2. The fact that she has been kept almost totally stationery for 3 days following surgery, when she should have been exercising her limb

3. The small urine output that may signal post-operation infection.

4. Her living quarters -- in a trailer that provide plenty of opportunity for falling and re-fracturing of limb.

5. Her age which again places her at greater risk for falling.

6. Mrs. Well's desire to return to her housework. "Only very light work should be performed post-surgery of the hip with no bending, twisting, or crossing the legs at the hip joint, or at the ankles"(Queen Elizabeth Hospital Birmingham). Similarly, Mrs. Wells lives in a rural area- she should avoid gardening. Only light housework should be engaged in.

7. Mrs. Wells needs someone to help her do routine tasks such as bathing and dressing. She only has a son who lives with her, and she is poor. This may indicate that she may not receive the necessary care (Queen Elizabeth Hospital Birmingham: online

An Individualized teaching plan for Ms. Wells

I would explain the physiology of the hip joint and the performance of the surgery so that Ms. Wells understand the physiology of her injury and why she needs to take care of the spot so that re-fracturing not occur. I will also tell Ms. Wells that the 3 months following surgery is the period when the joint is weaker and can become dislocated more easily therefore...

Only very light work with no bending, twisting, or crossing the legs at the hip joint, or at the ankles"(* Queen Elizabeth Hospital Birmingham). Movements should not be forced at hip. She should not sit on low seats. She should avoid standing for long periods of time, and then stand with her feet slightly apart. She should not garden.
2. She should not cross legs or ankles when sitting. Other instructions about sitting (and demonstration) will be given her.

3. Demonstration of how to sleep (not to cross leg with pillow between legs) will be given her.

4. Occupational therapist will show her how to use the toilet. Whilst bathing should be avoided for at least 3 months following surgery.

5. Therapist will show her how to dress (essentially she has to dress operated leg first and undress it last, and should never bend down more than 90 degrees to touch below either knee.

6. Instructions on how to get in and out of car will be given to her. Her knee must be kept straight at all times.

References

Queen Elizabeth Hospital Birmingham. Information for patients about precautions following Hemiarthroplasty surgery http://www.ihb.nhs.ik/pdf/Pifollowing Hemiarthroplasty.pdf www.ofc-oregon.com Complications of orthopedic surgery http://www.ofcoregon.com/assets_ofc/COMPLICATIONS_OF_ORTHOPEDIC_SURGERY.pdf