is causing emotional distress.
Requirements: fill out pages
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