Post-Op Hip ORIF (Day 2): 7 Critical Nursing Assessments

On postoperative day 2 after Open Reduction Internal Fixation (ORIF) of hip fracture, these assessments drive early complication detection and mobilization readiness:

1. Neurovascular Integrity (Operative Leg): q4h × 24h → q shift. Assess: pulses (dorsalis pedis, posterior tibial), capillary refill <3s, sensation (light touch, pinprick), motor function (toe wiggle, ankle dorsiflexion/plantarflexion). Compare bilaterally. Document compartment syndrome signs (pain out of proportion, paresthesia, pallor, pulselessness, paralysis).
2. Pain Assessment & Management: Standardized scale (NRS 0–10) q4h PRN. Multimodal regimen: scheduled acetaminophen 1g q6h + celecoxib 200mg q12h + PRN opioid (hydromorphone/oxycodone). Target: pain ≤4 at rest, ≤6 with PT. Monitor sedation/respiratory rate.
3. Surgical Site Inspection: q shift. Assess: incision approximation, drainage (serous/sanguineous/purulent), erythema extent, warmth, dehiscence/evisceration. Reinforce dressing per protocol. Notify surgeon for: spreading cellulitis, hematoma, gaping.
4. Vital Signs & Hemodynamics: q4h × 24h → q shift. Trend: BP, HR, SpO₂, temp. Orthostatic check before first ambulation. Fluid balance: strict I&O; target euvolemia (replace insensible + drain output).
5. Respiratory Status / Atelectasis Prevention: q4h lung sounds. Incentive spirometry 10 breaths/hr awake. Cough/deep breathe q2h. Early mobilization = best prophylaxis. Monitor for fat embolism syndrome (hypoxia, petechiae, confusion) – rare but POD 1–3 peak.
6. VTE Prophylaxis & Surveillance: Mechanical (IPC devices) + Pharmacologic (enoxaparin 40mg daily or rivaroxaban 10mg daily per protocol). Assess HIT risk (4Ts score) if platelets drop >50%. Calf tenderness/swelling → duplex US.
7. Early Mobilization & PT: POD 0–1: bed exercises, dangling. POD 1–2: stand pivot transfer → walker gait (WBAT or per surgeon). PT bid. Goals: prevent deconditioning, VTE, pneumonia, pressure injury. Document distance, assist level, pain score.

Red Flags for Rapid Response

• New confusion/hypoxia → PE/fat embolism.
• Sudden calf pain/swelling → DVT.
• Wound breakdown + fever → deep infection.
• Neurovascular change → compartment syndrome / nerve injury.