A nurse is reviewing the discharge instructions for a client who had a total hip replacement. Which of the following statements by the client indicate a need for further teaching? (Select all that apply.)

Choice A reason:

Atelectasis is the collapse of alveoli in the lungs, which can impair gas exchange and cause hypoxia. It can occur after surgery due to anesthesia, pain, or immobility. However, atelectasis does not usually cause fever and chills, unless it is complicated by pneumonia.

Choice B reason:

Dehydration is the loss of fluid and electrolytes from the body, which can affect blood pressure, heart rate, and kidney function. It can occur after surgery due to blood loss, vomiting, or inadequate intake. However, dehydration does not usually cause fever and chills, unless it is associated with infection or heat stroke.

Choice C reason:

Inflammation is the body's response to tissue injury or infection, which involves increased blood flow, swelling, pain, and heat. It can occur after surgery as part of the normal healing process. However, inflammation does not usually cause fever and chills, unless it is severe or systemic.

Choice D reason:

Infection is the invasion and multiplication of microorganisms in the body, which can trigger an immune response and cause inflammation, fever, and chills. It can occur after surgery due to contamination of the surgical site, catheters, or intravenous lines. Infection is the most likely cause of fever and chills in a postoperative patient.

Choice A reason:

This is a correct statement by the client. Using a pillow between the legs when sleeping helps to maintain the hip in abduction and prevent dislocation of the prosthesis.

Choice B reason:

This is also a correct statement by the client. Avoiding crossing the legs or bending forward prevents excessive flexion of the hip and reduces the risk of dislocation.

Choice C reason:

This is another correct statement by the client. Reporting any signs of infection or bleeding to the doctor is important to prevent complications such as wound infection, hematoma, or sepsis.

Choice D reason:

This is an incorrect statement by the client that indicates a need for further teaching. Resuming normal activities as soon as the client feels better is not advisable, as it may cause excessive stress on the joint and lead to loosening or fracture of the prosthesis. The client should follow a gradual rehabilitation program and avoid activities that involve high impact, twisting, or lifting.

Choice E reason:

This is also an incorrect statement by the client that indicates a need for further teaching. Taking anticoagulant medication as prescribed is not enough to prevent thromboembolic events after a total hip replacement. The client should also wear compression stockings, use intermittent pneumatic compression devices, and perform ankle and foot exercises as instructed. The client should also monitor for signs of bleeding or bruising and report any abnormal findings to the doctor.